Elsevier

Surgery

Volume 132, Issue 4, October 2002, Pages 697-709
Surgery

Central Surgical Association
Surgical outcomes of isolated caudate lobe resection: A single series of 19 patients*

Presented at the 59th Annual Meeting of the Central Surgical Association, Pittsburgh, Pa, March 7-9, 2002.
https://doi.org/10.1067/msy.2002.127691Get rights and content

Abstract

Background. Isolated caudate lobe resection is a complex surgical procedure that requires technical expertise and knowledge of the surgical anatomy. Methods. All consecutive patients who were operated on for isolated caudate lobe resections by the senior author were studied. En bloc resections with adjacent hepatic parenchyma (as part of extended hepatectomies) or partial resections of the caudate lobe were excluded. Follow-up was completed by outpatient evaluation and mail correspondence. Results. Nineteen patients met the inclusion criteria (6 male, 13 female). Mean age (±SD) was 52 (±3) years. Primary diagnoses were colorectal metastases, hemangioma, hepatocellular carcinoma, adenoma, and neuroendocrine metastases. Margins were negative in all but 1 patient. One patient needed inferior vena cava resection. Pringle's maneuver was used in 1 patient (5%). Mean (±SD) operative time was 211 (±15) minutes, and estimated blood loss was 760 (±150) mL. Median blood transfusion was 0 U (range, 0-4). Complications (bile leak) were seen in 1 patient (5%). Median length of stay was 7 days (range, 4-14). There were no perioperative deaths. Conclusions. Isolated caudate lobe resection is a feasible procedure that can be done with low morbidity/mortality. Sound surgical judgment and detailed knowledge of the caudate lobe anatomy are keys for a safe performance of this procedure. (Surgery 2002;132:697-709.)

Section snippets

Methods

We examined the records of all consecutive patients who underwent complete isolated caudate lobe resection by the senior author (D.M.N.) between 1981 and 2000. Patients who had caudate resection en bloc with adjacent hepatic segments or lobes with or without bile duct resections or subsegmental (wedge) resections of the caudate lobe were excluded. Patients with simultaneous resection of other organs or distant hepatic segments (not in continuity) were included. Histopathology was recorded.

Results

From 90 patients who underwent caudate lobe resection during the study period, 19 who underwent isolated resection of the lobe were culled for this analysis. The other 71 patients had caudate lobectomies in continuity with left or right hepatectomy. There was a preponderance of women (n = 13). Mean (±SD) patient age was 52 (±3) years, with a range of 36 to 76 years. Twelve resections were done for colorectal metastases. Other diagnoses included HCC (n = 2), 1 of them with cirrhosis; hemangioma

Discussion

Isolated resection of the caudate lobe has been considered a technically challenging procedure.1 Its position behind the major lobes and its close proximity to the portal triad, hepatic veins, and IVC poses a complex access to this lobe. In major centers, caudate lobe excision comprises only 0.5% to 4% of the total number of hepatic resections3, 7 and isolated excisions of the caudate lobe are even more infrequent. As recently as 1998, only 2 out of 30 patients with HCC located in the caudate

References (22)

  • D Elias et al.

    Surgical approach to segment I for malignant tumors of the liver

    Surg Gynecol Obstet

    (1992)
  • T Tono et al.

    Surgical treatment of hepatic lobe metastases originating from colorectal primaries

    Int Surg

    (2000)
  • N Nagasue et al.

    Resection of the caudate lobe of the liver for primary and recurrent hepatocellular carcinomas

    J Am Coll Surg

    (1997)
  • Y Nimura et al.

    Hilar cholangiocarcinoma - surgical anatomy and curative resection

    J Hepatobiliary Pancreat Surg

    (1995)
  • S Nakamura et al.

    Surgical anatomy of the hepatic veins and the inferior vena cava

    Surg Gynecol Obstet

    (1981)
  • T Takayama et al.

    A new method for marking hepatic subsegment: counterstaining identification technique

    Surgery

    (1991)
  • T Takayama et al.

    Resection after intraarterial chemotherapy of a hepatoblastoma originating in the caudate lobe

    Surgery

    (1990)
  • T Takayama et al.

    Segmental liver resections, present and future: caudate lobe resection for liver tumors

    Hepatogastroenterology

    (1998)
  • M Shimada et al.

    Characteristics of hepatocellular carcinoma originating in the caudate lobe

    Hepatology

    (1994)
  • K Takayasu et al.

    Clinical and radiologic features of hepatocellular carcinoma originating in the caudate lobe

    Cancer

    (1986)
  • D Bartlett et al.

    Complete resection of the caudate lobe of the liver

    Br J Surg

    (1996)
  • Cited by (0)

    *

    Reprint requests: David M. Nagorney, MD, Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

    View full text