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Al-Ameri AAM, Zheng S. Survival outcomes after caudate lobectomy for hepatocellular carcinoma: systematic review and meta-analysis. ANZ J Surg 2024; 94:335-341. [PMID: 38193603 DOI: 10.1111/ans.18860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Caudate lobectomy (CLB) remains the most effective treatment for caudate lobe hepatocellular carcinoma (CL-HCC). However, there is controversy regarding the survival after CLB. This meta-analysis aims to investigate the survival outcomes following CLB for the treatment of CL-HCC. METHODS In line with PRISMA and MOOSE guidelines, a search for all eligible studies was performed. The pooled estimates of survival rates and hazard ratios (HRs) with their 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. RESULTS Sixteen studies comprising 864 patients met the inclusion criteria. The pooled estimates of 3- and 5-year overall survival (OS) rates were 62.3% and 42.9% respectively and the pooled estimate of 3- and 5-year recurrence-free survival (RFS) rates were 39.3% and 24.4% respectively. CL-HCC showed inferior OS (HR:1.39, 95% CI: 0.91-1.88, P < 0.001) and RFS (HR:1.33, 95% CI: 1.10-1.56, P < 0.001) than other sites HCC. Isolated CLB showed better OS (HR:0.9, 95% CI:0.39-1.41, p < 0.001) and RFS (HR:0.76, 95% CI: 0.03-1.5, P = 0.04) than combined CLB. CONCLUSIONS The survival outcomes for CL-HCC after CLB are lower compared to other sites HCC. Isolated CLB offers better survival outcomes compared to combined CLB. However, choosing isolated or combined approaches should be prioritized according to patient and tumour characteristics.
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Affiliation(s)
- Abdulahad Abdulrab Moahmmed Al-Ameri
- Department of Hepatobiliaryand Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China
- National Health Commission Key Laboratory of Combined Multi-organ Transplantation, Hangzhou, China
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment For Hepatobiliary and Pancreatic Cancer, Chinese Academy of Medical Sciences, Hangzhou, China
- Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Hangzhou, China
| | - Shusen Zheng
- Department of Hepatobiliaryand Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China
- National Health Commission Key Laboratory of Combined Multi-organ Transplantation, Hangzhou, China
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment For Hepatobiliary and Pancreatic Cancer, Chinese Academy of Medical Sciences, Hangzhou, China
- Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Hangzhou, China
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Huang J, Sun D, Xu D, Zhang Y, Hu M. A comprehensive study and extensive review of the Caudate lobe: The last piece of "Jigsaw" puzzle. Asian J Surg 2024; 47:1-7. [PMID: 37331854 DOI: 10.1016/j.asjsur.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/20/2023] Open
Abstract
Many liver surgeons have updated their understanding of the liver in recent years because of detailed studies on the liver anatomy and the rapid advances in laparoscopic liver surgery. Despite newer approaches, concepts and methods, research on the caudate lobe continues to be based on case reports and several persistent challenges concerning caudate lobe surgery that are worth discussing. Based on the literature and the author's experience, this study considers and addresses the challenges associated with caudate lobectomy encountered by most liver surgeons. We searched PubMed for relevant articles in English for 'caudate lobe', 'cholangiocellular carcinoma', 'laparoscopic caudate resection', 'right-side boundary of the caudate lobe' and 'assessment of hepatic functional reserve' published up to May 2022. This study reviewed the anatomical history of the caudate lobe, focusing on the challenges associated with caudate lobe-related surgical resection. Due to the unique anatomical position of the caudate lobe, surgical strategy for caudate lobe resection is particularly important, and the technical requirements for hepatobiliary surgeons are also extremely strict. Therefore, understanding the anatomical history of the caudate lobe and discussing the challenges associated with caudate lobectomy is essential.
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Affiliation(s)
- Jie Huang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650102, Yunnan, China.
| | - DaLi Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650102, Yunnan, China
| | - Dingwei Xu
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650102, Yunnan, China
| | - Yan Zhang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650102, Yunnan, China
| | - Manqing Hu
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650102, Yunnan, China
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Yoshida N, Midorikawa Y, Higaki T, Nakayama H, Moriguchi M, Aramaki O, Tsuji S, Okamura Y, Takayama T. Validity of the Algorithm for Liver Resection of Hepatocellular Carcinoma in the Caudate Lobe. World J Surg 2022; 46:1134-1140. [PMID: 35119511 DOI: 10.1007/s00268-022-06453-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND We aimed to validate our algorithm for resecting Hepatocellular carcinoma (HCC) in the caudate lobe based on tumor location, tumor size, and indocyanine green clearance rate. METHODS Patients who underwent curative resections for solitary HCC in the caudate lobe were included. The surgical outcomes of patients with HCC in the caudate lobe were compared with those of patients with HCC in other sites of the liver. RESULTS After one-to-one matching, the caudate-lobe group (n = 150) had longer operation time, greater amount of bleeding, lower weight of resected specimens, and shorter distance between tumor and resection line than the other-sites group (n = 150), but the complication rates were not different between the groups (38.0% vs. 34.1%, P = 0.719). After a median follow-up period of 3.0 years (range, 0.3-16.2 years), the median overall survivals were 6.5 (95% confidence interval [CI], 5.3-7.9) and 7.5 years (95% CI, 6.3-9.7) in the caudate-lobe and other-site groups, respectively (P = 0.430). Median recurrence-free survivals in the caudate-lobe group (1.9 years; 95% CI, 1.4-2.7) had a tendency to be shorter than those in the other-sites group (2.3 years; 1.7-3.4) (P = 0.052). CONCLUSIONS Patients' survival and complication rates in the caudate-lobe group were comparable to those in the other-sites group; therefore, our algorithm for resecting HCC in the caudate lobe is of clinical use.
