[A Case of Hilar Cholangiocarcinoma That Was Resected after Portal Vein Embolization and Hepatic Vein Embolization].

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The patient was a 68-year-old man. The diagnosis was Bismuth type 1 hilar cholangiocarcinoma with right hepatic arterial infiltration. Right hepatectomy with extra hepatic bile duct resection was planned. Computed tomography(CT)volumetry using SYNAPSE VINCENT revealed the volume of entire liver to be 1,417 mL, future liver remnant volume(FLR-V)to be 390 mL(28%), and estimated indocyanine green clearance rate of future liver remnant(ICG-Krem)to be 0.043. It was too small, so portal vein embolization(PVE)was performed, and 4 days after PVE, hepatic vein embolization(HVE)was done. Fourteen days after PVE, FLR-V increased by 472 mL(34%), and future liver remnant function(FLR-f)assessed by single- photon emission computed tomography(SPECT)increased by 563 mL(41%). Twenty-eight days after PVE, FLR-V increased by 573 mL(41.8%), FLR-f 648 mL(47%), ICG-Krem 0.064, and functional ICG-Krem assessed by SPECT 0.073. Thirty- two days after PVE, right hepatectomy with extra hepatic bile duct resection was performed. Surgery time was 764 min, and blood loss was 1,900 mL. The cancer was pathologically diagnosed as moderately differentiated adenocarcinoma, pT2a, pN0, pM0, pStageⅡ, R0 resected. The patient's postoperative course was uneventful, and he discharged 23 days after surgery. He started to receive adjuvant S-1(120 mg)chemotherapy 28 days after surgery, and there has been no evidence of recurrence for 4 months.

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