Total Laparoscopic Radical Resection of S1 + S4 for Bismuth–Corlette Type IV Hilar Cholangiocarcinoma (With Video)

• Published in: Annals of surgical oncology 2024-09, Vol.31 (9), p.5631-5635
• Main Authors: Huang, Jie, Li, Jian-Wei, Xu, Dingwei
• Format: Article
• Language: English
• Subjects: Antigens; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Bile ducts; Bile Ducts, Intrahepatic - pathology; Bile Ducts, Intrahepatic - surgery; Biliary tract; Bilirubin; Carcinoembryonic antigen; Carcinoma; Chemotherapy; Cholangiocarcinoma; Cholangiocarcinoma - pathology; Cholangiocarcinoma - surgery; Computed tomography; Hepatectomy; Hepatectomy - methods; Hepatic artery; Hepatobiliary Tumors; Humans; Jaundice; Klatskin Tumor - pathology; Klatskin Tumor - surgery; Laparoscopy; Laparoscopy - methods; Liver diseases; Lymph Node Excision - methods; Lymph nodes; Magnetic resonance imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Patients; Portal vein; Prognosis; Reconstructive surgery; Surgery; Surgical Oncology; α-Fetoprotein
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-024-15531-2

Background The management of Bismuth–Corlette type IV hilar cholangiocarcinoma typically necessitates extensive hepatectomy, resection of the extrahepatic bile ducts, regional lymph node dissection, and reconstruction of the biliary tract; however, there is a high incidence of postoperative liver dysfunction and failure. Methods A 64-year-old male patient was admitted to our department after 1 month of escalating jaundice and abdominal discomfort. Upon admission, his total bilirubin was 334 μmol/L and his direct bilirubin was 221 μmol/L. His carbohydrate antigen 19-9 was > 1200.00 U/mL, his carcinoembryonic antigen was 98.90 U/mL, and his α-fetoprotein was normal. Enhanced computed tomography (CT) and magnetic resonance imaging scans revealed a thickened and enlarged biliary tree extending from the common hepatic duct to the orifices of the left and right hepatic ducts. Results The patient underwent total laparoscopic radical resection of S1 + S4, accompanied by radical lymphadenectomy with skeletonization and biliary reconstruction. The surgery was successfully conducted within 450 min, with a minimal blood loss of 200 mL. The histological grading was T2bN1M0 (stage III). CT on postoperative day 5 showed satisfactory postoperative recovery. The patient was discharged from the hospital on postoperative day 10 without complications, following which the patient underwent a regimen of single-agent capecitabine chemotherapy. Over a 20-month follow-up period, no recurrence was observed. Conclusions Resection of hepatic segments S1 + S4 is a viable surgical option for hilar carcinoma in cases with poor liver function or when the carcinoma is confined to both hepatic ducts without invasion of the hepatic artery and portal vein.