Perihilar cholangiocarcinoma with constitutional indocyanine green defect treated by right hemihepatectomy extending to segment 1

Abstract

A 68-year-old man was admitted to our hospital with a diagnosis of resectable perihilar cholangiocarcinoma. In a preoperative indocyanine green (ICG) test, the ICG retention rate at 15 minutes (ICG R15) was more than 100%. Despite this finding, Child-Pugh classification and 99m-Tc-galactosyl-human serum albumin (GSA) liver scintigraphy did not show any abnormal findings and there was no background disease. Thus, we diagnosed constitutional ICG excretory defect and decided to perform radical surgery. We performed right hemihepatectomy extending to segment 1, extrahepatic bile duct resection and portal vein resection, and there were no postoperative complications. For patients requiring hepatectomy with this disease, it was concluded that the indications for surgery and the surgical procedure should be considered comprehensively, based on findings of liver function tests other than the ICG test, such as a general liver function test and GSA liver scintigraphy.