Anterior approach for complete isolated caudate lobectomy.
OBJECTIVE
Complete isolated caudate lobectomy is a technique-demanding procedure that entails the surgeon's judgement and precise knowledge of liver anatomy.


METHODS
All consecutive patients who underwent complete isolated caudate lobectomy were studied. En bloc excisions combined with adjacent hepatic parenchyma (as part of extended hepatectomies) or wedge excisions of the caudate lobe were excluded. All patients were followed-up to date.


RESULTS
Thirteen patients met the inclusion criteria (9 male, 4 female). Mean age (+/-SD) was 47 (+/-9) years. Primary diagnoses included hepatocellular carcinoma, hemangioma and adenoma. Margins were negative in all but two patients. Intraoperative US showed no tumor embolus within the main hepatic veins. Mean (+/-SD) operative time was 245 (+/-45) minutes, and estimated blood loss was 680 (+/-210) mL. Median blood transfusion was 420mL (range, 0 approximately 2500mL). Complications included bile leak in one patient, ascites in 2. Median length of hospitalization was 13 days (range, 11-21). There was no perioperative mortality.


CONCLUSIONS
Complete isolated resection of the caudate lobe using the anterior approach should be the first choice for treatment of a tumor located in the caudate lobe alone, although the procedure is extremely difficult and highly dangerous.
Hu
Ji-Xiong
JX
Department of General Surgery, The Second Affiliated Hospital, XiangYa Medical College, Central South University, Changsha, P R China. hujixiong@medmail.com.cn
Miao
Xiong-Ying
XY
Zhong
De-Wu
DW
Dai
Wei-Dong
WD
Liu
Wei
W
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome