Objective:

To discuss the role of Portal Vein Embolization (PVE) in optimizing surgical outcomes for patients with hilar cholangiocarcinoma by enhancing future liver remnant (FLR) hypertrophy.

Approach:

• Case Presentation: A 61-year-old male with Bismuth-Corlette type IIIA hilar cholangiocarcinoma underwent PVE to increase FLR from 34% to 60.5%, enabling safe extended right hepatectomy.
• Surgical Techniques: The report highlights the use of PVE and discusses other liver hypertrophy techniques such as Liver Venous Deprivation (LVD) and ALPPS.

Key Findings:

• PVE successfully induced FLR hypertrophy from 34% to 60.5%, allowing for safe extended hepatectomy without post-hepatectomy liver failure (PHLF).
• The case emphasizes the importance of preoperative PVE in patients with marginal FLR.

Interpretation:

The case illustrates the successful conversion of a marginal FLR into an adequate physiological reserve through PVE, facilitating safe surgical resection in this patient with hilar cholangiocarcinoma.

Limitations:

• The report is based on a single case study, which may limit the applicability of the findings to a broader patient population.
• The infrequent performance of PVE suggests a need for more extensive experience and data to support its widespread use.

Conclusion:

This case highlights the critical role of preoperative PVE in enhancing surgical safety and outcomes for patients with hilar cholangiocarcinoma.