Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2020; 12(2): 68-76
Published online Feb 27, 2020. doi: 10.4240/wjgs.v12.i2.68
Left hepatic trisectionectomy for perihilar cholangiocarcinoma with a right-sided round ligament: A case report
Tomoyuki Ishida, Satoshi Nara, Keiichi Akahoshi, Takeshi Takamoto, Yoji Kishi, Minoru Esaki, Nobuyoshi Hiraoka, Kazuaki Shimada
Tomoyuki Ishida, Satoshi Nara, Keiichi Akahoshi, Takeshi Takamoto, Yoji Kishi, Minoru Esaki, Kazuaki Shimada, Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan
Nobuyoshi Hiraoka, Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo 104-0045, Japan
Author contributions: Ishida T and Nara S drafted the initial version of the manuscript; Akahoshi K, Takamoto T, Kishi Y, Esaki M, Hiraoka N, and Shimada K critically reviewed and revised the manuscript; All authors issued a final approval of the submitted version.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Satoshi Nara, MD, Doctor, Staff Physician, Surgeon, Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. sanara@ncc.go.jp
Received: September 1, 2019
Peer-review started: September 1, 2019
First decision: September 25, 2019
Revised: November 13, 2019
Accepted: November 26, 2019
Article in press: November 26, 2019
Published online: February 27, 2020
Processing time: 137 Days and 8 Hours
Abstract
BACKGROUND

A right-sided round ligament (RSRL) is a rare, congenital anomaly of the intrahepatic portal vein, with a reported frequency of 0.2%-1.2%. For patients with perihilar cholangiocarcinoma associated with an RSRL, an accurate understanding of the vascular and biliary anatomy is indispensable.

CASE SUMMARY

We report a 70-year-old male with perihilar cholangiocarcinoma associated with an RSRL. After percutaneous transhepatic embolization of the left and anterior portal branches, we conducted a left trisectionectomy of the liver with extrahepatic bile duct resection and hepaticojejunostomy. The postoperative course was uneventful, and R0 resection was achieved. When the liver volume of each section was compared between 7 patients with an RSRL and 20 patients with normal portal vein anatomy, the posterior section in RSRL patients was significantly larger than that in patients with normal portal vein anatomy (median: 457 mL vs 306 mL, P = 0.031). In patients with perihilar cholangiocarcinoma associated with an RSRL, left trisectionectomy has several surgical advantages: (1) The posterior branch of the portal vein often ramifies independently, and the division of the portal vein is easily conducted; (2) A relatively large amount of remnant liver can be retained; and (3) The anatomy of the posterior branch of the Glissonian pedicle is similar to that in patients with normal anatomy.

CONCLUSION

In patients with an RSRL and perihilar cholangiocarcinoma that does not involve the posterior section, left trisectionectomy may be a favorable choice.

Keywords: Right-sided round ligament; Left-sided gallbladder; Perihilar cholangiocarcinoma; Case report

Core tip: A right-sided round ligament (RSRL) is a rare, congenital portal vein anomaly. We present a case of perihilar cholangiocarcinoma in a 70-year-old male with an RSRL. Additionally, we reviewed the medical records of 7 patients with an RSRL who underwent hepatobiliary and pancreatic surgery at our hospital. Left trisectionectomy may be a favorable choice for resection in patients with an RSRL and perihilar cholangiocarcinoma because: (1) The posterior branch of the portal vein often ramifies independently; (2) The volume of the posterior section is relatively large; and (3) The anatomy of the posterior Glissonian pedicle in an RSRL is not very different from that in ordinary patients.