Hilar portal vein wedge resection and patch venoplasty in patients undergoing bile duct resection for hepatobiliary malignancy: A report of two cases.

Margin-free resection is one of the most important factors for favorable prognosis in patients undergoing resection for hepatobiliary malignancies. Herein, we present two cases of hepatobiliary malignancies in patients who underwent bile duct resection combined with hilar portal vein (PV) resection and vein allograft patch plasty. The first case was a 51-year-old female patient with gallbladder cancer, in whom we performed extended cholecystectomy, bile duct resection and extensive lymph node dissection. The tumor-invaded PV wall was meticulously excised and the defect was repaired with a cryopreserved iliac vein allograft patch. The extent of the tumor was pT4N2M0 (stage IVB), thus concurrent chemoradiation therapy and adjuvant chemotherapy were performed. This patient is currently alive for 7 years after surgery without any evidence of tumor recurrence. The second case was a 79-year-old male patient with perihilar cholangiocarcinoma of type I and gallbladder cancer, in whom extended bile duct resection and extensive lymph node dissection were performed. The extent of the bile duct tumor was pT4N1M0 (stage IVA) and that of gallbladder tumor was pT2N0M0 (stage II). No additional treatment was provided because of old age and poor general condition. This patient passed away 11 months after surgery due to rapid progression of tumor recurrence. In conclusion, hilar PV wedge resection and roofing patch venoplasty is a useful option to facilitate complete tumor resection in patients undergoing bile duct resection for hepatobiliary malignancy.