Isolated caudate lobe resection for hepatic tumor: surgical approaches and perioperative outcomes

Published on Sep 1, 2010in American Journal of Surgery2.565
· DOI :10.1016/J.AMJSURG.2009.10.018
Yi Wang1
Estimated H-index: 1
,
Lei Y. Zhang1
Estimated H-index: 1
+ 2 AuthorsTian G. Wei1
Estimated H-index: 1
Sources
Abstract
Abstract Background Caudate lobe of the liver is relatively inaccessible because of its deep location and lying between the major vascular structures. Therefore, isolated caudate lobe resection (ICLR) is a much challengeable operation. Methods Review of prospectively collected data from patients who underwent ICLR for hepatic tumor. Results Forty-six patients (mean age 46.8 years) underwent ICLR for malignant (39 cases) and benign (7 cases) hepatic tumors. ICLRs were performed by 3 different approaches and in different ways of hepatic vascular control: without any vascular control in 7 patients, under Pringle maneuver in 26 patients, and under sequential inflow and outflow vascular occlusion in 13 patients. There were no perioperative deaths, and the postoperative complication rate was 8.7% (4/46). The mean operative time was 174.5 ± 44.3 minutes and the mean estimated intraoperative blood loss was 504.4 ± 356.2 mL. Conclusions ICLR is a technically demanding but safe procedure. Choice of surgical approaches and ways of hepatic vascular control should be based on tumor location and surgeons'experience.
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#2Jin Wook Chung (Seoul National University Hospital)H-Index: 73
Last. Jae Hyung Park (Seoul National University Hospital)H-Index: 31
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#1Henry Lik-Yuen Chan (CUHK: The Chinese University of Hong Kong)H-Index: 9
Purpose We aimed to investigate the impact of hepatitis B virus (HBV) DNA and HBV genotypes/subgenotypes on the risk of hepatocellular carcinoma (HCC). Patients and Methods A prospective cohort of patients infected with chronic HBV in a surveillance program for HCC since 1997 was studied. Ultrasound and alpha-fetoprotein evaluation were regularly performed to detect HCC. Risk factors for HCC and the relationship between HBV DNA and HBV genotypes were determined. Results Among 1,006 patients with...
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A A r esection of the caudate lobe (segments I, IX, or both) f the liver often presents a technical challenge, even to ccomplished hepatic surgeons. It is an autonomous segent of the liver that is surgically difficult to approach ecause of its location deep in the hepatic parenchyma eneath the confluence of the main hepatic (left and iddle) veins and between the porta hepatis, the ligaentum venosum, and the inferior vena cava (IVC). The caudate lobe is generally divided into three reions: the le...
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To resect a small liver tumor located in the paracaval portion, we adopted transhepatic enucleation, i.e. enucleation of the tumor from the transected plane along the main portal fissure. In contrast
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#1Shinji Tanaka (Kyushu University)H-Index: 70
#2Mitsuo Shimada (Kyushu University)H-Index: 91
Last. Yoshihiko Maehara (Kyushu University)H-Index: 108
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Abstract Background Hepatocellular carcinoma (HCC) originating in the caudate lobe is rare, and the treatment for this type of carcinoma is difficult because of its unique anatomic location. Methods This retrospective study assessed the surgical outcome of patients with caudate lobe HCC. There were 20 cases of HCC originating in the caudate lobe among 435 patients with primary HCC who underwent hepatic resection in our department from 1990 to 2002. The caudate tumors were located in the Spiegel ...
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PURPOSE To evaluate the effectiveness of radiofrequency (RF) ablation for liver tumors located in the caudate lobe. MATERIALS AND METHODS Ten patients (46–79 years of age; median, 70 y), eight with hepatocellular carcinoma (HCC) and cirrhosis and two with colorectal metastases in the caudate lobe, were treated with 5.8% NaCl tissue-perfused monopolar ( n = 7) or bipolar ( n = 3) RF ablation. The median tumor diameter was 41 mm (range, 25–70 mm). Procedures were performed under ultrasound and com...
