Ventral approach for resecting hepatocellular carcinoma in the caval portion of the caudate lobe.

Published on Jun 1, 2018in Surgery3.356
· DOI :10.1016/J.SURG.2018.01.002
Tokio Higaki11
Estimated H-index: 11
(Nihon University),
Tadatoshi Takayama90
Estimated H-index: 90
(Nihon University),
Yutaka Midorikawa30
Estimated H-index: 30
(Nihon University)
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 segmentectomy for IV, VII, or VIII (segmentectomy group) were studied. We compared surgical outcomes, including postoperative morbidity and survival, between the 2 groups. Results When compared with the segmentectomy group, platelet count was lower (12.8 × 10 4 /µL [range, 2.4–33.8] vs 14.8 × 10 4 /µL [3.2–41.4], P  = .085), operation time was significantly longer (442 minutes [range, 184–710] vs 333 minutes [131–810], P P  = .001), and the percentage of patients with cirrhosis was greater (19 [46.3%] vs 41 [29.7%], P  = .059) in the extended segmentectomy group. However, the morbidity rate (48.7% and 33.3%, P  = .096) and median overall survival period (5.2 years; [95% confidence interval, 4.6–6.6] vs 6.2 years, [5.4–9.7], P  = .203) were not significantly different between the 2 groups. Conclusion The ventral approach for the resection of hepatocellular carcinoma in the caval portion of the caudate lobe is a viable alternative to other approaches, especially in patients with insufficient liver function.
The definition and extent of the human caudate lobe in the liver is unclear, and thus, the anatomy of the caudate lobe was studied using 23 corrosion liver casts, with special reference to the portal venous and biliary branches. These branches and their ramification type in the caudate lobe showed that this lobe includes: (1) the Spiegel lobe; (2) the paracaval portion; and (3) the caudate process portion. The three portions often have their own independent branches; for example, the portal veno...
36 CitationsSource
#1Tadatoshi Takayama (Nihon University)H-Index: 90
#2Masatoshi MakuuchiH-Index: 134
Last. Kimitaka Kogure (Gunma University)H-Index: 14
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3 CitationsSource
#1Takahiro Kajiwara (Nihon University)H-Index: 3
#2Yutaka Midorikawa (Nihon University)H-Index: 30
Last. Tadatoshi Takayama (Nihon University)H-Index: 90
view all 8 authors...
Background In liver resection, bile leakage remains the most common cause of operative morbidity. In order to predict the risk of this complication on the basis of various factors, we developed a clinical score system to predict the potential risk of bile leakage after liver resection.
14 CitationsSource
#1Toshiya Ochiai (Kyoto Prefectural University of Medicine)H-Index: 25
#2Hiromichi Ishii (Kyoto Prefectural University of Medicine)H-Index: 7
Last. Eigo Otsuji (Kyoto Prefectural University of Medicine)H-Index: 57
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Background Isolated anatomic total caudate lobectomy is indicated in patients who have liver tumors limited to the caudate lobe. However, isolated caudate lobe resection is a challenging surgical procedure that required safe and reliable techniques. All portal and hepatic veins that connect this area originate from the first branch of the portal vein or vena cava; therefore, the operator must be cautious of the potential for massive bleeding.
8 CitationsSource
#4Hui Liu ('SMMU': Second Military Medical University)H-Index: 8
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.
8 CitationsSource
#1Yanming Zhou (Ha Tai: Xiamen University)H-Index: 22
#2Xiaofeng Zhang ('SMMU': Second Military Medical University)H-Index: 16
Last. Bin Li (Ha Tai: Xiamen University)H-Index: 20
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Background Caudate resection for hepatocellular carcinoma (HCC) remains a challenging procedure. This study aimed to assess the surgical outcomes of HCC originating from caudate lobe. Methods Twenty-three patients with HCC in the caudate lobe who received surgical treatment were retrospectively reviewed. Results Surgical procedures included 13 isolated caudatectomy (56.5%) and 10 combined caudatectomy (43.5%). Eight patients (34.7%) experienced post-operative complications. Mortality was nil. Th...
3 CitationsSource
#1Shintaro Yamazaki (Nihon University)H-Index: 16
#2Tadatoshi Takayama (Nihon University)H-Index: 90
Last. Tokio Higaki (Nihon University)H-Index: 11
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Background: Abdominal drains have been placed prophylactically and removed in liver resection without robust evidence. The present study was designed to establish the optimal time for removal of such drains. Methods: Data on abdominal prophylactic drains were analysed in a consecutive series of patients who underwent liver resection for malignancy between 2006 and 2009. Bilirubin levels in drain fluid were measured and bacteriological cultures were taken on days 1, 3, 5 and 7 after surgery. Drai...
48 CitationsSource
#1Yoshihiro SakamotoH-Index: 63
#2Satoshi NaraH-Index: 17
Last. Tomoo KosugeH-Index: 86
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Background Operative and nonoperative treatment for hepatocellular carcinoma (HCC) originating in the caudate lobe is regarded as challenging because of its deep location in the liver and possibly worse prognosis than HCC in other sites in the liver. The objective of this study is to investigate the clinicopathologic factors and survival of patients who underwent hepatectomy for solitary HCC originating in the caudate lobe. Methods A retrospective review of 783 patients who underwent curative he...
32 CitationsSource
#1Yi WangH-Index: 1
#2Lei Y. ZhangH-Index: 1
Last. Tian G. WeiH-Index: 1
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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 app...
14 CitationsSource
#1Peng LiuH-Index: 2
#2Jiamei Yang ('SMMU': Second Military Medical University)H-Index: 23
Last. Yanming ZhouH-Index: 22
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AIM: To evaluate the short- and long-term outcomes of liver resection for caudate lobe hepatocellular carcinoma (HCC). METHODS: We retrospectively analyzed 114 consecutive patients with HCC, originating from the caudate lobe, who underwent resection between January 2001 and January 2007. Univariate and multivariate analyses were performed on several clinicopathologic variables to determine the factors affecting long-term outcome and intrahepatic recurrence. RESULTS: Overall mortality and morbidi...
28 CitationsSource
Cited By3
#1Tadatoshi Takayama (Nihon University)H-Index: 90
#2Yutaka Midorikawa (Nihon University)H-Index: 30
Last. Masatoshi MakuuchiH-Index: 134
view all 10 authors...
OBJECTIVE: To propose an algorithm for resecting hepatocellular carcinoma (HCC) in the caudate lobe. BACKGROUND: Owing to a deep location, resection of HCC originating in the caudate lobe is challenging, but a plausible guideline enabling safe, curable resection remains unknown. METHODS: We developed an algorithm based on sublocation or size of the tumor and liver function to guide the optimal procedure for resecting HCC in the caudate lobe, consisting of 3 portions (Spiegel, process, and caval)...
9 CitationsSource
#1Xin-Feng Zhou (CAS: Chinese Academy of Sciences)H-Index: 1
#2Qing Xia (CAS: Chinese Academy of Sciences)H-Index: 1
Last. Shu-Jie Xie (CAS: Chinese Academy of Sciences)H-Index: 1
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Our aims were to compare the therapeutic efficacy of surgical resection of caudate lobe hepatocellular carcinoma and noncaudal lobe hepatocellular carcinoma in the Chinese population. The study group consisted of 220 patients undergoing caudate lobe hepatectomy during the period spanning from January 2003 to November 2017, and 220 patients with caudate lobe hepatectomy were selected as the control group. There were 142 cases (64.5%) of surgical margin of R0 in patients with caudate lobe liver ca...
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