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BILIARY  CONFLUENCE  EXCISION
WITH  RIGHT  HEPATECTOMY
AND  TOTAL  CAUDECTOMY
FOR  HILAR  CHOLANGIOCARCINOMA

dr. F. Ardito

Hepato-biliary and Digestive Surgery Unit

 

This is a case of  56 years-old woman admitted in our Unit after occurrence of jaundice for about one month without abdominal pain and pruritus. Laboratory features  presented elevated levels (serum bilirubin: 7.5 mg/dl, alkaline phosphatase 5 times more than normal values, and gamma GT 10 times more than normal values). MRI and ERCP showed hilar biliary obstruction and hilar cholangiocarcinoma (Klatskin tumor) was diagnosed. Tumor extension involved the main bile duct confluence, the right hepatic duct and its secondary confluence, and therefore it was classified as type 3 A sec. Bismuth (Fig. 1, 2).
Octreotide scintigraphy (Fig. 2) documented a strong captation of the hepatic lesion without other localizations.
Fig. 3: Abdominal  CT  scan
In order to reduce the risk of postoperative liver failure, a preoperative right portal embolization was planned to obtain a hypertrophy of the left lobe. Therefore endoscopic drainage was performed with two biliary stents (Fig. 4), and then right portal embolization was carried out using titanium coils (Fig. 5).
Fig. 4:  E.R.C.P.		Fig. 5:  Right portal
		embolization titanium coils
		in  the right portal vein.
		segue ...>>