title: Anterior hepatic parenchymal transection for complete caudate lobectomy to treat liver cancer situated in or involving the paracaval portion of the caudate lobe.
abstract: BACKGROUND
  Complete caudate lobectomy using the anterior hepatic parenchymal transection approach is a proper but technically demanding operation for tumors situated in or involving the paracaval portion of the caudate lobe. This study was intended to share our experience on this operation.
  
  
  METHODS
  Forty-nine consecutive patients who received complete caudate lobectomy using the anterior hepatic parenchymal transection approach were studied. The clinicopathologic and perioperative data, complications, and survival were analyzed.
  
  
  RESULTS
  Of the 49 patients, 15 (30.6 %) received isolated complete caudate lobectomy and 34 (69.4 %) received complete caudate lobectomy associated with segmentectomy IV. The median tumor size was 7.3 cm (2.4-18.0 cm), the operating time was 200 min (120-370 min), and the operative blood loss was 700 ml (200-3000 ml). The postoperative complication rate was 36.7 %. There was no perioperative death. Patients in the associated complete caudate lobectomy group had larger tumors (P<0.001), higher platelet counts (P=0.033), shorter operation time (P=0.004), and less patients with residual tumor (P=0.03) than those in the isolated complete caudate lobectomy group. There were no significant differences in cirrhosis, surgical resection margin, blood loss, postoperative complications, and prognosis between the two groups.
  
  
  CONCLUSIONS
  Complete caudate lobectomy using the anterior hepatic parenchymal transection approach was technically feasible and safe for patients with tumors situated in or involving the paracaval portion of the caudate lobe. Associated resection of segment IV can be used to facilitate the surgery and decrease the chance of local residual tumor.
authors.affiliation: The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Shanghai, 200438, China.
authors.forename: Zhen-Guang
authors.initials: ZG
authors.lastname: Wang
authors.forename: WanYee
authors.initials: W
authors.lastname: Lau
authors.forename: Si-Yuan
authors.initials: SY
authors.lastname: Fu
authors.forename: Hui
authors.initials: H
authors.lastname: Liu
authors.forename: Ze-Ya
authors.initials: ZY
authors.lastname: Pan
authors.forename: Yuan
authors.initials: Y
authors.lastname: Yang
authors.forename: Jin
authors.initials: J
authors.lastname: Zhang
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
authors.forename: Wei-Ping
authors.initials: WP
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D061646:Operative Time; D011183:Postoperative Complications; D011379:Prognosis