An advanced intrahepatic cholangiocarcinoma treated with minimally invasive resection: case report

Although reports for laparoscopic liver resection (LLR) on intrahepatic cholangiocarcinoma (ICC) are increasing, its major challenges are in lymph node (LN) dissection and bile duct reconstruction. Here we present a case report of advanced ICC, who underwent combined minimally invasive surgery. A 70-year-old man with a 9.5 cm mass and bile duct dilatation on the right liver was referred to our department. The findings of endoscopic retrograde cholangiography showed obstruction of the right branch of bile duct and stenosis on hilar portion of the main duct. Combined minimally invasive surgery of LLR and LN dissection and bile duct reconstruction through a small laparotomy was performed under the diagnosis of ICC. An 8-cm caudal-cranial incision on the right upper abdomen was placed. Through the incision, LN dissection and bile duct divisions were performed. After inserting a wound protector devise with a surgical glove to the incision, trocar ports and CO₂-pneumoperitonium were introduced. Transection of the liver was performed on the Rex-Cantlie line exposing inferior vena cava (IVC) and the resected right liver was removed, both laparoscopically. Bile duct reconstruction with Roux-en-Y hepatico-jejunostomy was performed through the small laparotomy. The patient recovered uneventfully. He survived for 6.5 years, with the recurrence at 4 years, after the surgery and died of the disease. We believe this is one of the choices for advanced ICC, which has needs for LN dissection and bile duct reconstruction.