Background : Perihilar cholangiocarcinoma (PHCC) usually spreads longitudinally along bile duct and invades vertically to hepatic artery, portal vein and liver parenchyma. Radical resection of cancer is still the hope of long-term survival for patients with PHCC. Precise evaluation of cancer invasion before operation is crucial for surgeons to achieve R0 resection. Biliary drainage is needed to relieve obstructive jaundice prior to extended liver resection to prevent postoperative cholangitis or liver insufficiency.

Methods : Comprehensive analysis of the extent of cancer invasion, patient’s liver function, future liver remnant, and general performance is essential for preoperative planning. Caudate lobe should be resected together with hemi liver if future liver remnant is enough. Complete dissection of regional lymph node is recommended for the accurate staging of PHCC. Precise preoperative planning and aggressive extended resection in PHCC could prolong patient’s overall survival with better quality of life.

Results : One 68-year-old man presented with obstructive jaundice. He received endoscopic biliary drainage to lower serum total bilirubin level less than 2 mg/dL . CT scan and cholangiography showed tumor in perihilar bile duct with left side extension. Under the diagnosis of Bismuth type IIIB perihilar cholangiocarcinoma, he undergone left hemihepatectomy with caudate lobectomy and complete hilar dissection by laparotomy. Pathology examination showed T3 lesion with regional lymph node metastasis. No postoperative complication occurred. Cancer recurred in paraaortic lymph node 12 months after operation. He died on postoperative 17th months without jaundice.

Conclusions : Precise preoperative planning and aggressive extended resection in PHCC could prolong patient’s overall survival with better quality of life.