Case Description

• The patient was a 42-year-old male with a locally advanced Klatskin tumour.
• The tumour originated at the left margin of the hepatic duct bifurcation. It invaded the anterior branch of the right hepatic artery and the left hepatic artery. It also invaded the left portal vein and the anterior branch of the right portal vein. However, an accessory segment 7 and segment 6/7 branches of the right portal vein were free of tumour.
• To optimize the liver for surgery, biliary system drainage and left PV embolization were performed.
• An extended left hepatectomy involving segments 1 to 5 and 8 was planned, preserving segments 6 and 7.
• This transection line divided both an accessory segment 7 and segment 6/7 branches of the right portal vein. Both were reconstructed to the main portal vein during in-situ cold perfusion.