Hepatectomy with simultaneous resection of portal vein for Bismuth IV perihilar cholangiocarcinoma: a case report

Background: Surgical resection is the only potential treatment choice for patients with cholangiocarcinoma. Portal vein invasion used to be a primary cause of irresectable tumor. Nowadays, portal vein resection and reconstruction has become a routine surgical procedure.Case presentation: A 65-year-old male patient, suffering from jaundice and abnormal liver function was referred to our hospital for intensive examination. Before admission to our center, the patient had been undergoing percutaneous transhepatic cholangial drainage (PTCD) for six days for the palliation of jaundice and liver function. A series of check-ups and examinations resulted in the diagnosis of Bismuth type IV perihilar cholangiocarcinoma. The patient later received right hemihepatectomy and Roux-en-Y choledochojejunostomy. As the portal vein was affected by tumor, it was partially removed and reconstructed. In addition, the portal vein thrombus (PVT) was removed, and a portal vein stent was placed. After surgery, the patient received six courses of chemotherapy. A gemcitabine-based regimen in combination with S-1 were used. Nineteen months after the surgery, the patient is still healthy.Conclusions: This report demonstrates that hepatectomy with simultaneous resection of portal vein for Bismuth type IV perihilar cholangiocarcinoma may contribute to a satisfactory result. Consequently, combined resection and reconstruction is often required when negative pathological resection (R0 resection) is performed.