Background and Aims: There is no agreement on embolectomy for hepatocellular cancer (HCC) with type B4 bile duct tumor thrombus (BDTT) at present. Here, the authors report the treatment procedures of a patient with HCC and type B4 BDTT, so as to provide a reference for the treatment of this condition.
Methods: The clinical data of one patient with HCC and type B4 BDTT treated in Fujian Provincial Hospital in March 2019 were reviewed. The patient underwent surgical treatment after accurate preoperative assessment. A “q-type” biliary tumor thrombectomy was performed during operation, which was namely, that a longitudinal incision from the anterior wall of the common bile duct to the anterior wall of the right hepatobiliary duct to completely expose the BDTT, and then a circular transection was made on the confluence of the right hepatic duct to the common hepatic duct to completely remove extrahepatic BDTT. The intra- and postoperative variables as well as the follow-up results were analyzed.
Results: The patient underwent right hemihepatectomy, cholecystectomy, “q-type” biliary thrombectomy, and hepatoduodenal ligament lymph node dissection. All procedures were successfully completed. The operative time was 313 min and the intraoperative blood loss was 150 mL. Postoperative pathological results showed that the right liver tumor was poorly differentiated HCC with a size of 4 cm × 3 cm× 3 cm, and the presence of the hepatic capsular invasion, and microvascular tumor thrombus, and the tumor thrombus in common bile duct was HCC. The patient recovered smoothly without complications such as bile leakage, abdominal infection or liver failure. The patient was discharged from hospital on postoperative day 7. During the 14-month follow-up, the patient had a good quality of life, with no evidence of recurrence. 
Conclusion: For HCC type B4 BDTT, “q-type” biliary thrombectomy is a safe and effective procedure and it also adheres to the tumor-free operation principle. So, it is recommended to be applied in clinical practice.