Left hepatic trisectionectomy for perihilar cholangiocarcinoma with a right-sided round ligament: A case report

World Journal of Gastrointestinal Surgery
Tomoyuki IshidaKazuaki Shimada

Abstract

A right-sided round ligament (RSRL) is a rare, congenital anomaly of the intrahepatic portal vein, with a reported frequency of 0.2%-1.2%. For patients with perihilar cholangiocarcinoma associated with an RSRL, an accurate understanding of the vascular and biliary anatomy is indispensable. We report a 70-year-old male with perihilar cholangiocarcinoma associated with an RSRL. After percutaneous transhepatic embolization of the left and anterior portal branches, we conducted a left trisectionectomy of the liver with extrahepatic bile duct resection and hepaticojejunostomy. The postoperative course was uneventful, and R0 resection was achieved. When the liver volume of each section was compared between 7 patients with an RSRL and 20 patients with normal portal vein anatomy, the posterior section in RSRL patients was significantly larger than that in patients with normal portal vein anatomy (median: 457 mL vs 306 mL, P = 0.031). In patients with perihilar cholangiocarcinoma associated with an RSRL, left trisectionectomy has several surgical advantages: (1) The posterior branch of the portal vein often ramifies independently, and the division of the portal vein is easily conducted; (2) A relatively large amount of remnant liver can...Continue Reading

References

Jan 1, 1992·Annals of Surgery·H BismuthT Diamond
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Mar 1, 1997·Annals of Surgery·M NagaiM Makuuchi
Dec 14, 2011·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Junichi ShindohNorihiro Kokudo
Feb 26, 2013·American Journal of Surgery·Russell W StrongShinn Yeung
Mar 6, 2013·The British Journal of Surgery·M EsakiT Sano
Sep 7, 2016·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Ryuta NishitaiDai Manaka
Mar 5, 2017·Journal of Hepato-biliary-pancreatic Sciences·Takehito OtsuboMasakazu Yamamoto

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