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#1William G. Hawkins (WashU: Washington University in St. Louis)H-Index: 63
#2Ronald P. DeMatteo (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 129
Last. Leslie H. Blumgart (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 123
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Background Resection of the caudate lobe of the liver is technically demanding, with the disparate goals of preserving major vascular and biliary structures without compromising tumor clearance. Our objective was to assess our results with resection of the caudate lobe of the liver for malignant disease. Study design From 1992 to 2004, we performed caudate resection for malignancy in 150 patients. Clinicopathologic correlates, surgical methods, patterns of recurrence, and survival were analyzed....
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#1Hideo Yamamoto (Nagoya University)H-Index: 11
#2Masato Nagino (Nagoya University)H-Index: 93
Last. Yuji Nimura (Nagoya University)H-Index: 33
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Background Hepatic neoplasms in the paracaval portion of the caudate lobe (S1r) are usually difficult to treat surgically because such neoplasms often invade the hepatic veins and/or inferior vena cava (IVC). We reevaluated resected cases of colorectal liver metastases involving S1r to confirm the significance of aggressive surgical treatments. Methods Between July 1977 and December 2002, 95 consecutive patients with colorectal liver metastases underwent hepatic resection. Seven patients with li...
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#1Satoshi Kondo (Hokkaido University)H-Index: 65
#2Hiroyuki Katoh (Hokkaido University)H-Index: 52
Last. Toshiaki Morikawa (Hokkaido University)H-Index: 27
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Background The caudate lobe of the liver is divided into three subsegments based on the portal blood supply: the Spiegel lobe, the paracaval portion (S1r), and the caudate process. An isolated paracaval (S1r) subsegmentectomy is indicated for a small hepatocellular carcinoma localized within S1r. Because this challenging procedure has not been described, we report the details of successful surgical technique.
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#2Florencia G. Que (Mayo Clinic)H-Index: 52
Last. David M. Nagorney (Mayo Clinic)H-Index: 116
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Abstract Background. Isolated caudate lobe resection is a complex surgical procedure that requires technical expertise and knowledge of the surgical anatomy. Methods. All consecutive patients who were operated on for isolated caudate lobe resections by the senior author were studied. En bloc resections with adjacent hepatic parenchyma (as part of extended hepatectomies) or partial resections of the caudate lobe were excluded. Follow-up was completed by outpatient evaluation and mail corresponden...
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#1Tian-Ge Sun (Third Military Medical University)H-Index: 1
#2Xiaojun Wang (Third Military Medical University)H-Index: 5
Last. Shu-guo Zheng (Third Military Medical University)H-Index: 16
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BACKGROUND The paracaval portion of the caudate lobe is located in the core of the liver. Lesions originating in the paracaval portion often cling to or even invade major hepatic vascular structures. The traditional open anterior hepatic transection approach has been adopted to treat paracaval-originating lesions. With the development of laparoscopic surgery, paracaval-originating lesions are no longer an absolute contraindication for laparoscopic liver resection. This study aimed to evaluate th...
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#1Andrea Ruzzenente (University of Verona)H-Index: 34
#2Andrea Ciangherotti (University of Verona)H-Index: 2
Last. Alfredo Guglielmi (University of Verona)H-Index: 48
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Background Although isolated caudate lobe (CL) liver resection is not a contraindication for minimally invasive liver surgery (MILS), feasibility and safety of the procedure are still poorly investigated. To address this gap, we evaluate data on the Italian prospective maintained database on laparoscopic liver surgery (IgoMILS) and compare outcomes between MILS and open group. Methods Perioperative data of patients with malignancies, as colorectal liver metastases (CRLM), hepatocellular carcinom...
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#1Heithem JeddouH-Index: 3
#2Stylianos TzedakisH-Index: 1
Last. Karim BoudjemaH-Index: 56
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Background As defined by Couinaud et al. and Takasaki et al., the dorsal sector (DS) or caudate area is the portion of liver parenchyma located between the retrohepatic inferior vena cava (IVC) and the main hepatic veins confluence.1,2 Its complete resection, usually approached by right- or left-sided liver parenchymotomy, remains technically challenging.3,4 Moreover, these approaches usually fail to properly expose the middle (paracaval portion) and most cranial portion (i.e. behind the hepatic...
