Right Trisegmentectomy and Caudate Lobectomy with Portal Vein (PV) and Inferior Vena Cava (IVC) Reconstruction for Intrahepatic Cholangiocarcinoma (ICC): More Preoperation 3D-Simulated Details and More Safety.

BACKGROUND

Extended hepatectomy combined with complex vascular reconstruction for huge intrahepatic cholangiocarcinoma (ICC) invading the first hilum, and even inferior vena cava (IVC), is an extreme surgical procedure. High-quality three-dimensional (3D) simulations can offer a clear understanding of intraoperative anatomical structures, allowing for increases in resectability rates and reductions in postoperative complications.1 In this video, we present a case of precise surgical resection based on 3D simulation: right trisegmentectomy and caudate lobectomy with portal vein (PV) and IVC reconstruction.

PATIENTS AND

METHODS

The patient, a 70-year-old female, was admitted with obstructive jaundice. Preoperative 3D simulation revealed that a large tumor invaded the PV and IVC. Additionally, by leveraging the visualization and planning capabilities for complex vascular reconstruction provided by 3D simulation, we gained a three-dimensional understanding of hepatic pedicle branching patterns and anatomical relationships. Ultimately, trisectionectomy and caudate lobectomy, with reconstruction of the PV-LPV and IVC were performed. Moreover, during the reconstruction of the IVC, we preserved both hepatic inflow and outflow to the remnant liver, avoiding total hepatic inflow occlusion.

RESULTS

The surgery lasted approximately 503 min. The reconstruction of the PV-LPV and IVC took 16 and 22 min, respectively. The patient recovered uneventfully and was discharged on the 15th postoperative day. Postoperative pathology included poorly differentiated cholangiocarcinoma. The patient was disease-free at the 1-year follow-up evaluation.

CONCLUSIONS

Extended hepatectomy combined with complex vascular reconstruction is safe for advanced ICC. Additionally, as we continue to push the boundaries of surgical precision, 3D simulation will play an increasingly pivotal role in advancing liver surgery.