Inferior segmentectomy IV: a surgical approach for hilar cholangiocarcinoma

To access the proximal dilated bile duct of hilar cholangio-carcinoma, an inferior segmentectomy IV was proposed to be a beneficiary means of exposure of the whole length of the confluence of the hepatic duct. This method consists of partial resection of the quadrate lobe along the inferior sulcus, between the mid-axis of the gallbladder fossa and the falciform ligament. Eleven patients were enrolled into this study. In addition to removal of all the tumor mass, the author could access four secondary confluences and restore bilio-enteric bypasses. Six of them with curative resection had 24 months of mean survival (range 1 to 48 months: median 26 months). The remaining five patients with palliative resection had 7.2 months of mean survival (range 1 to 15 months: median 8 months). Regarding operative mortality, two patients died from massive intraoperative bleeding during the resection of the tumor. Successful approaches to perform a hilar resection and biliary bypass, an inferior segmentectomy IV are required for better access.