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#1Shinya Hayami (Wakayama Medical University)H-Index: 59
#2Masaki Ueno (Wakayama Medical University)H-Index: 27
Last. Hiroki Yamaue (Wakayama Medical University)H-Index: 69
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INTRODUCTION: Surgical techniques for Spiegel lobectomy remain technically difficult because of its deep anatomical location. Laparoscopic Spiegel lobectomy has not yet been standardized or widely reported. In the current study, we introduce technical improvements, including the liver hanging maneuver, to laparoscopic Spiegel lobectomy. Additionally, we demonstrate the safety and feasibility of this procedure. MATERIALS AND SURGICAL TECHNIQUE: We performed consecutive laparoscopic Spiegel lobect...
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#1Ji-Xiong Hu (CSU: Central South University)H-Index: 7
#2Wei-Dong Dai (CSU: Central South University)H-Index: 6
Last. Tenglong Tang (CSU: Central South University)
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The caudate lobe lies between major vascular structures: the inferior vena cava posteriorly and the portal triad inferiorly and the right and the middle and left hepatic veins at the upper part [1]. Couinaud’s definition of the caudate lobe is based on morphological segmentation but not on portal perfusion. Thus, Kumon’s definition of the caudate lobe was widely accepted and applied, in which the caudate lobe was divided into three parts: the Spiegel lobe, paracaval portion, and caudate process ...
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#1Tokio Higaki (Nihon University)H-Index: 12
#2Tadatoshi Takayama (Nihon University)H-Index: 92
Last. Yutaka Midorikawa (Nihon University)H-Index: 31
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Abstract Background Resection of hepatocellular carcinoma located in the caudate lobe is challenging because this anatomical location is difficult to approach, especially the caval portion. Methods We performed resection of the caval portion of the caudate lobe using a ventral approach combined with the resection of segment IV, VII, or VIII for hepatocellular carcinoma in 41 patients (extended segmentectomy group). As a control group, 138 patients with hepatocellular carcinoma who underwent segm...
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#4Hui Liu ('SMMU': Second Military Medical University)H-Index: 26
Background Complete caudate lobectomy using the anterior hepatic parenchymal transection approach is a proper but technically demanding operation for tumors situated in or involving the paracaval portion of the caudate lobe. This study was intended to share our experience on this operation.
Source
#1Tan To Cheung (HKU: University of Hong Kong)H-Index: 37
#2Wai Key Yuen (HKU: University of Hong Kong)H-Index: 23
Last. Chung Mau Lo (HKU: University of Hong Kong)H-Index: 110
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Background One of the best treatments for isolated hepatocellular carcinoma in the caudate lobe is major hepatectomy with caudate lobectomy, but it is not suitable for patients with poor liver function reserve. Isolated caudate lobectomy, which is a very difficult operation, is thus an alternative option. Methods Here we report an isolated caudate lobectomy with an anterior approach in the treatment of a large hepatocellular carcinoma with underlying cirrhosis, with focus on the technical aspect...
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#1Wei-Dong Dai (CSU: Central South University)H-Index: 6
: Isolated caudate lobectomy for huge hepatocellular carcinoma (HCC) (10 cm or greater in diameter) is a technically demanding surgical procedure that entails the surgeon's experience and precise anatomical knowledge of the liver. We describe our clinical experiences and evaluate the results of partial or total isolated caudate lobectomy for HCC larger than 10 cm in the caudate lobe. En bloc excisions combined with adjacent hepatic parenchyma (as part of extended hepatectomies) were excluded. Tw...
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#1Jia-Hua Yang (SHU: Shanghai University)H-Index: 11
#2Jun Gu (SJTU: Shanghai Jiao Tong University)H-Index: 26
Last. Yingbin Liu (SJTU: Shanghai Jiao Tong University)H-Index: 36
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Background: How to resect the caudate lobe safely is a major challenge to current liver surgery which requires further study. Methods: Nine cases (6 hepatic cell carcinoma, 2 cavernous hemangioma and 1 intrahepatic cholangiocacinoma) were performed using the anterior transhepatic approach in the isolated complete caudate lobe resection. During the operation, we used the following techniques: the intraoperative routine use of Peng’s multifunction operative dissector (PMOD), inflow and outflow of ...
Source
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