ABSTRACT

In Klatskin tumors, which are radiotherapy and chemotherapy resistant, the only treatment of choice prolonging life is surgery. Surgical principle is complete R0 resection including lymph nodes, associated liver segments and caudate lobe obtaining all negative-margin biliary tracts. A 65-year-old male patient presented with obstruction icterus. On imaging modalities, apart from a mass causing biliary obstruction extending to left main biliary duct, satellitosis nodules were also detected within the left lobe. Surgery was decided after having completed perioperative preparations for the patient in whom distant organ metastasis was not observed. Upon not detecting peritoneal diseases following laparoscopic exploration, it was shifted to the conventional method. The distal margin was sent to Frozen investigation following the disconnection of the coledochus after connecting the left hepatic artery and portal vein. Samples from the proximal biliary tract were also sent for Frozen investigation following left hepatectomy. Since distal margin was not positive when the proximal margin was clean, pancreaticoduodenectomy was also added. Hepatic artery exploration was decided upon not detecting color change in liver, palpation in the hepatic artery and flow on Doppler USG after the resection. During exploration, hepatic artery thrombosis was found secondary to hepatic artery dissection. Due to the fact that other hepatic artery reconstructions techniques were not probable, it was decided not to perform hepatic artery reconstruction in the form of aortahepatic bypass with a 6-mm Gore-Tex graft. The patient is being followed uneventful in his 14th month. Since hepatic artery reconstructions in hepatobiliary malignancies require microsurgical procedures and have high mortality rates, they are among the top controversial topics among surgeons. Aortahepatic bypass with synthetic Gore-Tex vascular graft should be kept in mind for both application ease and not requiring additional dissection.

Keywords: Extended hepatectomy, hilar cholangiocarcinom, pancreaticoduodenectomy, acute liver failure, aorta-hepatic artery bypass