Isolated paracaval subsegmentectomy of the caudate lobe of the liver.
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.


METHODS
The portal pedicle isolation technique provides easy access to the S1r portal pedicle. A tape is passed along the midline of the anterior surface of the vena cava and its lower end is passed through the caudate parenchyma dorsoventrally to establish a landmark for the left border of S1r. A liver-splitting anterior approach is used to open the interlobar plane widely to the precaval tape. As exposing the vena cava and the root of the right hepatic vein, parenchymal dissection is advanced to the right and then, upward.


RESULTS
The procedure was performed successfully in a 51-year-old man with hepatitis B who had a 2-cm hepatocellular carcinoma in S1r. Blood loss was 645 ml.


CONCLUSIONS
An isolated paracaval subsegmentectomy of the caudate lobe can be performed successfully, although it is likely to remain an uncommonly used procedure.
Kondo
Satoshi
S
Department of Surgical Oncology, Division of Cancer Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, 060-8638 Sapporo, Japan. kondows@med.hokudai.ac.jp
Katoh
Hiroyuki
H
Hirano
Satoshi
S
Ambo
Yoshiyasu
Y
Tanaka
Eiichi
E
Okushiba
Shunichi
S
Morikawa
Toshiaki
T
D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged