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
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.