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Affiliation(s)
- Nao Yoshida
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yutaka Midorikawa
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan. .,Department of General Surgery, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan.
| | - Tokio Higaki
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hisashi Nakayama
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masamichi Moriguchi
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Osamu Aramaki
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Shingo Tsuji
- Research Center for Advanced Science and Technology, Genome Science Division, University of Tokyo, Tokyo, 153-8904, Japan
| | - Yukiyasu Okamura
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan
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Xu ZG, Zhang FH, Sun DW, Zheng QT, Ji GW, Wang K. Surgical Strategy for Resecting Hepatocellular Carcinoma in the Caudate Lobe: Isolated or Combined Lobectomy? A Single-Center Study and Meta-Analysis. J Hepatocell Carcinoma 2022; 9:13-25. [PMID: 35118017 PMCID: PMC8802904 DOI: 10.2147/jhc.s349335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Resection of hepatocellular carcinoma (HCC) originating in the caudate lobe remains challenging, while the optimal extent of resection is debated. We aimed to evaluate the relative benefits of combined caudate lobectomy (CCL) versus isolated caudate lobectomy (ICL) for caudate HCC. Methods Patients who underwent curative-intent resection for caudate HCC between January 2010 and December 2018 were identified from a single-center database. Surgical outcomes of the two strategy groups were analyzed before and after propensity score matching. A systematic review with meta-analysis was also performed to compare outcomes of CCL versus ICL for caudate HCC. Results A total of 28 patients were included: 11 in the CCL and 17 in the ICL group. Compared with ICL, the CCL group contained patients with larger tumors and a higher incidence of vascular invasion. After propensity score matching, 6 pairs of patients were selected. In the well-matched cohort, CCL demonstrated significantly improved recurrence-free survival (RFS) (P = 0.047) compared with ICL; no significant differences were noted for overall survival (OS), operation time, blood loss and morbidity rate. A total of 227 patients from nine eligible studies and ours were involved in the systematic review. Meta-analysis revealed that CCL provided better RFS (hazard ratio 0.54, 95% confidence interval 0.31–0.92) than ICL; no significant differences were observed in OS, operation time, blood loss and morbidity rate. Conclusion CCL confers superior RFS over ICL without compromise of perioperative outcomes and should be prioritized for patients with caudate HCC when feasible, especially for those with large-sized tumors.
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Affiliation(s)
- Zheng-Gang Xu
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, People’s Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, People’s Republic of China
| | - Fei-Hong Zhang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, People’s Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, People’s Republic of China
| | - Dong-Wei Sun
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, People’s Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, People’s Republic of China
| | - Qi-Tong Zheng
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, People’s Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, People’s Republic of China
| | - Gu-Wei Ji
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, People’s Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, People’s Republic of China
| | - Ke Wang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, People’s Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, People’s Republic of China
- Correspondence: Ke Wang; Gu-Wei Ji, Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People’s Republic of China, Tel +86 18061675088; +86 15951758275, Fax +86 68136450, Email ;
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Abstract
OBJECTIVE To propose an algorithm for resecting hepatocellular carcinoma (HCC) in the caudate lobe. BACKGROUND Owing to a deep location, resection of HCC originating in the caudate lobe is challenging, but a plausible guideline enabling safe, curable resection remains unknown. METHODS We developed an algorithm based on sublocation or size of the tumor and liver function to guide the optimal procedure for resecting HCC in the caudate lobe, consisting of 3 portions (Spiegel, process, and caval). Partial resection was prioritized to remove Spiegel or process HCC, while total resection was aimed to remove caval HCC depending on liver function. RESULTS According to the algorithm, we performed total (n = 43) or partial (n = 158) resections of the caudate lobe for HCC in 174 of 201 patients (compliance rate, 86.6%), with a median blood loss of 400 (10-4530) mL. Postoperative morbidity (Clavien grade ≥III b) and mortality rates were 3.0% and 0%, respectively. After a median follow-up of 2.6 years (range, 0.5-14.3), the 5-year overall and recurrence-free survival rates were 57.3% and 15.3%, respectively. Total and partial resection showed no significant difference in overall survival (71.2% vs 54.0% at 5 yr; P = 0.213), but a significant factor in survival was surgical margin (58.0% vs 45.6%, P = 0.034). The major determinant for survival was vascular invasion (hazard ratio 1.7, 95% CI 1.0-3.1, P = 0.026). CONCLUSIONS Our algorithm-oriented strategy is appropriate for the resection of HCC originating in the caudate lobe because of the acceptable surgical safety and curability.
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Iizumi T, Okumura T, Sekino Y, Takahashi H, Tsai YL, Takizawa D, Ishida T, Hiroshima Y, Nakamura M, Shimizu S, Saito T, Numajiri H, Mizumoto M, Nakai K, Sakurai H. Long-term clinical outcomes of patients receiving proton beam therapy for caudate lobe hepatocellular carcinoma. JOURNAL OF RADIATION RESEARCH 2021; 62:682-687. [PMID: 34036362 PMCID: PMC8273797 DOI: 10.1093/jrr/rrab040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/27/2021] [Indexed: 05/09/2023]
Abstract
Hepatocellular carcinoma (HCC) located in the caudate lobe (caudate HCC) is rare; however, patients with this type of tumour have poorer prognoses than those with HCC in other segments. Despite many published reports on the clinical usefulness of proton beam therapy (PBT) for HCC, data on the clinical outcomes of patients undergoing PBT for caudate HCC remain scarce. Therefore, the present study aimed to investigate the outcomes of this group of patients. Thirty patients with caudate HCC who underwent definitive PBT between February 2002 and February 2014 were retrospectively analysed. The total irradiation doses ranged from 55 to 77 (median 72.6) Gy relative biological dose. The median follow-up period was 37.5 (range, 3.0-152.0) months. The overall survival (OS) rates at one, three and five years were 86.6%, 62.8% and 46.1%, respectively. According to univariate and multivariate analyses, Child-Pugh A (P < 0.01), having a single tumour (P = 0.02) and a low serum alpha-fetoprotein level (AFP; P < 0.01) were significant factors predicting longer survival. The local control (LC) rates at one, three and five years were 100%, 85.9% and 85.9%, respectively, while the corresponding progression-free survival (PFS) rates were 65%, 27.5% and 22%, respectively. No grade 3 or worse adverse events were observed. PBT is effective and safe for the treatment of caudate HCC, and should therefore be considered a feasible option for intervention in patients with this disease.
