To evaluate the safety and efficacy of microsurgical hepatic artery reconstruction in the treatment of intrahepatic cholangiocarcinoma involving the first porta hepatis (ICC-IFPH) and hilar cholangiocarcinoma (HCCA).

Clinical data of 11 patients diagnosed with ICC-IFPH or HCCA in the First Affiliated Hospital of Guangxi Medical University from June 2017 to October 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 6 patients were male and 5 female, aged 44-73 years, with a median age of 55 years. All patients underwent tumor resection combined with hepatic artery resection and reconstruction. Perioperative data and follow-up data were observed.

The average operation time was (541±154) min. The median blood loss was 696 (200, 1 900) ml. The reconstruction time of hepatic artery was (23±6) min. The inner diameter of artery was (2.0±0.5) mm, and the length of resected artery was (3.3±1.0) cm. Postoperative patency rate of hepatic artery was 100% (11/11). R0 resection was performed in 10 cases and R1 resection in 1 case. According to the Clavien-Dindo classification, 2 patients developed grade Ⅲa complications, including postoperative bile leakage and liver abscess in 1 case and pancreatic fistula in the other case. No postoperative liver failure or perioperative death occurred. During postoperative follow-up, 3 patients died at postoperative 3, 10 and 48 months, respectively. The median follow-up duration was 10 months, and 7 patients were followed up for over 12 months.

Microsurgical hepatic artery reconstruction is a safe and feasible procedure for ICC-IFPH and HCCA, which can provide oxygen-enriched arterial blood for the remaining liver, lower the incidence of postoperative liver failure, enhance surgical resection rate of cholangiocarcinoma, and improve the quality of life and clinical prognosis of patients.