EXTENDED RIGHT TRISEGMENTECTOMY FOR HILAR BILE-DUCT CARCINOMA

Extended right trisegmentectomy with total caudate lobectomy, extrahep atic bile duct resection and lymphadenectomy was performed for a 54-ye ar-old man, who was diagnosed as type IV hilar bile duct carcinoma. Af ter division of the right portal vein and all the portal venous branch es to the caudate lobe and the left medial segment, the left hepatic a rtery and ifs branches to the segment II and III were dissected from t he corresponding bile ducts to about 1 cm beyond the left margin of th e umbilical portion of the left portal vein, where the lateral segment al bile ducts were divided after transection of the hepatic parenchyma . All bile duct margins were free from cancer microscopically. To our knowledge this is the first report of extended right trisegmentectomy for hilar bile duct carcinoma, in which the bile ducts of the left lat eral segment are divided at the left side of the umbilical portion of the left portal vein. This technique facilitates making the intrahepat ic bile duct stumps free from cancer. However, ifs impact on long-term survival remains to be determined.