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Affiliation(s)
- Takashi Iizumi
- Corresponding author. Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan. TEL: +81-29-853-7100; FAX: +81-29-853-7102; E-mail:
| | - Toshiyuki Okumura
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Yuta Sekino
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Hiroaki Takahashi
- Department of Diagnostic Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Yu-Lun Tsai
- Department of Radiation Oncology, Cathay General Hospital, Taipei, 106, Taiwan
| | - Daichi Takizawa
- Department of Radiation Oncology, Hitachi General Hospital, Ibaraki, 317-0077, Japan
| | - Toshiki Ishida
- Department of Radiation Therapy, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Ibaraki, 309-1793, Japan
| | - Yuichi Hiroshima
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Masatoshi Nakamura
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Shosei Shimizu
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Takashi Saito
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Kei Nakai
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
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Parenchymal-sparing approaches for resection of tumors located in the paracaval portion of the caudate lobe of the liver-utility of limited resection and central hepatectomy. Langenbecks Arch Surg 2021; 406:2099-2106. [PMID: 34075474 DOI: 10.1007/s00423-021-02220-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Resection of liver cancer involving the paracaval portion (PC) of the caudate lobe is challenging because the PC is located deepest in the liver. This study aimed to elucidate the utility of two parenchymal-sparing approaches of limited resection and central hepatectomy for resecting tumors located in the PC. METHODS In 2018 and 2020, 12 out of 143 patients underwent hepatectomy for tumors located in the PC of the liver. In six patients, limited resection (LR) of the PC after full mobilization of the liver off the inferior vena cava (IVC) was performed for tumors excluding the hilar plate or large hepatic veins (large HVs), including major hepatic veins or thick short hepatic veins. In six patients, central hepatectomy (CH) using liver tunnel was performed for tumors involving or close to the hilar plate and/or large HVs. RESULTS During CH, the surgical view of the cranial side of the hilar plate was wide enough to perform combined resection of the large HVs in front of the IVC. Five of the six CHs were performed with resection of the LHVs. No LRs were accompanied with resection of the LHVs. The CH was associated with longer Pringle's time (76 min vs. 29.5 min, p = 0.015) and blood loss (1104 ml vs. 370 ml, p = 0.041). The preserved liver parenchyma volumes were 82% and 95% of the total liver volume after CH and LR, respectively. CONCLUSION Our parenchymal-sparing approach for resection of liver cancer located in the PC is feasible for curative resection.
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Yan L, Chen L, Qian K, Kan X, Zhang H, Liang B, Zheng C. Caudate Lobe Hepatocellular Carcinoma Treated with Sequential Transarterial Chemoembolization and Iodine 125 Seeds Implantation: A Single-Center Retrospective Study. Cancer Manag Res 2021; 13:3901-3912. [PMID: 34012296 PMCID: PMC8128345 DOI: 10.2147/cmar.s309310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/20/2021] [Indexed: 01/05/2023] Open
Abstract
Purpose Resection of the hepatocellular carcinoma (HCC) in the caudate lobe (CL) is challenging even for accomplished surgeons. This retrospective study evaluated the safety and efficacy of transarterial chemoembolization (TACE) and iodine 125 seeds implantation (ISI) for unresectable or “ablation unsuitable” HCC-CL detected at the initial presentation in clinical practice. Patients and Methods A total of 20 HCC-CL patients undergoing sequential TACE and ISI from January 2014 to October 2018 were enrolled in this study. The overall survival (OS), progression-free survival (PFS), tumor response rate, and complication rates were analyzed and compared to non-caudate lobe (NCL) HCC patients. Multivariate analyses for potential clinical and radiological factors were performed using the Cox proportional hazard model. Results The technical success rate was 100%, as all the patients received 28 ISI treatments. The median OS was 35 months. The 1-, 3-, and 5-year OS rates were 100%, 63.2%, and 11.1%, respectively. The median PFS was 16 months. The objective response rate was 60.0%. The puncture tract bleeding (2/20) and pneumothorax (1/20) were the most common complications in operation, but no operation-related deaths occurred. One year after the surgery, biliary tract injury occurred in 1 patient, necessitating percutaneous biliary intervention. No statistical difference was observed between the CL and NCL groups. Multivariable analysis revealed that Barcelona Clinic Liver Cancer stage B and tumor size >3 cm were two significant factors associated with OS. Conclusion Sequential TACE and ISI were associated with the survival benefits in HCC-CL and should be considered as a reliable therapy for surgeons and interventional radiologists.
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Affiliation(s)
- Liangliang Yan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Lei Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Kun Qian
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Xuefeng Kan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Hongsen Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Bin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
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Hepatic Vascular Exclusion Minimizes Hemorrhage During Isolated Caudate Lobectomy. Int Surg 2020. [DOI: 10.9738/intsurg-d-16-00055.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives
Isolated caudate lobectomy is a challenging operation for hepatobiliary surgeons. Unexpected massive hemorrhage is one of the major concerns for successful operation. Addressing the issue of bleeding control and prophylaxis during isolated caudate lobectomy is necessary. Our aim was to summarize the application of hepatic vascular exclusion in the operation to decrease blood loss.
Methods
Twenty-six cases of isolated caudate lobectomy were reviewed. Different hepatic vascular exclusion and its outcome were analyzed.
Results
All the operations were accomplished successfully with satisfactory average blood loss (325.38 mL) and without major postoperative complications. Hepatic vascular exclusion was used in nearly four-fifths of the cases. Pringle maneuver, portal vein exclusion, total hepatic vascular exclusion, selective total hepatic vascular exclusion, and selective regional total hepatic vascular exclusion were applied selectively.
Conclusions
Hepatic vascular exclusion decreased possible blood loss effectively during isolated caudate lobectomy. Full mobilization of the liver facilitates hepatic vascular exclusion. Certain precautionary measures and effective remedies are necessary for unexpected bleeding. Isolated caudate lobectomy should be carried out by experienced hepatobiliary surgeons.
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Shimada S, Kamiyama T, Yokoo H, Orimo T, Nagatsu A, Ohata T, Kamachi H, Taketomi A. Prognoses and Clinicopathological Characteristics for Hepatocellular Carcinoma Originating from the Caudate Lobe After Surgery. World J Surg 2019; 43:1085-1093. [PMID: 30478681 DOI: 10.1007/s00268-018-4869-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim was to evaluate the prognoses and clinicopathological characteristics of solitary hepatocellular carcinoma (HCC) originating from the caudate lobe (HCC-CL). METHODS We analyzed 584 patients with a solitary tumor <10 cm from January 1990 to November 2014. Patients were classified into a caudate lobe group (CL; n = 39) and a non-caudate lobe group (NCL; n = 545). We investigated the prognoses and clinicopathological characteristics of solitary HCC-CL. We compared the surgical procedures performed in these cases. RESULTS HCC-CL had a similar rate of portal venous invasion (PVI) as HCC-NCL (21% vs. 19%); however, the frequency of tumor thrombus at the first branch of the portal vein (PV) or extension to the trunk or the opposite side of the PV was significantly higher in HCC-CL (8% vs. 2%). HCC-CL had similar OS rates compared to HCC-NCL; however, HCC-CL showed significantly poorer RFS. Although there were no significant differences among the three surgical procedures, blood loss and complication rates tended to be higher in cases who underwent an isolated caudate lobectomy. Tumor size ≥5 cm, PVI, and liver fibrosis or cirrhosis (LF or LC) were independent unfavorable factors for both OS and RFS. PIVKA-II ≥120 mAU/ml was an independent unfavorable factor for RFS. CONCLUSION HCC-CL presented a poorer RFS rate. Patients with a tumor size ≥5 cm, PIVKA-II ≥120 mAU/ml, portal venous invasion, and LF or LC should be diligently followed up as these cases have a high risk of recurrence.
