Isolated Caudate Lobectomy with Bile Duct Resection Performed in a Patient with Type IV Hilar Bile Duct Cancer

ABSTRACT

The prognosis of hilar bile duct cancer has been improved by extensive curative resection, but limited functional reserve of the liver occasionally does not permit such a major hepatectomy. We report a type IV hilar bile duct cancer case undergone isolated caudate lobectomy as a limited but curative resection, in whom the indocyanine green retention test at 15 minutes revealed 23.9% despite long-term biliary decompression and the whole liver was rather atrophic. Complete removal of the Spiegel lobe, paracaval portion, and caudate process combined with hilar bile duct resection made 3 right and 4 left intrahepatic duct openings, which were reconstructed as a whole at each side of transection plane after ductoplasty. The patient recovered uneventfully. Although surgical technique for isolated caudate lobectomy must be more difficult comparing with other anatomical hepatectomy, but it can be a ultimate technique of limited curative resection for advanced hilar bile duct cancer patients with decreased hepatic reserve. Comprehension to the anatomy of the caudate lobe is a prerequisite for its resection, thus we discussed it in detail.