Algorithm for Resecting Hepatocellular Carcinoma in the Caudate Lobe

Published on Jun 1, 2021in Annals of Surgery12.969
· DOI :10.1097/SLA.0000000000003384
Tadatoshi Takayama92
Estimated H-index: 92
(Nihon University),
Yutaka Midorikawa31
Estimated H-index: 31
(Nihon University)
+ 7 AuthorsMasatoshi Makuuchi135
Estimated H-index: 135
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). Partial resection was prioritized to remove Spiegel or process HCC, while total resection was aimed to remove caval HCC depending on liver function. RESULTS: According to the algorithm, we performed total (n = 43) or partial (n = 158) resections of the caudate lobe for HCC in 174 of 201 patients (compliance rate, 86.6%), with a median blood loss of 400 (10-4530) mL. Postoperative morbidity (Clavien grade ≥III b) and mortality rates were 3.0% and 0%, respectively. After a median follow-up of 2.6 years (range, 0.5-14.3), the 5-year overall and recurrence-free survival rates were 57.3% and 15.3%, respectively. Total and partial resection showed no significant difference in overall survival (71.2% vs 54.0% at 5 yr; P = 0.213), but a significant factor in survival was surgical margin (58.0% vs 45.6%, P = 0.034). The major determinant for survival was vascular invasion (hazard ratio 1.7, 95% CI 1.0-3.1, P = 0.026). CONCLUSIONS: Our algorithm-oriented strategy is appropriate for the resection of HCC originating in the caudate lobe because of the acceptable surgical safety and curability.
#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...
#1Yun Jin (ZJU: Zhejiang University)H-Index: 5
#2Liang Wang (ZJU: Zhejiang University)H-Index: 2
Last. Jiang-tao Li (ZJU: Zhejiang University)H-Index: 9
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AIM: To establish the surgical flow for anatomic isolated caudate lobe resection. METHODS: The study was approved by the ethics committee of the Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU). From April 2004 to July 2014, 20 patients were enrolled who underwent anatomic isolated caudate lobectomy at SAHZU. Clinical and postoperative pathological data were analyzed. RESULTS: Of the total 20 cases, 4 received isolated complete caudate lobectomy (20%) and 16 received iso...
#1Mohammad Abu HilalH-Index: 22
#2Luca AldrighettiH-Index: 61
Last. Daniel CherquiH-Index: 85
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Objective:The European Guidelines Meeting on Laparoscopic Liver Surgery was held in Southampton on February 10 and 11, 2017 with the aim of presenting and validating clinical practice guidelines for laparoscopic liver surgery.Background:The exponential growth of laparoscopic liver surgery in recent
#1Guido Torzilli (Humanitas University)H-Index: 56
#2Fabio ProcopioH-Index: 17
Last. Daniele Del FabbroH-Index: 21
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OBJECTIVE: This prospective intention-to-treat validation study evaluated the liver tunnel (LT) technique for patients having ≥1 deep centrally located liver tumor, with or without middle hepatic vein (MHV) invasion. BACKGROUND: Conservative surgery has been proposed for patients with deep liver tumors having complex relationships. LT is one such novel technique. METHODS: Eligible patients were prospectively enrolled for LT. LT relies on tumor-vessel detachment, and the presence of communicating...
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...
#1Tadatoshi Takayama (Nihon University)H-Index: 92
#2Masatoshi MakuuchiH-Index: 135
Last. Kimitaka Kogure (Gunma University)H-Index: 14
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#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: 59
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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.
#1Masatoshi Kudo (Kindai University)H-Index: 119
#2N. Izumi (Kindai University)H-Index: 3
Last. Yutaka Matsuyama (Kindai University)H-Index: 58
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The 19th Nationwide Follow-up Survey of Primary Liver Cancer in Japan comprised 20 850 primary liver cancer patients newly registered at 482 medical institutions over a period of 2 years (from 1 January 2006 to 31 December 2007). Of these, 94.7% had hepatocellular carcinoma (HCC) and 4.4% had intrahepatic cholangiocarcinoma (ICC). In addition, follow-up data were obtained regarding 34 752 patients who were registered in the previous survey. Epidemiological and clinicopathological factors, diagno...
#1Junichi Shindoh (UTokyo: University of Tokyo)H-Index: 30
#2Masatoshi MakuuchiH-Index: 135
Last. Norihiro Kokudo (UTokyo: University of Tokyo)H-Index: 100
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Background & Aims Anatomic resection (AR) of the tumor-bearing portal territory has been reported to be associated with a decreased recurrence of hepatocellular carcinoma (HCC). However, because of the heterogeneity of the study populations, its oncologic advantage remains controversial. The objective of the present study was to determine the clinical advantage of AR for primary HCC, based on the data from a large prospective cohort treated under a constant surgical policy. Methods In 209 Child-...
#1Yoshihiro Mise (University of Texas MD Anderson Cancer Center)H-Index: 25
#2Thomas A. AloiaH-Index: 65
Last. Claudius ConradH-Index: 50
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To investigate prognostic impact of parenchymal-sparing hepatectomy (PSH) for solitary small colorectal liver metastasis (CLM).It is unclear whether PSH confers an oncologic benefit through increased salvageability or is a detriment through increasing recurrence rate.Database of 300 CLM patients with a solitary tumor (≤ 30 mm in size) was reviewed from 1993 to 2013. A total of 156 patients underwent PSH and 144 patients underwent right hepatectomy, left hepatectomy, or left lateral sectionectomy...
Cited By9
#1Wenxuan Xie (SYSU: Sun Yat-sen University)
#2Jiehui Tan (SYSU: Sun Yat-sen University)
Last. Xuezhen Zeng (SYSU: Sun Yat-sen University)
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We aimed to compare the efficacy of hepatic resection and percutaneous ablation for resectable caudate HCC within Milan criteria and to investigate the prognostic factors. Between August 2006 and August 2020, a total of 67 eligible patients with resectable caudate HCC within Milan criteria in three centers were retrospectively analyzed and divided into hepatic resection group (n = 46) and percutaneous ablation group (n = 21). Recurrence-free survival (RFS) and overall survival (OS) rates were co...
#1Masaharu Kogure (Kyorin University)H-Index: 6
#2Yutaka Suzuki (Kyorin University)H-Index: 14
Last. Yoshihiro Sakamoto (Kyorin University)H-Index: 65
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PURPOSE Resection of liver cancer involving the paracaval portion (PC) of the caudate lobe is challenging because the PC is located deepest in the liver. This study aimed to elucidate the utility of two parenchymal-sparing approaches of limited resection and central hepatectomy for resecting tumors located in the PC. METHODS In 2018 and 2020, 12 out of 143 patients underwent hepatectomy for tumors located in the PC of the liver. In six patients, limited resection (LR) of the PC after full mobili...
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