Extended left hepatectomy with sequential triple-vessel resection and reconstruction for advanced cholangiocarcinoma:...

The resectability of cholangiocarcinoma is often limited by vascular involvement; however, advancements in hepatobiliary and transplant surgery have enabled increasingly complex resections. We describe a novel, sequential approach to resection of cholangiocarcinoma involving triple-vessel reconstruction of the hepatic artery, portal vein, and inferior vena cava (IVC). A 71-year-old woman underwent resection of an intra-hepatic cholangiocarcinoma invading the hilar vessels. The procedure involved sequential resection, reconstruction and revascularization of the hepatic artery, portal vein and IVC before removing the specimen en-bloc. This approach preserved vascular inflow or outflow at each step, thereby minimizing the risk of ischemic liver injury and circumventing the time limitations of other techniques such as total vascular exclusion. The patient's postoperative course was uneventful, and she was discharged on postoperative day 14. At 44-month follow-up, she remains well with no radiological evidence of recurrence. Sequential vascular resection may represent a feasible strategy for selected patients with locally advanced cholangiocarcinoma.