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Affiliation(s)
- Shingo Shimada
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15-West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Toshiya Kamiyama
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15-West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Hideki Yokoo
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15-West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tatsuya Orimo
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15-West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Akihisa Nagatsu
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15-West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takanori Ohata
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15-West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hirofumi Kamachi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15-West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15-West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
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Chen JC, Huang CY, Wang JC, Zhang YJ, Xu L, Chen MS, Zhou ZG. Robot-assisted laparoscopic partial hepatic caudate lobectomy. MINIM INVASIV THER 2018; 28:292-297. [PMID: 30261777 DOI: 10.1080/13645706.2018.1521434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Hepatic caudate lobectomy is considered to be a technically difficult surgery because of the unique anatomy and deep location of the hepatic caudate lobe. Here, we assessed the technical feasibility and safety of robotic partial caudate lobectomy using the da Vinci® Surgical System and compared it with traditional open/laparoscopic surgery.Material and methods: Six patients diagnosed with liver cancer (primary liver cancer, 5; metastasis of breast cancer, 1) who underwent caudate lobectomy were prospectively enrolled. Two patients underwent robotic surgery, one underwent laparoscopic surgery, and three underwent traditional/open surgery. Surgical procedure, recovery, and characteristics of robotic surgery were noted and compared with other approaches.Results: All surgeries were successfully completed, and no serious postsurgical complications were observed. In the robotic group, the time taken to complete the surgery and the estimated intraoperative bleeding were 150 and 90 min and 50 and 100 ml in patient 1 and patient 2, respectively. The patients were able to tolerate fluid diet on the following postsurgical day. These two patients had no postsurgical complications and were discharged from the hospital on days 5 and 6 after recovery, respectively. Pathologically, the margins of specimens obtained from these two patients were tumor-free (R0 resection). Tumor size in the traditional/open group was larger than that in the robotic and laparoscopic groups. Blood loss in the laparoscopic case was 50 ml and was less than that in the traditional/open surgery cases (300, 2100, and 1500 ml).Conclusions: Robot-assisted partial hepatic caudate lobectomy is a technically feasible surgery. Our study illustrated an advantage of robotic hepatic caudate lobectomy over laparoscopic or traditional/open surgery and suggested that da Vinci® minimally invasive hepatectomy is applicable in even more technically challenging anatomic locations.
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Affiliation(s)
- Jian-Cong Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Chun-Yu Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jun-Cheng Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yao-Jun Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Li Xu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Min-Shan Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Zhong-Guo Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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12
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Shindoh J, Nishioka Y, Hashimoto M. Bilateral anatomic resection of the ventral parts of the paramedian sectors of the liver with total caudate lobectomy for deeply/centrally located liver tumors: a new technique maximizing both oncological and surgical safety. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:E10-E16. [PMID: 29050064 DOI: 10.1002/jhbp.507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Systematic resection of the tumor-bearing portal territory is reportedly correlated with an improved survival of patients with liver tumors, especially in hepatocellular carcinoma. Despite advances in surgical management, however, anatomic resection of deeply/centrally located tumors remains a challenging procedure not only with technical difficulty but also because of decreased hepatic functional reserve frequently observed due to underlying liver disease. In this report, we have reported a novel technique that allows a promising approach for deeply/centrally located tumors with maximizing both the surgical and oncological safety. Bilateral anatomic resection of the ventral parts of the paramedian sectors (BVPM) offers a sufficient surgical window for safe access to the perihilar region. This technique is based on Hjortsjo's theory for liver anatomy and enables systematic removal of the 3rd-order portal territories. In addition, the current technique is advantageous in minimizing the loss of the normal liver parenchyma without leaving ischemia or congestion in the future liver remnant. Of the seven consecutive patients who were treated with this procedure, all the patients achieved R0 resection with acceptable rate of major morbidity (1/7, 14%). The BVPM may offer a safe and maximized chance of curative resection for deeply/centrally located liver tumors.
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Affiliation(s)
- Junichi Shindoh
- Hepatobiliary-pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Yujiro Nishioka
- Hepatobiliary-pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Masaji Hashimoto
- Hepatobiliary-pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
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13
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Ho KM, Han HS, Yoon YS, Cho JY, Choi YR, Jang JS, Kwon SU, Kim S, Choi JK. Laparoscopic Total Caudate Lobectomy for Hepatocellular Carcinoma. J Laparoendosc Adv Surg Tech A 2016; 27:1074-1078. [PMID: 27855267 DOI: 10.1089/lap.2016.0459] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Caudate lobe is located in the deep dorsal area of the liver between the portal triad and the inferior vena cava (IVC). Torrential bleeding can occur from the IVC and short hepatic veins during dissection. Isolated total caudate lobe resection is still rare and technically demanding. We herein present a video on the technical aspect of laparoscopic total caudate lobectomy. METHOD A 61-year-old woman was admitted for recurrent hepatocellular carcinoma detected on imaging. She had history of multifocal hepatocellular carcinoma in July 2015 and underwent open cholecystectomy, segment 6 and segment 8 tumorectomy. Ten months later, the computed tomography scan and magnetic resonance imaging showed a 1 cm arterial enhancing lesion in segment I (S1) with no other foci of recurrence. Laparoscopic total caudate lobectomy was contemplated. RESULTS The operative time was 270 minutes. The intraoperative blood loss was 200 mL and blood transfusion was not necessary. The patient was discharged on the fourth postoperative day without any complications. CONCLUSION This report showed the safety and feasibility of laparoscopic total caudate lobectomy. Nonetheless, it is a technically demanding procedure. It should be performed in carefully selected patients and by experienced hepatobiliary surgeons proficient in laparoscopic liver resection.
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Affiliation(s)
- Kit-Man Ho
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea.,2 Department of Surgery, Kwong Wah Hospital , Hong Kong, China
| | - Ho-Seong Han
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
| | - Yoo-Seok Yoon
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
| | - Jai Young Cho
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
| | - Young Rok Choi
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
| | - Jae Seong Jang
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
| | - Seong Uk Kwon
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
| | - Sungho Kim
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
| | - Jang Kyu Choi
- 1 Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam-si, Korea
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Hu HJ, Mao H, Shrestha A, Tan YQ, Ma WJ, Yang Q, Wang JK, Cheng NS, Li FY. Prognostic factors and long-term outcomes of hilar cholangiocarcinoma: A single-institution experience in China. World J Gastroenterol 2016; 22:2601-2610. [PMID: 26937148 PMCID: PMC4768206 DOI: 10.3748/wjg.v22.i8.2601] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/18/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the prognostic factors of hilar cholangiocarcinoma in a large series of patients in a single institution.
