Open AccessEn-Bloc Complete Segment 1 Resection and Left Hepatectomy for Klatskin Tumor
Author(s) -
Alexandru Bârcu,
Alin Kraft,
Cosmin Verdea,
Adina Croitoru,
Ioana Gabriela Lupescu,
Dana Tomescu,
Irinel Popescu,
Florin Botea
Publication year - 2021
Publication title -
chirurgia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.248
H-Index - 20
eISSN - 1842-368X
pISSN - 1221-9118
DOI - 10.21614/chirurgia.116.5.634
Subject(s) - medicine , klatskin tumor , hepatectomy , bile duct , resection margin , radiology , surgery , resection
video width="640" height="480" controls controlsList="nodownload" poster="https://www.revistachirurgia.ro/pdfs/video/Complete_segment_resection_hepatectomy_klatskin_tumor.jpg" style="margin-top: -20px;" source src="https://www.revistachirurgia.ro/pdfs/video/Complete_segment_resection_hepatectomy_klatskin_tumor.mp4" type="video/mp4" Your browser does not support the video tag. /video We present the case of a 37-year-old male patient with no significant history, hospitalized in our center for painless jaundice with sudden onset. CT contrast portal phase imaging revealed a tumor located at the main biliary confluence, in the proximity of the main portal bifurcation, with no venous or arterial vascular invasion, nor extrahepatic metastases. MRCP diagnosed a Bismuth- Corlette type Klatskin IIIb tumor. For complete assessment of biliary involvement and surgical planning, in addition to the Bismuth-Corlette classification, we took into consideration the presence of infiltration of the bile ducts for segment 1, documented at MRCP. Therefore, a left hepatectomy with en-bloc complete segment 1 resection, along with the main bile ducts and hilar lymphadenectomy, was considered best suited for achieving curative resection in this case. After an uneventful postoperative course, the patient was discharged in the 12th postoperative day. Currently, the patient is disease-free after 84 months. We consider that the long-term recurrence free survival was favored by the complete segment 1 resection. Therefore, for complete assessment of biliary involvement in Klatskin tumor, we recommend that in addition to Bismuth-Corlette classification, infiltration of the bile duct for segment 1 should always be evaluated. If present, the entire segment 1 should be removed for best oncological results.