title: Management of hepatocellular carcinoma rupture in the caudate lobe.
abstract: OBJECTIVE
  To demonstrate that caudate lobectomy is a valid treatment in cases of hepatocellular carcinoma (HCC) rupture in the caudate lobe based on our experience with the largest case series reported to date.
  
  
  METHODS
  A retrospective study of eight patients presenting with spontaneous rupture and hemorrhage of HCC in the caudate lobe was conducted. Two patients underwent ineffective transarterial embolization preoperatively. Caudate lobectomy was performed in all eight patients. Bilateral approach was taken in seven cases for isolated complete caudate lobectomy. Left-sided approach was employed in one case for isolated partial caudate lobectomy. Transarterial chemoembolization was performed postoperatively in all patients.
  
  
  RESULTS
  Caudate lobectomy was successfully completed in all eight cases. The median time delay from the diagnosis to operation was 5 d (range: 0.25-9). Median operating time was 200 min (range: 120-310) with a median blood loss of 900 mL (range: 300-1500). Five patient remained in long-term follow-up, with one patient becoming lost to follow-up at 3 years and two patients currently alive at 7 and 19 mo. One patient required reoperation due to recurrence. Gamma knife intervention was performed for brain metastasis in another case. Two patients survived for 10 and 84 mo postoperatively, ultimately succumbing to multiple organ metastases.
  
  
  CONCLUSIONS
  Caudate lobectomy is the salvage choice for HCC rupture in the caudate lobe. Local anatomy and physiologic features of the disease render caudate lobectomy a technically difficult operation. Postponement of surgical intervention is thus recommended while the rupture remains hemodynamically stable until an experienced surgeon becomes available. Prognosis is confounded by numerous factors, but long-term survival can be expected in the majority of cases.
authors.affiliation: De-Fei Hong, Shu-You Peng, Zhi-Fei Wang, Jian Cheng, Guo-Liang Shen, Yuan-Biao Zhang, Department of Hepatobiliary, Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: De-Fei
authors.initials: DF
authors.lastname: Hong
authors.affiliation: De-Fei Hong, Shu-You Peng, Zhi-Fei Wang, Jian Cheng, Guo-Liang Shen, Yuan-Biao Zhang, Department of Hepatobiliary, Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Ying-Bin
authors.initials: YB
authors.lastname: Liu
authors.affiliation: De-Fei Hong, Shu-You Peng, Zhi-Fei Wang, Jian Cheng, Guo-Liang Shen, Yuan-Biao Zhang, Department of Hepatobiliary, Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Shu-You
authors.initials: SY
authors.lastname: Peng
authors.affiliation: De-Fei Hong, Shu-You Peng, Zhi-Fei Wang, Jian Cheng, Guo-Liang Shen, Yuan-Biao Zhang, Department of Hepatobiliary, Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Jin-Zhong
authors.initials: JZ
authors.lastname: Pang
authors.affiliation: De-Fei Hong, Shu-You Peng, Zhi-Fei Wang, Jian Cheng, Guo-Liang Shen, Yuan-Biao Zhang, Department of Hepatobiliary, Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Zhi-Fei
authors.initials: ZF
authors.lastname: Wang
authors.affiliation: De-Fei Hong, Shu-You Peng, Zhi-Fei Wang, Jian Cheng, Guo-Liang Shen, Yuan-Biao Zhang, Department of Hepatobiliary, Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Cheng
authors.affiliation: De-Fei Hong, Shu-You Peng, Zhi-Fei Wang, Jian Cheng, Guo-Liang Shen, Yuan-Biao Zhang, Department of Hepatobiliary, Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Guo-Liang
authors.initials: GL
authors.lastname: Shen
authors.affiliation: De-Fei Hong, Shu-You Peng, Zhi-Fei Wang, Jian Cheng, Guo-Liang Shen, Yuan-Biao Zhang, Department of Hepatobiliary, Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Yuan-Biao
authors.initials: YB
authors.lastname: Zhang
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000556:secondary / Q000601:surgery*; D016461:Chemoembolization, Therapeutic; D017024:Chemotherapy, Adjuvant; D018450:Disease Progression; D004621:Embolization, Therapeutic; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D061646:Operative Time; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D016019:Survival Analysis; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Caudate lobectomy; Emergency; Hepatocellular carcinoma; Rupture; Transarterial embolization