Left hepatic trisectionectomy for perihilar cholangiocarcinoma with a right-sided round ligament: A case report

Table 1 Clinicopathological characteristics and surgical procedures of 7 patients with a right-sided round ligament at our hospital

Case	Sex	Age	Diagnosis	Operation	Portal anatomy	Portal configuration[12]	Biliary architecture[11]	Volumetry of the posterior/anterior/left liver
1	M	58	Hepatocellular carcinoma	Partial hepatectomy	Ppost-i	Z shape	NA	53%/32%/14%
2	M	58	Hepatocellular carcinoma	Partial hepatectomy	Ppost-i	Z shape	NA	56%/28%/15%
3	F	54	Colorectal liver metastasis	Right hemihepatectomy and choledochojejunostomy	P-bifurcation	I shape	NA	33%/30%/34%
4	M	71	Benign bile duct stenosis	Left trisectionectomy	Ppost-i	Z shape	Independent right lateral type	44%/33%/21%
5	F	41	Pancreatic head cancer	Pancreaticoduodenectomy	Ppost-i	Z shape	Total left type	41%/31%/27%
6	M	70	Perihilar cholangiocarcinoma	Left trisectionectomy	Ppost-i	Z shape	Total left type	42%/35%/21%
7	M	74	Combined hepatocellular cholangiocarcinoma	Extended posterior sectionectomy	P-bifurcation	I shape	Symmetrical type	21%/30%/44%1

¹In case 7, the posterior section was atrophied due to a tumor thrombus in the posterior branch of the portal vein. RSRL: Right-sided round ligament; Ppost-i: Independent branching of the posterior portal branch; P-bifurcation: Portal vein bifurcation type; NA: Not available.

Table 2 Comparison of the median liver volume and the percentage of each section between patients with a right-sided round ligament and normal portal vein anatomy

Liver section	RSRL, n = 7	Ppost-i, n = 5	P-bifurcation, n = 2	Normal PV anatomy, n = 20	P1 value	P2 value
Lateral section	247 mL (19.6%)	210 mL (17.5%)	296 mL (32.2%)	190 mL (18.5%)	0.431	0.767
Medial section	13 mL (1.0%)	12 mL (1.0%)	69 mL (6.8%)	102 mL (9.9%)	0.002	< 0.001
Anterior section	343 mL (30.8%)	371 mL (31.6%)	275 mL (29.9%)	384 mL (36.1%)	0.001	0.004
Posterior section	457 mL (41.8%)	501 mL (43.9%)	241 mL (27.2%)	306 mL (31.0%)	0.031	< 0.001
Caudate lobe (S1)	24 mL (2.3%)	23 mL (2.0%)	36 mL (3.8%)	17 mL (1.7%)	0.092	0.447
Total liver	1115 mL	1175 mL	917 mL	1032 mL	0.607	0.272

¹Right-sided round ligament vs normal anatomy;

²Independent branching of the posterior portal branch vs normal anatomy. RSRL: Right-sided round ligament; Ppost-i: Independent branching of the posterior portal branch; P-bifurcation: Portal vein bifurcation type; PV: Portal vein.