Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 7, 2012; 18(29): 3904-3909
Published online Aug 7, 2012. doi: 10.3748/wjg.v18.i29.3904
Choice of approach for hepatectomy for hepatocellular carcinoma located in the caudate lobe: Isolated or combined lobectomy?
Peng Liu, Bao-An Qiu, Gang Bai, Hong-Wei Bai, Nian-Xin Xia, Ying-Xiang Yang, Jian-Yong Zhu, Yang An, Bing Hu
Peng Liu, Bao-An Qiu, Gang Bai, Hong-Wei Bai, Nian-Xin Xia, Ying-Xiang Yang, Jian-Yong Zhu, Yang An, Bing Hu, Department of Hepatobiliary Surgery and Liver Transplantation Surgery, Navy General Hospital, Beijing 100048, China
Author contributions: Liu P performed liver resection, collected and analyzed the data, and drafted the manuscript; Qiu BA performed liver resection, designed the study, collected and analyzed the data, and revised the manuscript; Bai G, Bai HW, Xia NX, Yang YX, Zhu JY, An Y and Hu B collected the data and coordinated the work.
Correspondence to: Bao-An Qiu, MD, Professor, Department of Hepatobiliary Surgery and Liver Transplantation Surgery, Navy General Hospital, Beijing 100048, China. qiubaoannavy@163.com
Telephone: +86-10-66958512 Fax: +86-10-66958512
Received: November 6, 2011
Revised: April 5, 2012
Accepted: April 12, 2012
Published online: August 7, 2012
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.

Keywords: Hepatocellular carcinoma, Hepatectomy, Caudate lobectomy, Caudate lobe, Combined resection