METHODS: Eight hundred and fourteen patients with a diagnosis of hilar cholangiocarcinoma that were evaluated and treated between 1990 and 2014, of which 381 patients underwent curative surgery, were included in this study. Potential factors associated with overall survival (OS) and disease-free survival (DFS) were evaluated by univariate and multivariate analyses.
RESULTS: Curative surgery provided the best long-term survival with a median OS of 26.3 mo. The median DFS was 18.1 mo. Multivariate analysis showed that patients with tumor size > 3 cm [hazard ratio (HR) = 1.482, 95%CI: 1.127-1.949; P = 0.005], positive nodal disease (HR = 1.701, 95%CI: 1.346-2.149; P < 0.001), poor differentiation (HR = 2.535, 95%CI: 1.839-3.493; P < 0.001), vascular invasion (HR = 1.542, 95%CI: 1.082-2.197; P = 0.017), and positive margins (HR = 1.798, 95%CI: 1.314-2.461; P < 0.001) had poor OS outcome. The independent factors for DFS were positive nodal disease (HR = 3.383, 95%CI: 2.633-4.348; P < 0.001), poor differentiation (HR = 2.774, 95%CI: 2.012-3.823; P < 0.001), vascular invasion (HR = 2.136, 95%CI: 1.658-3.236; P < 0.001), and positive margins (HR = 1.835, 95%CI: 1.256-2.679; P < 0.001). Multiple logistic regression analysis showed that caudate lobectomy [odds ratio (OR) = 9.771, 95%CI: 4.672-20.433; P < 0.001], tumor diameter (OR = 3.772, 95%CI: 1.914-7.434; P < 0.001), surgical procedures (OR = 10.236, 95%CI: 4.738-22.116; P < 0.001), American Joint Committee On Cancer T stage (OR = 2.010, 95%CI: 1.043-3.870; P = 0.037), and vascular invasion (OR = 2.278, 95%CI: 0.997-5.207; P = 0.051) were independently associated with tumor-free margin, and surgical procedures could indirectly affect survival outcome by influencing the tumor resection margin.
CONCLUSION: Tumor margin, tumor differentiation, vascular invasion, and lymph node status were independent factors for OS and DFS. Surgical procedures can indirectly affect survival outcome by influencing the tumor resection margin.
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Dong J, Li W, Zeng Q, Li S, Gong X, Shen L, Mao S, Dong A, Wu P. CT-Guided Percutaneous Step-by-Step Radiofrequency Ablation for the Treatment of Carcinoma in the Caudate Lobe. Medicine (Baltimore) 2015; 94:e1594. [PMID: 26426638 PMCID: PMC4616865 DOI: 10.1097/md.0000000000001594] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The location of the caudate lobe and its complex anatomy make caudate lobectomy and radiofrequency ablation (RFA) under ultrasound guidance technically challenging. The objective of the exploratory study was to introduce a novel modality of treatment of lesions in caudate lobe and discuss all details with our experiences to make this novel treatment modality repeatable and educational. The study enrolled 39 patients with liver caudate lobe tumor first diagnosed by computerized tomography (CT) or magnetic resonance imaging (MRI). After consultation of multi-disciplinary team, 7 patients with hepatic caudate lobe lesions were enrolled and accepted CT-guided percutaneous step-by-step RFA treatment. A total of 8 caudate lobe lesions of the 7 patients were treated by RFA in 6 cases and RFA combined with percutaneous ethanol injection (PEI) in 1 case. Median tumor diameter was 29 mm (range, 18-69 mm). A right approach was selected for 6 patients and a dorsal approach for 1 patient. Median operative time was 64 min (range, 59-102 min). Median blood loss was 10 mL (range, 8-16 mL) and mainly due to puncture injury. Median hospitalization time was 4 days (range, 2-5 days). All lesions were completely ablated (8/8; 100%) and no recurrence at the site of previous RFA was observed during median 8 months follow-up (range 3-11 months). No major or life-threatening complications or deaths occurred. In conclusion, percutaneous step-by-step RFA under CT guidance is a novel and effective minimally invasive therapy for hepatic caudate lobe lesions with well repeatability.
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Affiliation(s)
- Jun Dong
- From the Department of Medical Imaging & Image Guided Therapy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, East Dong Feng Road 651, Guangzhou, Guangdong 510060, PR China (JD, WL, QZ, SL, LS, SM, AD, PW); and Department of Medical Statistics and Epidemiology School of Public Health, Sun Yat-sen University, Zhongshan 2nd Road, 74, Guangzhou, Guangdong 510080, PR China (XG)
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16
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Robot-assisted laparoscopic partial caudate lobe resection for hepatocellular carcinoma in cirrhotic liver. Surg Laparosc Endosc Percutan Tech 2015; 24:e88-91. [PMID: 24887545 DOI: 10.1097/sle.0b013e31829ce820] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the technical feasibility and safety of robot-assisted laparoscopic partial caudate lobe resection using the robotic surgical system. MATERIALS AND METHODS This is a report of the use of robot-assisted laparoscopic partial caudate lobe resection on 2 patients with hepatocellular carcinoma. RESULTS Robot-assisted laparoscopic partial caudate lobe resection was completed successfully in these 2 patients. The operating time was 137 and 150 minutes, respectively. The blood loss was 137 and 150 mL, respectively. They were able to tolerate liquids on the second postoperative day. Both patients recovered from the operation. They were discharged 4 and 5 days after the operation, respectively. The resected margins of both specimens were tumor free (R0 resections). CONCLUSIONS Robot-assisted laparoscopic partial caudate lobe resection is a feasible and safe procedure. Our results demonstrate the advantages of robotic system on short-term outcomes and suggest the extended indication of minimally invasive hepatectomy even in the technically challenging anatomic area.
