Parenchyma-sparing central hepatectomy combined with complete caudate lobectomy for bismuth–corlette type iiia perihilar cholangiocarcinoma: a case report

Perihilar cholangiocarcinoma (pCCA), also termed hilar cholangiocarcinoma or a Klatskin tumor, is an aggressive biliary malignancy. R0 resection remains the only potentially curative treatment, but conventional major hepatectomy may sacrifice substantial functional liver parenchyma. We report a 61-year-old woman with Bismuth–Corlette type IIIa pCCA who presented with polydipsia, polyuria, and obstructive jaundice. She had poorly controlled type 2 diabetes mellitus (HbA1c 10.55%) and dyslipidemia. After percutaneous transhepatic biliary drainage reduced the total bilirubin level from 156.2 to 56.0 µmol/L, multidisciplinary evaluation supported curative-intent surgery. She underwent central hepatectomy combined with complete caudate lobectomy, extrahepatic bile duct resection, cholecystectomy, regional lymphadenectomy, and Roux-en-Y hepaticojejunostomy. The procedure was converted to open surgery, and estimated blood loss was 1000 mL. Final histopathology confirmed pCCA with a large-duct histomorphologic phenotype, perineural invasion, and deficient mismatch repair (dMMR) characterized by loss of MLH1 and PMS2 expression. The pathological stage was pT1N0M0, stage I, according to the UICC TNM Classification of Malignant Tumours, 9th edition. All final biliary margins were negative, including the left hepatic duct, right anterior and posterior hepatic ducts, and distal bile duct, and no lymph node metastasis was found (0/5), indicating R0 resection. Adjuvant capecitabine monotherapy was recommended by the oncology team but had not been initiated at discharge. Serial imaging up to seven months after surgery showed no evidence of recurrence or distant metastasis. This case suggests that central hepatectomy combined with complete caudate lobectomy may provide a parenchyma-sparing option for carefully selected patients with pCCA when negative margins can be achieved. The presence of perineural invasion and dMMR warrants multidisciplinary postoperative management and continued long-term surveillance.