title: Portal vein reconstruction using a left renal vein graft for a patient with hilar cholangiocarcinoma.
abstract: We report a patient with hilar cholangiocarcinoma who underwent combined portal vein reconstruction using a left renal vein graft. A 68-year-old man was referred to the hospital with a one-week history of dark urine and jaundice. Cholangiography through the percutaneous transhepatic biliary drainage catheter and magnetic resonance cholangiopancreatography demonstrated complete obstruction of the hepatic primary confluence extended to the left secondary confluence. The patient underwent left hepatic lobectomy combined with total caudate lobectomy and extrahepatic bile duct resection. At operation, carcinoma invasion was observed from the portal trunk to the right portal branch. So, combined portal vein resection and graft interpose using left renal vein was performed. The caliber of left renal vein was wider than the right portal branch. No remarkable renal and hepatic dysfunction occurred postoperatively. In conclusion, left renal vein seems appropriate as an autograft when reconstructing the portal vein, especially main portal trunk, in patients with advanced hepatobiliary malignancies. It may be necessary to adjust the caliber when anastomosing the left renal vein to the right or left portal branch because the diameter of the left renal vein is usually wide.
authors.affiliation: First Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan. rsasaki@md.tsukuba.ac.jp
authors.forename: Ryoko
authors.initials: R
authors.lastname: Sasaki
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Fujita
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Takeda
authors.forename: Koichi
authors.initials: K
authors.lastname: Hoshikawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Takahashi
authors.forename: Osamu
authors.initials: O
authors.lastname: Funato
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nitta
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Yaegashi
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nakajima
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Saito
authors.forename: Go
authors.initials: G
authors.lastname: Wakabayashi
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ohkohchi
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D001806:Blood Urea Nitrogen; D018281:Cholangiocarcinoma / Q000601:surgery*; D049448:Cholangiopancreatography, Magnetic Resonance; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D011169:Portal Vein / Q000601:surgery*; D012082:Renal Veins / Q000637:transplantation*; D014182:Transplantation, Autologous