title: Mesohepatectomy with total caudate lobectomy of the liver for hepatocellular carcinoma.
abstract: BACKGROUND
  Mesohepatectomy with total resection of the caudate lobe and extrahepatic bile duct is sometimes performed for hilar cholangiocarcinoma or gallbladder carcinoma; however, only a few reports on mesohepatectomy with total caudate lobectomy of the liver for hepatocellular carcinoma are available.
  
  
  METHODS
  A 71-year-old woman was preoperatively diagnosed with hepatocellular carcinoma in the central bisections (Couinaud's segments 4, 5, and 8) and the paracaval portion of the caudate lobe. Mesohepatectomy with total caudate lobectomy of the liver permitted the removal of tumors to provide a cancer-free raw surface of the liver. Mobilization of the caudate lobe is an important procedure in this surgery. Before the liver parenchyma was dissected, all short hepatic veins were ligated and divided from the left to the right side as the left lateral section was retracted to the right, and the caudate lobe branches of the portal vein and hepatic artery were ligated and divided. After the liver parenchymal dissection, both between the left lateral and medial sections and between the right anterior and posterior sections, the Glissonean branches of the caudate lobe were ligated and divided as the central bisections were anteriorly retracted. Finally, liver parenchymal dissection was performed between the caudate lobe and the right posterior section, which was along the right side of the inferior vena cava.
  
  
  RESULTS
  The surgery time was 538 minutes and blood loss was 1,207 mL. No blood transfusions were required during or after surgery. The postoperative course was uncomplicated. The patient is still alive 25 months after hepatectomy.
  
  
  CONCLUSIONS
  Although mesohepatectomy with total caudate lobectomy of the liver is technically more difficult than mesohepatectomy of the liver because the caudate lobe must be completely detached from the inferior vena cava and the hilar plate, it is a safe and effective treatment method in selected patients with hepatocellular carcinoma located at both the central bisections and the paracaval portion of the caudate lobe.
authors.affiliation: Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto 629-2261, Japan. ishii0512h@yahoo.co.jp
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ishii
authors.forename: Shinpei
authors.initials: S
authors.lastname: Ogino
authors.forename: Koki
authors.initials: K
authors.lastname: Ikemoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Toma
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakamura
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Itoh
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ochiai
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D014057:Tomography, X-Ray Computed
references.citation: J Hepatobiliary Pancreat Sci. 2012 May;19(3):195-202
references.pmid: 22076670
references.citation: World J Gastroenterol. 2003 Oct;9(10):2169-73
references.pmid: 14562371
references.citation: J Laparoendosc Adv Surg Tech A. 2009 Oct;19(5):653-6
references.pmid: 19645604
references.citation: Ann Surg. 2011 Jun;253(6):1102-10
references.pmid: 21412143
references.citation: Hepatogastroenterology. 1998 Jan-Feb;45(19):7-13
references.pmid: 9496478
references.citation: Surg Endosc. 2011 Jun;25(6):2020-2
references.pmid: 21136102
references.citation: J Am Coll Surg. 1994 Jul;179(1):72-5
references.pmid: 8019729
references.citation: Presse Med (1893). 1954 May 5;62(33):709-12
references.pmid: 13177441
references.citation: Br J Surg. 2008 Aug;95(8):990-5
references.pmid: 18574845
references.citation: World J Surg. 1989 Nov-Dec;13(6):786-90
references.pmid: 2560286
references.citation: Am J Surg. 2000 May;179(5):356-60
references.pmid: 10930479
references.citation: J Am Coll Surg. 2008 Oct;207(4):499-509
references.pmid: 18926451
references.citation: Surg Gynecol Obstet. 1987 Feb;164(2):155-8
references.pmid: 3810429
references.citation: J Hepatobiliary Pancreat Sci. 2012 Jan;19(1):3-8
references.pmid: 21938411
references.citation: J Hepatobiliary Pancreat Sci. 2012 Jan;19(1):44-7
references.pmid: 21947576
references.citation: World J Gastroenterol. 2006 Feb 14;12(6):935-9
references.pmid: 16521223
references.citation: J Hepatobiliary Pancreat Surg. 2005;12(5):351-5
references.pmid: 16258801
references.citation: World J Surg. 2009 Sep;33(9):1922-6
references.pmid: 19582505
references.citation: Langenbecks Arch Surg. 2006 Jun;391(3):209-15
references.pmid: 16565854
references.citation: Ann Surg. 2001 Jan;233(1):45-50
references.pmid: 11141224
references.citation: Surgery. 2007 Apr;141(4):533-7
references.pmid: 17383531
references.citation: Hepatogastroenterology. 2003 Sep-Oct;50(53):1327-9
references.pmid: 14571728
references.citation: J Am Coll Surg. 1999 May;188(5):508-15
references.pmid: 10235579
references.citation: Dig Surg. 2011;28(3):198-204
references.pmid: 21540607
references.citation: Surg Oncol. 2007 Aug;16(2):99-106
references.pmid: 17583496
references.citation: Dig Surg. 1998;15(3):218-23
references.pmid: 9845588
references.citation: J Laparoendosc Adv Surg Tech A. 2007 Feb;17(1):36-8
references.pmid: 17362176