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Choi WS, Kim HC, Hur S, Choi JW, Lee JH, Yu SJ, Chung JW. Role of C-Arm CT in Identifying Caudate Arteries Supplying Hepatocellular Carcinoma. J Vasc Interv Radiol 2014; 25:1380-8. [DOI: 10.1016/j.jvir.2014.02.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/22/2014] [Accepted: 02/25/2014] [Indexed: 12/28/2022] Open
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Surgical strategy for isolated caudate lobectomy: experience with 16 cases. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2014; 2014:983684. [PMID: 25100899 PMCID: PMC4102013 DOI: 10.1155/2014/983684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/10/2014] [Accepted: 06/15/2014] [Indexed: 12/19/2022]
Abstract
Introduction. Surgical resection is the most effective treatment for neoplasm in the caudate lobe. Isolated caudate lobectomy is still a challenge for hepatobiliary surgeons. No widely accepted surgical strategy for the procedure has been developed yet. Objective. To get a better understanding of isolated caudate lobectomy and to optimize the procedure. Materials and Methods. 16 cases of isolated caudate lobectomy were reviewed to summarize the surgical experience. Results. All the 16 cases of isolated caudate lobectomy were carried out successfully, among which left side approach was adopted in two cases (12.5%), right side approach in three cases (18.75%), and both sides approach in 11 cases (68.75%). No severe complications occurred. Conclusion. The majority of neoplasms confined to the caudate lobe can be resected safely by left and right side approach with proper anatomic surgical procedure, usually in the sequence of mobilization, outflow control, inflow control, and division of the hepatic parenchyma. Fully mobilizing the caudate lobe from the inferior vena cava (IVC) is of great importance. Division of the retrohepatic ligament and the venous ligament facilitated the procedure.
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Yan PN, Tan WF, Yang XW, Zhang CS, Jiang XQ. Applied anatomy of small branches of the portal vein in transverse groove of hepatic hilum. Surg Radiol Anat 2014; 36:1071-7. [DOI: 10.1007/s00276-014-1290-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 03/31/2014] [Indexed: 12/28/2022]
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Dai WD, Huang JS, Hu JX. Isolated Caudate Lobe Resection for Huge Hepatocellular Carcinoma (10 cm or greater in diameter). Am Surg 2014. [DOI: 10.1177/000313481408000224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Isolated caudate lobectomy for huge hepatocellular carcinoma (HCC) (10 cm or greater in diameter) is a technically demanding surgical procedure that entails the surgeon's experience and precise anatomical knowledge of the liver. We describe our clinical experiences and evaluate the results of partial or total isolated caudate lobectomy for HCC larger than 10 cm in the caudate lobe. En bloc excisions combined with adjacent hepatic parenchyma (as part of extended hepatectomies) were excluded. Twenty-seven patients were included in the study (24 male, three3 female). Median age was 43 years (range, 18 to 81 years). All primary diagnoses were HCC. Twenty-one patients had surgical margins lesser than 1 cm. Tumor embolus within the main trunk of the portal vein was found in five patients by intraoperative ultrasound. Median operative time was 288 minutes (range, 160 to 310 minutes), and estimated intraoperative blood loss was 2260 mL (range, 200 to 7000 mL). Median blood transfusion was 1460 mL (range, 0 to 7200 mL). Postoperative morbidity rate was 44.4 per cent. There were no postoperative deaths. Overall survival rates at 1, 3, and 5 years were 80.2, 52.1, and 27.1 per cent, respectively. Nineteen patients (70.4%) had tumor recurrence as of the last follow-up. The recurrence lesion was treated in most of these patients. Isolated caudate lobectomy for huge HCC is a technically demanding but safe procedure, although the procedure is sometimes extremely difficult.
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Affiliation(s)
- Wei-Dong Dai
- Department of General Surgery, XiangYa 2nd Hospital, Central South University, Hangsha, China
| | - Jiang-Sheng Huang
- Department of General Surgery, XiangYa 2nd Hospital, Central South University, Hangsha, China
| | - Ji-Xiong Hu
- Department of General Surgery, XiangYa 2nd Hospital, Central South University, Hangsha, China
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Philips P, Farmer RW, Scoggins CR, McMasters KM, Martin RCG. Caudate lobe resections: a single-center experience and evaluation of factors predictive of outcomes. World J Surg Oncol 2013; 11:220. [PMID: 24010947 PMCID: PMC3848559 DOI: 10.1186/1477-7819-11-220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 08/27/2013] [Indexed: 12/30/2022] Open
Abstract
Background Despite the increasing frequency of liver resection for multiple types of disease, caudate lobe resection remains a rare surgical event. The goal of this study is to review our experience and evaluate possible predictors of adverse outcomes in patients undergoing caudate lobectomy. Methods We reviewed a 1,900-patient prospective hepato-pancreatico-biliary database from January 2000 to December 2011, identifying 36 hepatectomy patients undergoing caudate lobe resection. Clinicopathologic characteristic and outcome data were compared using chi-square, T-test, ANOVA, Kaplan-Meier, and Cox regression analysis. Primary endpoints were the incidence and severity of complications, and secondary endpoints were blood loss, hospital stay, and transfusion requirements. Patients were also divided in two groups with group A being patients operated on before December 2007 and group B after 2007. We compared the demographics, risk factors, complication rates, and operative details between the two groups. Results Thirty-six patients underwent caudate lobe resection for cholangiocarcinoma (47.2%), metastatic colorectal cancer (36.1%), hepatocellular carcinoma (8.3%), or benign disease (8.3%). Nine patients (29%) had additional liver resection. Median overall survival (OS) was 21 months. Complications occurred in 52.7% (19/36) of patients with a median grade of 2. Tobacco abuse was associated with an increased risk of operative complications (73.3% vs. 38.9%, p = 0.03). Prior history of cardiac disease was associated with a higher complication rate (87% vs. 42%, p = 0.03). Neoadjuvant chemotherapy, biliary procedures, hepatitis, and prior major abdominal surgery were not predictive of complications. Major complication was also predicted by the volume of RBC transfusion (2.7 vs. 4.1 units, p = 0.003). In our subgroup analysis of the patients undergoing surgery before and after 2007, the two groups were well matched based on age, comorbidities, and risk factors. The complication rates and rates of high-grade complications were similar, but blood loss (600 ml vs. 400 ml, p = 0.03), inflow occlusion time (Pringle time 12.6 vs. 6, p = 0.00), and hospital stay (9.5 vs. 7 days, p = 0.01) were significantly lower in group B. Conclusions With appropriate patient selection, caudate lobe resection is an effective component of surgery for hepatic disease. Tobacco use and prior cardiac history increase the risk of complications.
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Affiliation(s)
- Prejesh Philips
- Department of Surgery, Division of Surgical Oncology, University of Louisville, 315 E Broadway, Suite# 311, Louisville KY 40202, USA.
