Long-term survival following extended hepatectomy with concomitant resection of all major hepatic veins for intrahepatic cholangiocarcinoma: report of a case.

Intrahepatic cholangiocarcinoma involving all major hepatic veins was diagnosed in a 62-year-old man. Multidetector-row computed tomography showed a massive tumor occupying segments 2-5, 7, and 8, with invasion of all major hepatic veins, although the inferior right hepatic vein, draining the venous flow of segment 6, was clearly visualized. Therefore, we planned an extended left trisectionectomy, involving resection of segments 1-5, 7, and 8, with extrahepatic bile duct resection and concomitant resection of all major hepatic veins. We performed portal vein embolization of the right anterior portal branch and the portal branch of segment 7 to identify the demarcation between segments 6 and 7 on the surface of the right lobe. We were able to divide the hepatic parenchyma between segments 6 and 7 and the planned surgery was accomplished, with repositioning of the confluence of the inferior right hepatic vein to prevent outflow blockage. The histological findings were pT3N0M0, Grade2, Stage III, and R0 resection, according to the UICC classification (seventh edition). Although remnant liver metastases were detected 75 months after surgery, the patient is still alive and being treated with chemotherapy, 88 months after surgery. We report this case to demonstrate how using portal vein embolization to identify the hepatic segment helps accomplish extended hepatectomy preserving only one segment and that R0 resection by extended hepatectomy with concomitant resection of all hepatic veins can achieve a satisfactory outcome.