[Technical points of portal vein resection and reconstruction for perihilar cholangiocarcinoma: based on the experience of Nagoya University Hospital].

Perihilar cholangiocarcinoma (PHCC) frequently invades the portal venous system. For advanced PHCC (e.g., cT4 stage), hepatectomy combined with portal vein resection and reconstruction (PVR) is often the only feasible surgical option. However, the complexity of PVR techniques and the concurrent need for extensive hepatectomy significantly increase perioperative mortality risks. This article systematically reviews the current evidence and surgical practices of high-volume center PVR, aiming to define the optimal timing and methods for safe PVR implementation, and summarizes the surgical outcomes of PVR, including the incidence of portal vein thrombosis complications and long-term survival rates. Based on existing evidence, PVR is recommended only when there is genuine adhesion invasion between the tumor and the inflow vessels of the future liver remnant, and routine no-touch vascular resection and reconstruction (VR) is not recommended. In a large cohort of PHCC cases at Nagoya University Hospital, the 90-day mortality rate in the VR group was higher than that in the non-VR group (3.6% vs. 1.2%), but both groups achieved a median overall survival of 30 months, significantly higher than the non-surgical group (10 months). Additionally, the article details the standard PVR protocol at Nagoya University Hospital, signs of anastomotic failure, selection of autologous interposition grafts, postoperative surveillance, and anticoagulation therapy for portal vein thrombosis.