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Fujimori M, Takaki H, Nakatsuka A, Uraki J, Yamanaka T, Hasegawa T, Shiraki K, Takei Y, Yamakado K. Combination therapy of chemoembolization and radiofrequency ablation for the treatment of hepatocellular carcinoma in the caudate lobe. J Vasc Interv Radiol 2013. [PMID: 23177108 DOI: 10.1016/j.jvir.2012.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the clinical utility of radiofrequency (RF) ablation combined with chemoembolization in treatment of hepatocellular carcinoma (HCC) located in the caudate lobe. MATERIALS AND METHODS Between September 2000 and October 2011, 20 consecutive patients with single HCC measuring≤5 cm were treated with combination therapy of chemoembolization and RF ablation. Technical success was defined as completion of a planned electrode placement and ablation protocol. The effectiveness of the technique was defined as disappearance of tumor enhancement with an ablative margin of≥5 mm. Technical success, technique effectiveness, local tumor progression, overall and recurrence-free survival, and complications were evaluated. RESULTS RF electrodes were placed in planned sites of each tumor, and ablation was complete in all patients (technical success rate 100%). Tumor enhancement disappeared with sufficient ablative margins after 20 RF sessions in all patients (technique effectiveness rate 100%). Major and minor complication rates were 10.0% and 15.0%. Local tumor progression was found in 2 of 20 patients (10.0%) with local tumor progression rates of 6.3% at 1 year and 13.5% at 3 years and 5 years. Six patients died during the follow-up period (mean, 40.0 months; range, 2.0-110.5 months). Overall and recurrence-free survival rates were 94.4% and 70.8% at 1 year, 86.6% and 36.9% at 3 years, and 67.5% and 45.5% at 5 years. CONCLUSIONS RF ablation combined with chemoembolization is a safe and useful therapeutic option to treat HCCs located in the caudate lobe.
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Affiliation(s)
- Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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Ishii H, Ogino S, Ikemoto K, Toma A, Nakamura K, Itoh T, Ochiai T. Mesohepatectomy with total caudate lobectomy of the liver for hepatocellular carcinoma. World J Surg Oncol 2013; 11:82. [PMID: 23557004 PMCID: PMC3621591 DOI: 10.1186/1477-7819-11-82] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/10/2013] [Indexed: 12/15/2022] Open
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. CONCLUSION 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.
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Affiliation(s)
- Hiromichi Ishii
- Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto, 629-2261, Japan
| | - Shinpei Ogino
- Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto, 629-2261, Japan
| | - Koki Ikemoto
- Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto, 629-2261, Japan
| | - Atsushi Toma
- Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto, 629-2261, Japan
| | - Kenji Nakamura
- Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto, 629-2261, Japan
| | - Tsuyoshi Itoh
- Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto, 629-2261, Japan
| | - Toshiya Ochiai
- Division of Surgery, Kyoto Prefectural Yosanoumi Hospital, 481 Otokoyama, Yosano-cho, Yosa-gun, Kyoto, 629-2261, Japan
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Sun LH, Han HQ, Wang PZ, Tian WJ. Emergency caudate lobectomy for ruptured hepatocellular carcinoma with multiple primary cancers. World J Gastroenterol 2013; 19:418-421. [PMID: 23372368 PMCID: PMC3554830 DOI: 10.3748/wjg.v19.i3.418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 12/17/2012] [Accepted: 12/25/2012] [Indexed: 02/06/2023] Open
Abstract
We report a case of metachronous multiple primary malignancies involving both rectum and liver with colonic metastasis from hepatocellular carcinoma (HCC) through hematogenous pathway. A 72-year-old woman was admitted to the emergency department with right upper abdominal pain for 4 h. Considering her surgical history of Mile’s procedure plus liver resection for rectal cancer with liver metastasis three years ago and the finding of urgent computed tomography scan on admission, the preoperative diagnosis was spontaneous rupture of rectal liver metastasis located in caudate lobe and colonic metastasis from rectal cancer. The patient underwent an emergency isolated caudate lobectomy at a hemorrhagic shock status. Pathology reported a primary HCC in the caudate lobe and colonic metastasis of HCC with tumor embolus in the surrounding vessels of the intestine. No regional lymph node involvement was found. It is hypothesized that HCC may disseminate hematogenously to the ascending colon, thus making it a rare case.
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Isolated caudate lobe resection for hepatocellular carcinoma. FORMOSAN JOURNAL OF SURGERY 2012. [DOI: 10.1016/j.fjs.2012.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zhou Y, Zhang X, Wu L, Xu D, Li B. Surgical outcomes of hepatocellular carcinoma originating from caudate lobe. ANZ J Surg 2012; 83:275-9. [PMID: 22931453 DOI: 10.1111/j.1445-2197.2012.06232.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2012] [Indexed: 01/08/2023]
Affiliation(s)
- Yanming Zhou
- Department of Hepato-Biliary-Pancreato-Vascular Surgery; First Affiliated Hospital of Xiamen University; Xiamen; China
| | - Xiaofeng Zhang
- Department IV of Hepatic Surgery; Eastern Hepatobiliary Surgery Hospital, Second Military Medical University; Shanghai; China
| | - Lupeng Wu
- Department of Hepato-Biliary-Pancreato-Vascular Surgery; First Affiliated Hospital of Xiamen University; Xiamen; China
| | - Donghui Xu
- Department of Hepato-Biliary-Pancreato-Vascular Surgery; First Affiliated Hospital of Xiamen University; Xiamen; China
| | - Bin Li
- Department of Hepato-Biliary-Pancreato-Vascular Surgery; First Affiliated Hospital of Xiamen University; Xiamen; China
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Early control of short hepatic portal veins in isolated or combined hepatic caudate lobectomy. Hepatobiliary Pancreat Dis Int 2012; 11:377-82. [PMID: 22893464 DOI: 10.1016/s1499-3872(12)60195-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Caudate lobectomy has long been considered technically difficult. This study aimed to elaborate the significance of early control of short hepatic portal veins (SHPVs) in isolated hepatic caudate lobectomy or in hepatic caudate lobectomy combined with major partial hepatectomy, and to describe the anatomical characteristics of SHPVs. METHODS The data of 117 patients who underwent either isolated or combined caudate lobectomy by the same team of surgeons from 2005 to 2009 were retrospectively analyzed. From 2005 to 2007 (group A, n=55), we carried out early control of short hepatic veins (SHVs) only; from 2008 to 2009 (group B, n=62), we carried out early control of both SHVs and SHPVs. The two groups were compared to evaluate which surgical procedure was better. A detailed anatomical study was then carried out on the last 25 consecutive patients in group B to study the number and distribution of SHPVs during surgery. RESULTS Patients in group B had less intra-operative blood loss, less impairment of liver function, shorter postoperative hospital stay, fewer postoperative complications and required less blood transfusion (P<0.05). The number of SHPVs in the 25 patients was 183, with 7.3+/-2.7 per patient. The diameters of SHPVs were 1 to 4 mm. On average, 3.4 SHPVs/patient came from the left portal vein, 2.2 from the bifurcation, 1.4 from the right portal vein, and 0.3 from the main portal vein. On average, 3.3 SHPVs/patient supplied segment I of the liver, 0.4 for segment II, 2.1 for segment IV, 1.4 for segment V and 0.1 for segment VI. CONCLUSION Early control of SHPVs in isolated or combined hepatic caudate lobectomy may be a useful method to decrease surgical risk and improve postoperative recovery.
