Skip to main content

Advertisement

SpringerLink
Log in

Total upper transversal hepatectomy with outflow reconstruction for advanced mass-forming cholangiocarcinoma

  • Technical Note
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

We describe a complex case of extended hepatectomy with venous outflow reconstruction for the treatment of advanced mass-forming cholangiocarcinoma (MFCCC) invading the three main hepatic veins (HVs). A 50-year-old woman who received a diagnosis of MFCCC and judged unresectable, was referred to our hospital. After multidisciplinary team evaluation, the patient underwent abdominal computed tomography, gadoxetic acid-enhanced magnetic resonance imaging, and fluorodeoxyglucose positron emission tomography. The radiological examinations showed a large mass located in S4s-8 and S1, in contact with the right hepatic vein (RHV), the inferior right hepatic vein, the anterior wall of the inferior vena cava (IVC), infiltrating the middle and left hepatic veins (MHV, LHV). Several communicating veins between the RHV, MHV and LHV were detected. The case was further investigated, and the surgical strategy planned by means of using three-dimensional simulation software. A total upper transversal hepatectomy with resection of the main HVs and outflow reconstruction was performed. The outflow of the remnant liver was restored performing a vascular anastomosis between the parenchymal stump of the RHV and the IVC. Meticulous review of pre-operative imaging techniques with three-dimensional simulation of hepatectomy together with advanced use of intra-operative ultrasound allowed us to offer the chance of cure to a patient otherwise considered unresectable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Sempoux C, Jibara G, Ward SC, Fan C, Qin L, Roayaie S et al (2011) Intrahepatic cholangiocarcinoma: new insights in pathology. Semin Liver Dis 31:49–60

    Article  Google Scholar 

  2. Torzilli G, Procopio F, Donadon M, Del Fabbro D, Cimino M, Garcia-Etienne C et al (2012) Upper transversal hepatectomy. Ann Surg Oncol 19:3566

    Article  Google Scholar 

  3. Torzilli G, Viganò L, Gatti A, Costa G, Cimino M, Procopio F et al (2017) Twelve-year experience of “radical but conservative” liver surgery for colorectal metastases: impact on surgical practice and oncologic efficacy. HPB (Oxford) 19:775–784

    Article  Google Scholar 

  4. Torzilli G, Montorsi M, Donadon M, Palmisano A, Del Fabbro D, Gambetti A et al (2005) “Radical but conservative” is the main goal for ultrasonography-guided liver resection: prospective validation of this approach. J Am Coll Surg 201:517–528

    Article  Google Scholar 

  5. Torzilli G, Viganò L, Fontana A, Procopio F, Terrone A, Cimino M et al (2020) Oncological outcome of R1 vascular margin for mass-forming cholangiocarcinoma. A single center observational cohort analysis. HPB (Oxford) 22:570–577

    Article  Google Scholar 

  6. Donadon M, Costa G, Cimino M, Procopio F, Del Fabbro D, Palmisano A et al (2016) Diagnosis and management of bile leaks after hepatectomy: results of a prospective analysis of 475 hepatectomies. World J Surg 40:172–181

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Dr. Francesco Taliente, MD, for the help during the manuscript preparation.

Funding

The authors have no funding sources to disclose.

Author information

Authors and Affiliations

  1. Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center – IRCCS, Via Manzoni, 56, 20089, Rozzano, Milano, Italy

    Damiano Gentile, Matteo Donadon & Guido Torzilli

  2. Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy

    Matteo Donadon, Efrem Civilini & Guido Torzilli

  3. Department of Vascular Surgery, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy

    Efrem Civilini

Authors
  1. Damiano Gentile
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matteo Donadon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Efrem Civilini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guido Torzilli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guido Torzilli.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Human or animal rights

The present study complies with the guidelines for human studies. The research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The Institutional Review Board of our hospital approved this study. The patient gave the informed consent for operation, clinical data acquisition, study description, and publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gentile, D., Donadon, M., Civilini, E. et al. Total upper transversal hepatectomy with outflow reconstruction for advanced mass-forming cholangiocarcinoma. Updates Surg 73, 769–773 (2021). https://doi.org/10.1007/s13304-020-00946-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-020-00946-9

Keywords

Search

Navigation