Case Presentation Extended Left Hepatectomy for Bismuth Type IV Cholangiocarcinoma

Video case: the patient was a 66-years-old woman, heavy smoker, with grade 2 obesity, non-insulin depended type II diabetes mellitus and high blood pressure. She was investigated for obstructive jaundice and was diagnosed via contrast enhanced cholangio-MRI and CT scan with a Bismuth type IV hilar cholangiocarcinoma invading the left portal vein and left hepatic artery with left hemiliver hypotrophy and compensatory hypertrophy of the right hemiliver. Given the extent of the tumor and the impossibility of obtaining an efficient biliary drainage both endoscopic and percutaneous approach, the patient was recommended for liver resection, following a thorough assessment of the biological status. 

We performed a common bile duct resection en-bloc with left hepatectomy partially extended to the segments V and VIII and en-bloc with the caudate lobe. Lymphadenectomy was also performed, including hilar, celiac trunk and superior retropancreaticoduodenal lymph nodes. Reconstruction was performed via Roux en Y cholangiojejunostomy with 3 biliary ducts (B6 + B7, B5 and B8). Postoperatively, the patient developed acute renal failure with ascitic syndrome, which went into remission after prolonged intensive care measures. The hystopathological examination revealed a moderately differentiated hillar cholangiocarcinoma with 10% poorly differentiated, poorly cohesive component, pT2 pN1, associated with high grade intraepithelial biliary neoplasia.

* the case was presented as an e-poster during CONFER, Romania, Iasi, November 2022