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Liu P, Qiu BA, Bai G, Bai HW, Xia NX, Yang YX, Zhu JY, An Y, Hu B. Choice of approach for hepatectomy for hepatocellular carcinoma located in the caudate lobe: Isolated or combined lobectomy? World J Gastroenterol 2012; 18:3904-9. [PMID: 22876044 PMCID: PMC3413064 DOI: 10.3748/wjg.v18.i29.3904] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 04/05/2012] [Accepted: 04/12/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the significance of the surgical approaches in the prognosis of hepatocellular carcinoma (HCC) located in the caudate lobe with a multivariate regression analysis using a Cox proportional hazard model.
METHODS: Thirty-six patients with HCC underwent caudate lobectomy at a single tertiary referral center between January 1995 and June 2010. In this series, left-sided, right-sided and bilateral approaches were used. The outcomes of patients who underwent isolated caudate lobectomy or caudate lobectomy combined with an additional partial hepatectomy were compared. The survival curves of the isolated and combined resection groups were generated by the Kaplan-Meier method and compared by a log-rank test.
RESULTS: Sixteen (44.4%) of 36 patients underwent isolated total or partial caudate lobectomy whereas 20 (55.6%) received a total or partial caudate lobectomy combined with an additional partial hepatectomy. The median diameter of the tumor was 6.7 cm (range, 2.1-15.8 cm). Patients who underwent an isolated caudate lobectomy had significantly longer operative time (240 min vs 170 min), longer length of hospital stay (18 d vs 13 d) and more blood loss (780 mL vs 270 mL) than patients who underwent a combined caudate lobectomy (P < 0.05). There were no perioperative deaths in both groups of patients. The complication rate was higher in the patients who underwent an isolated caudate lobectomy than in those who underwent combined caudate lobectomy (31.3% vs 10.0%, P < 0.05). The 1-, 3- and 5-year disease-free survival rates for the isolated caudate lobectomy and the combined caudate lobectomy groups were 54.5%, 6.5% and 0% and 85.8%, 37.6% and 0%, respectively (P < 0.05). The corresponding overall survival rates were 73.8%, 18.5% and 0% and 93.1%, 43.6% and 6.7% (P < 0.05).
CONCLUSION: The caudate lobectomy combined with an additional partial hepatectomy is preferred because this approach is technically less demanding and offers an adequate surgical margin.
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Liu P, Yang J, Niu W, Xie F, Wang Y, Zhou Y. Surgical treatment of huge hepatocellular carcinoma in the caudate lobe. Surg Today 2011; 41:520-5. [PMID: 21431485 DOI: 10.1007/s00595-009-4313-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 11/05/2009] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess the outcome and effectiveness of liver surgery for huge hepatocellular carcinoma (HCC) in the caudate lobe. METHODS This study retrospectively examined 18 patients who underwent surgical treatment for huge HCC in the caudate lobe. An isolated caudate lobectomy and an extended caudate lobectomy were each performed in nine patients (50%). The intraoperative and postoperative complications and treatments for recurrence were recorded. The survival curve was estimated using the Kaplan-Meier method. RESULTS The postoperative mortality and morbidity were nil and 33.3%, respectively. Fourteen patients (77%) had tumor recurrence as of the last follow-up. The recurrence was treated in all patients. Eleven patients underwent transcatheter arterial chemoembolization, a median of three times per patient (range, 1-7); one of those patients also received percutaneous ethanol injection therapy and radiotherapy of recurrent nodules. One patient was treated with systemic chemotherapy. One patient underwent liver transplantation, and one underwent a repeated liver resection. The overall survival rates at 1, 3, and 5 years were 83%, 47%, and 31%, respectively. CONCLUSION Long-term survival can be achieved using an aggressive surgical approach in selected patients with huge HCC in the caudate lobe.
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Affiliation(s)
- Peng Liu
- Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225 Changhai Road, Shanghai, 200438, PR China
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Kim HC, Chung JW, Jae HJ, Yoon JH, Lee JH, Kim YJ, Lee HS, Yoon CJ, Park JH. Caudate lobe hepatocellular carcinoma treated with selective chemoembolization. Radiology 2010; 257:278-87. [PMID: 20697120 DOI: 10.1148/radiol.10100105] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To analyze the clinical outcomes of chemoembolization for solitary caudate lobe hepatocellular carcinoma (HCC) found at initial presentation. MATERIALS AND METHODS This retrospective study was approved by the institutional review board; the requirement for informed patient consent was waived. From July 1998 to June 2009, 40 patients (28 men, 12 women; mean age, 57 years) found to have a single HCC lesion in the caudate lobe at initial presentation were treated with chemoembolization and evaluated for overall survival and progression-free survival. Multivariate analyses for potential clinical and radiologic factors were performed by using the Cox proportional hazard model. RESULTS Selective chemoembolization via the caudate artery was achieved in 34 (85%) patients. Overall survival rates at 1, 2, 3, 4, and 5 years were 92%, 79%, 65%, 56%, and 56%, respectively. Selective chemoembolization of the caudate artery was a critically important factor in longer overall survival (hazard ratio, 0.091; 95% confidence interval [CI]: 0.021, 0.389; P < .001), and portal vein tumor thrombosis (hazard ratio, 31.25; 95% CI: 4.88, 200.1; P < .001) and multiple tumor-feeding vessels (hazard ratio, 6.87; 95% CI: 1.47, 32.1; P = .014) were significant factors in shorter overall survival. Selective chemoembolization of the caudate artery was also a significant factor in longer progression-free survival (hazard ratio, 0.278; 95% CI: 0.10, 0.76; P = .013). CONCLUSION Selective chemoembolization via the caudate artery is possible in most patients with caudate lobe HCC and a critical factor in longer overall survival and longer progression-free survival.
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Affiliation(s)
- Hyo-Cheol Kim
- Department of Radiology, Seoul National University College of Medicine; Institute of Radiation Medicine; Seoul National University Medical Research Center, Seoul, Korea
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