ObjectiveTo review the clinical experience and evaluate the results in patients who underwent caudate lobectomy for malignant tumor at caudate lobe of liver. MethodsClinicopathological characteristics of 51 patients who underwent caudate lobectomy because of malignant tumors at caudate lobe of liver in our hospital from May 2007 to December 2013 were reviewed retrospectively, and operative detail, complication rate, and survival rate were described. ResultsThe cancer were resected successfully in 51 patients with malignant tumors at caudate lobe of liver. Thirty patients were performed isolated caudate lobectomy and 21 patients performed combined lobectomy. Of the 51 patients, 9 patients were treated with retrograde caudate lobectomy. The operation time was 180.0-360.0 min, with the average value of 244.0 min. The bleeding volume was 400.0-1 000.0 mL, with the average value of 630.0 mL. In all patients, there was no perioperative death and no postoperative bleeding happened, and 17 patients who suffered from interrelated complications were cured or got better by conservative treatments. Fifty-one patients were followed up for 6-60 months, and the median survival time was 38.0 months. During the follow-up period, 29 patients dead, 21 patients suffered from recurrence, and 12 patients suffered from metastasis. The cumulative survival rates of 1-, 3-, and 5-year were 76.1%, 54.7%, and 31.8% respectively after caudate lobectomy. ConclusionThe caudate lobectomy in treatment of malignant tumor at caudate lobe of liver is effective and feasible.
ObjectiveTo summarize experience of surgical treatment for hilar cholangiocarcinoma. MethodsFrom January 2009 to July 2011, 87 patients with hilar cholangiocarcinoma were enrolled into the department of Biliary and Pancreatic Surgery of the Second Affiliated Hospital of Harbin Medical University. The intra-and post-operative results were analyzed. ResultsOut of 87 cases, the resection rate was 67.8% (59/87). The radical (R0) resection rate was 48.3% (42/87), R1 resection rate was 11.5% (10/87), palliative (R2) resection rate was 8.0% (7/87). The patients were successfully got through the perioperative period, threre was no operative mortality. 1-year, 3-year, 5-year survival rates of the R0 resection group were 92.9% (39/42), 31.0% (13/42), 19.0% (8/42), respectively. No patient was alive more than 3 years in the groups of R2 resection and internal or external drainage. 1-year and 2-year survival rates of the R1 resection group were 70.0% (7/10) and 20.0% (2/10), respectively. 1-year survival rate of the R2 resection group was 57.1% (4/7). 1-year survival rate of the internal or external drainage group was 35.7% (10/28). 1-year, 3-year, and 5-year survival rates of the R1 resection group and R2 resection group were significantly lower than those of the R0 resection group (P<0.05). ConclusionFor hilar cholangiocarcinoma, radical resection is the only method to cure. Preoperative evaluation, percutaneous transhepatic cholangial drainage so as to relieve obstruction of biliary tract, proper liver resection and intraoperative pathology for resection margin are imperative guarantees lead to radical resection. Palliative resection might prolong survival time and improve quality of life.
ObjectiveTo investigate the feasibility and safety of subtotal hepatectomy with preservation of caudate lobe for extensive hepatolithiasis with atrophy of left and right hepatic lobe and obvious hypertrophy of caudate lobe.MethodThe clinicopathologic data of patient with hepatolithiasis whose left and right hepatic lobe atrophied and caudate lobe obviously hypertrophied admitted to the West China Hospital of Sichuan University in February 2020 were analyzed retrospectively.ResultsThe patient was in good general condition before the operation. The cardiopulmonary and kidney functions were normal. The liver function was Child-Pugh A grade, and the liver reserve function was good. The body surface area of the patient was 1.745 m2 and the standard liver volume was 1 235 mL. The volume of caudate lobe calculated by the 3D reconstruction of CT image was 735 mL, accounted for 59.5% of the standard liver volume. The patient was evaluated to be able to tolerate the operation. The patient successfully experienced the operation of subtotal hepatectomy with caudate lobe preservation. The postoperative liver function recovered well. The gastric tube was removed on the 4th day after the operation. The peritoneal drainage tube was removed on the 5th day after the operation. The patient was discharged on the 6th day after the operation. The postoperative pathological diagnosis: The intrahepatic bile duct was dilated with stones inside. A large number of inflammatory cell infiltrated around the bile duct. The fibrous tissue hyperplasia, small bile duct hyperplasia and inflammatory cell infiltration were observed in the portal area. The pathological changes were consistent with the changes of hepatolithiasis.ConclusionAccording to analysis results of this case, subtotal hepatectomy with preservation of caudate lobe is safe and feasible for hepatolithiasis patient with obvious atrophy of left and right hepatic lobe and obvious hypertrophy of caudate lobe.
The caudate lobe of the liver has always been regarded as the deepest segment, with most complicated anatomy. The surgeon’s understanding of the caudate lobe and its subsegments has undergone a complex and tortuous process. In recent years, the special view and fine anatomy of the caudate lobe in laparoscopic resection of caudate lobe of liver have been proved or challenged based on the traditional anatomical knowledge of the liver gross specimen, cast specimen and three-dimensional reconstruction. It is these validations and challenges that keep surgeons revising and restoring the caudate anatomy to its true form. This article will discuss these new ideas and describe the laparoscopic total caudate lobectomy in detail from the point of view of a laparoscopic surgeon.