At the end of July this year, a Mr. Huang came to the Hepatobiliary Center clinic. In the past month, he had been feeling pain and discomfort in his upper right abdomen. Considering his previous history of cholecystitis, he thought he would be fine with some anti-inflammatory drugs. But the last few days, Mr. Huang looked in the mirror and found that the skin of his eyes had turned yellow, and his body was also a bit itchy. He then felt something was wrong and wanted to get up and go to the hospital for a checkup. A few days later, the examination report came back, and the condition was not optimistic: MRI of liver showed that there was abnormal signal in the right posterior lobe of liver near the hepatoportal, considering the possibility of hepatic cholangiocarcinoma; the right branch of portal vein was also infiltrated. The liver function index was abnormal. Mr. Huang felt his condition was serious and came to our clinic in a hurry. While arranging for Mr. Huang’s hospitalization, in addition to perfecting some other examinations, our team carefully analyzed his condition together: since the tumor was located in the hepatic hilar region, it might invade the right and left hepatic ducts, causing jaundice, and at the same time involved the portal vein, if surgery was performed, radical resection of high-grade cholangiocarcinoma, resection of the right half of the liver and caudate lobe of the liver would be required, and reconstruction of the portal vein might also be needed to achieve complete cure. In short, the surgical risks were enormous and the surgery was extremely difficult. Considering that Mr. Huang was only 55 years old, we thought it was worth the risk. After careful and thorough preparation, Mr. Huang was wheeled into the operating room. The surgery was very thrilling. After opening the abdominal cavity, we realized that the situation was more complicated than we thought: the right hepatic duct and the confluence of the left and right hepatic ducts were found to be wrapped by the tumor, and the tumor had also invaded the right branch of the portal vein, and the lymph nodes in the hilar region were also enlarged. In addition, the whole right liver had been affected by the tumor, and it was difficult to peel off clearly because of the serious adhesion with the surrounding tissues. It was difficult to peel off clearly. A slight mistake during the operation would cause hemorrhage and endanger life. In the face of this situation, we did not panic, and the operation was carried out according to the predetermined plan, carefully separating the tumor and blood vessels in the hepatic hilum, and gradually completing portal vein reconstruction and tumor resection. During the surgery, we had to protect the normal blood supply to the left liver to avoid postoperative liver failure; at the same time, we had to peel off the right liver and the mass, and to remove and reconstruct the involved portal vein bifurcation. In particular, surgery involving the caudate lobe of the liver has always been considered a “no-go” area for liver surgery, which shows the difficulty of this operation! After eight hours of intense operation, our team finally completed the surgery successfully, and Mr. Huang was transferred to the ICU for monitoring and treatment. After about half a month of rehabilitation, Mr. Huang gradually recovered, his liver function was normal, and he was discharged successfully. 1.Characteristics of hepatoportal cholangiocarcinoma: ①Tumor in bile duct will soon invade surrounding tissues, such as invasion of portal vein or hepatic artery often leads to unresectable. ②There is no specific symptom in early stage, so it is not easy to detect. Once symptoms occur, it is already in the middle and late stage, mainly manifesting as painless jaundice, deep yellow urine, light colored stool or even clay color, itchy skin, etc. ③Due to low radical resection rate, insensitivity to radiotherapy and chemotherapy, poor efficacy and low five-year survival rate, hilar cholangiocarcinoma has long been considered as one of the most challenging surgeries in hepatobiliary surgery. 2. Diagnostic and treatment methods of hilar cholangiocarcinoma: ①Ultrasound is simple, non-invasive and the main screening method; CT, MRI and MRCP, are the most important examination methods; CT (especially CTA) can not only diagnose, but also determine the extent of tumor invasion, vascular invasion and lymph node metastasis; MRI and MRCP can obtain high quality bile duct images and clearly show the whole bile duct, which is more instructive for MRI and MRCP can obtain high quality images of the bile ducts and clearly show the whole bile ducts, which are more useful for clinical staging. The currently recognized unresectable hilar cholangiocarcinoma includes: tumor invasion of bilateral secondary or higher bile duct branches; extensive infiltration, occlusion, encapsulation and thrombosis of portal vein trunk; tumor invasion of secondary or higher bile ducts on one side combined with infiltration or encapsulation of portal vein or hepatic artery on the opposite side; atrophy of one liver lobe combined with infiltration or encapsulation of portal vein or hepatic artery on the opposite side; lymph node metastasis or distant metastasis beyond the hepatoduodenal ligament. metastases or distant metastases beyond the hepatoduodenal ligament. Other than these, radical surgery for hilar cholangiocarcinoma can be performed. (Arrow above shows: mass and dilated bile duct in the hilar region) (Arrow above shows: important vessels and tumor in the hilar region) (Arrow above shows: structures in the hilar region) (Arrow above shows: tumor specimen)