Case Report: Making room for radicality: balancing liver reserve and oncologic clearance in hilar cholangiocarcinoma through portal vein embolisation - Report - MDSpire

Case Report: Making room for radicality: balancing liver reserve and oncologic clearance in hilar cholangiocarcinoma through portal vein embolisation

  • By

  • Elvin Jia Hong Lee

  • Zhun Shen Tan

  • Azlanudin Azman

  • Isa Azzaki Zainal

  • Muhammad Zahid Abdul Muien

  • Ian Chik

  • July 8, 2026

  • 0 min

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Clinical Report: Optimizing Surgical Outcomes in Hilar Cholangiocarcinoma

Overview

This case study highlights the use of portal vein embolization (PVE) to enhance future liver remnant (FLR) hypertrophy in a patient with hilar cholangiocarcinoma.

Background

Hilar cholangiocarcinoma poses significant surgical challenges due to the risk of post-hepatectomy liver failure (PHLF), especially when the FLR is marginal. Strategies such as PVE have emerged to improve liver function and enable surgical resection.

Data Highlights

Clinical EventDate
Diagnosis of hilar cholangiocarcinoma[Date]
Right PVE performed[Date]
Extended right hepatectomy[Date]
FLR before PVE34%
FLR after PVE60.5%

Key Findings

  • Hilar cholangiocarcinoma accounts for 50%-60% of all cholangiocarcinomas.
  • Post-hepatectomy liver failure (PHLF) is a major risk following extended hepatectomy.
  • Portal vein embolization (PVE) can significantly increase the future liver remnant (FLR) volume.
  • The patient in this case study achieved a FLR increase from 34% to 60.5% after PVE.
  • Extended right hepatectomy was safely completed without PHLF due to adequate FLR.

Clinical Implications

This case demonstrates the application of preoperative portal vein embolization (PVE) in a patient with marginal FLR.

Conclusion

This case illustrates the application of PVE in a patient with hilar cholangiocarcinoma.

Related Resources & Content

  1. Utilization of Left Renal Vein Graft and In Situ Hepatic Perfusion During Hepatectomy for Tumors Invading Hepatic Veins: Enhancing Hemodynamics and Surgical Approach, Journal of Gastrointestinal Surgery, 2022
  2. R0 Two-Stage Hepatectomy with Portal Vein Ligation: Advancing Treatment for Patients with Extensive Bilobular Colorectal Liver Metastases, Journal of Gastrointestinal Surgery, 2008
  3. Outcomes of Splenectomy and Curative Interventions in Hepatocellular Carcinoma Patients with Portal Hypertension: A Retrospective Analysis, Journal of Gastrointestinal Surgery, 2018
  4. EASL Clinical Practice Guidelines on the management of extrahepatic cholangiocarcinoma, EASL, 2025
  5. British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma, BSG, 2024
  6. Impact of Portal Vein Embolization on the Management of Hepatocellular Carcinoma and Its Influence on Recurrence Rates: A Case-Control Analysis
  7. Biliary Tract Cancers, Version 2.2025, NCCN Clinical Practice Guidelines In Oncology
  8. EASL Clinical Practice Guidelines on the management of extrahepatic cholangiocarcinoma
  9. British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma
  10. Meta-analysis of liver venous deprivation vs portal vein embolization in treating liver cancer with an insufficient liver remnant - PubMed
  11. Combined Portal and Hepatic Vein Embolization Produces Greater Hypertrophy than Portal Vein Embolization Alone with Similar Post-Hepatectomy Outcomes and is not Impacted by Hepatic Artery Infusion Chemotherapy - PubMed
  12. Frontiers | A systematic review and meta-analysis of liver venous deprivation versus portal vein embolization before hepatectomy: future liver volume, postoperative outcomes, and oncological safety
  13. First results from the international registry on liver venous deprivation (EuroLVD) - PubMed

Original Source(s)

Case Report: Making room for radicality: balancing liver reserve and oncologic clearance in hilar cholangiocarcinoma through portal vein embolisation

  • by Elvin Jia Hong Lee, Zhun Shen Tan, Azlanudin Azman, Isa Azzaki Zainal, Muhammad Zahid Abdul Muien, Ian Chik

  • July 8, 2026

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