title: Anatomical liver segmentectomy 2 for combined hepatocellular carcinoma and cholangiocarcinoma with tumor thrombus in segment 2 portal branch.
abstract: BACKGROUND
  Hepatic resection is the only effective treatment for combined hepatocellular carcinoma and cholangiocarcinoma.
  
  
  METHODS
  A 52-year-old man was preoperatively diagnosed with hepatocellular carcinoma in segment 2 with tumor thrombus in the segment 2 portal branch. Anatomical liver segmentectomy 2, including separation of the hepatic arteries, portal veins, and bile duct, enabled us to remove the tumor and portal thrombus completely. Modified selective hepatic vascular exclusion, which combines extrahepatic control of the left and middle hepatic veins with occlusion of left hemihepatic inflow, was used to reduce blood loss. A pathological examination revealed combined hepatocellular carcinoma and cholangiocarcinoma with tumor thrombus in the segment 2 portal branch. No postoperative liver failure occurred, and remnant liver function was adequate.
  
  
  CONCLUSIONS
  The separation method of the hepatic arteries, portal veins, and bile duct is safe and feasible for a liver cancer patient with portal vein tumor thrombus. Modified selective hepatic vascular exclusion was useful to control bleeding during liver transection. Anatomical liver segmentectomy 2 using these procedures should be considered for a patient with a liver tumor located at segment 2 arising from a damaged liver.
authors.affiliation: Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto 629-2261, Japan. ishii0512h@yahoo.co.jp
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ishii
authors.forename: Takuma
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Michihiro
authors.initials: M
authors.lastname: Kudou
authors.forename: Masumi
authors.initials: M
authors.lastname: Nishimura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Toma
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakamura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mazaki
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Itoh
mesh_terms: D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D013927:Thrombosis / Q000473:pathology / Q000601:surgery*