title: Selective hypertrophy of the lobus caudatus as a novel approach enabling extended right hepatectomy in the presence of a non-perfused left lateral liver lobe.
abstract: BACKGROUND
  Portal vein embolization (PVE) is a well-established technique to enhance functional hepatic reserves of segments II and III before curative extended right hepatectomy for tumors of the right liver lobe. However, an adequate hepatopetal flow of the left lateral portal vein branches is required for a sufficient PVE-associated hypertrophy.
  
  
  METHODS
  Here, we report a 65-year old patient suffering from a locally advanced intrahepatic cholangiocarcinoma in the right liver lobe and segment IV. A curative extended right hepatectomy after preoperative PVE of liver segments IV-VIII was initially impossible because of partial thrombosis of the left lateral portal vein branches resulting in an ischemic-type atrophy of segments II and III. However, due to a massive hypertrophy of the caudate lobe following PVE of liver segments IV-VIII, subsequent extended right hepatectomy with intraoperative thrombectomy of segments II and III was made possible.
  
  
  CONCLUSIONS
  To our knowledge this is the first case in which an extended right hepatectomy for a liver malignancy, in the presence of atrophic left lateral section, was made possible by a massive PVE-associated hypertrophy of the caudate lobe.
authors.affiliation: Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
authors.forename: Georgi
authors.initials: G
authors.lastname: Atanasov
authors.affiliation: Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany ; Translational Centre for Regenerative Medicine, Leipzig University, Leipzig, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Schmelzle
authors.affiliation: Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Thelen
authors.affiliation: Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Wiltberger
authors.affiliation: Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
authors.forename: Hans-Michael
authors.initials: HM
authors.lastname: Hau
authors.affiliation: Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Krenzien
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Tim-Ole
authors.initials: TO
authors.lastname: Petersen
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Moche
authors.affiliation: Department of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany ; Translational Centre for Regenerative Medicine, Leipzig University, Leipzig, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Jonas
mesh_terms: D000368:Aged; D018281:Cholangiocarcinoma / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D006984:Hypertrophy; D008099:Liver / Q000098:blood supply / Q000473:pathology; D008113:Liver Neoplasms / Q000628:therapy*; D011169:Portal Vein
keywords: Cholangiocarcinoma; Extended right hepatectomy; PVE; Portal vein embolization