Caudate lobectomy: tumor location, topographic classification, and technique using right- and left-sided approaches to the liver

doi:10.1016/j.amjsurg.2007.11.020

The American Journal of Surgery

Volume 196, Issue 2, August 2008, Pages 245-251

https://doi.org/10.1016/j.amjsurg.2007.11.020 Get rights and content

Abstract

Background

Resection of the caudate lobe (involving segments I [dorsal sector] and/or IX [right paracaval region]) often presents a technical challenge. It is difficult to perform because of its deep location and adjacency to the major hepatic vessels (ie, the left and middle hepatic veins).

Methods

A literature review was performed based on a Medline search to identify articles on caudate lobectomy published from 1990 to 2005. This article describes the right and left-sided approaches to the liver for caudate resection according to caudate lobe tumor location and topographic classification.

Results

The results of 377 lobectomies were analyzed in this review. The left-sided approach to the liver was used in 55 (14.58%), the right-sided approach in 24 (6.36%), and both approaches in 298 (79.04%) caudate lobectomies. Primary benign and malign liver tumors, as well as secondary liver tumors, were resected.

Conclusions

Access to and resection of the caudate lobe should be determined on the basis of tumor location and hepatic function. The left or right approach to the caudate lobe can be recommended for local resection of tumor located at Spiegel's portion or process portion. Approaches to caudate lobectomy are therefore largely dependent on size and location of the lesion, type of associated resection, and presence of scarring from previous resection.

Section snippets

Patients and Methods

A literature review was performed based on a Medline search to identify articles on the right- and left-sided approaches to the liver for caudate lobectomy published from 1990 to 2005.

Results

Data on 377 caudate lobectomies were analyzed in this review. The left-sided approach to the liver was used in 55 (14.58%), the right-sided approach in 24 (6.36%), and both right- and left-sided approaches in 298 (79.04%) caudate lobectomies. Primary benign and malign liver tumors, as well as secondary liver tumors, were resected (Table 1).

Comments

The caudate lobe is generally divided into 3 regions: the left Spiegel lobe, the process portion, and the paracaval portion. Kumon² studied the anatomy of the paracaval portion and concluded that this portion is the liver parenchyma ventral to the hepatic IVC, between the Spiegel lobe and the right lobe, and adjacent to middle hepatic ventrally. Couinaud³ also confirmed the existence of a paracaval portion in the caudate lobe and classified this portion separately as segment IX.

Resection of the

Acknowledgments

The authors thank Marcos Retzer for the illustrations in this article.

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Cited by (38)

Middle hepatic vein variation provides a safe path for anterior transection of hepatocellular carcinoma in caudate lobe
2023, Hepatobiliary and Pancreatic Diseases International
Robotic anatomic isolated complete caudate lobectomy: Left-side approach and techniques
2021, Asian Journal of Surgery
Citation Excerpt :
Depending on the location and nature of the pathological changes, isolated caudate lobectomy can be differentiated as either a partial caudate lobectomy or a complete caudate lobectomy. There are four surgical approaches to caudate lobectomy in open surgery, namely a left-sided approach, a right-sided approach, a left and right combined approach, and a central approach.24–26 This study is the first to report the surgical procedures and key techniques of the left-sided approach for robotic anatomical isolated complete caudate lobectomy.
To demonstrate the surgical procedures and techniques of the robotic anatomical isolated complete caudate lobectomy.
A retrospective analysis was performed on the demographic, operative, postoperative outcomes of seven patients who underwent robotic anatomical isolated complete caudate lobectomy at our department from January 2018 to November 2019. Mobilization of the left lateral and Spiegel lobe, dissection of the short hepatic veins and liver parenchyma transection from the dorsal plane of middle and right hepatic vein were crucial procedures for the robotic left-side approach. Anatomic complete caudate lobectomy was defined as total removal of the caudate lobe, in which the dorsal middle and right hepatic vein, the inferior vena cava and its right side were fully exposed on the raw surface.
All patients successfully underwent the robotic anatomical isolated caudate lobectomy with a left-side approach without conversion to laparotomy, and without Clavien-Dindo Grade III or higher complications. The average tumor diameter was 65.00 ± 10.61 mm, the average operation time was 212.00 ± 74.53 min, the median bleeding loss was 100 mL, and the average postoperative hospital stay was 8.71 ± 4.89 d, respectively. There were four patients with primary hepatocellular carcinoma, one with tumor recurrence five months after surgery and three patients were free of recurrence. All patients survived at the last follow-up.
Robotic anatomical isolated complete caudate lobectomy with a left-sided approach is safe and feasible for selected patients.
Robotic isolated partial and complete hepatic caudate lobectomy: A single institution experience
2020, Hepatobiliary and Pancreatic Diseases International
Citation Excerpt :
With further understanding of the caudate lobe anatomy, reports on laparoscopic resection of the hepatic caudate lobe have been gradually increasing [4–11], but it is still considered technically challenging and demanding [12]. According to the nature, location, and size of caudate lobe tumors as well as liver function, isolated caudate lobectomy can be categorized into partial and complete caudate lobectomy [13,14]. Partial caudate lobectomy includes Spiegel lobectomy, caudate process lobectomy, and paracaval portion lobectomy.
Current reports on robotic hepatic caudate lobectomy are limited to Spiegel lobectomy. This study aimed to compare the safety and feasibility of robotic isolated partial and complete hepatic caudate lobectomy.
Clinical data of 32 patients who underwent robotic resection of the hepatic caudate lobe in our department from May 2016 to January 2020 were retrospectively analyzed. The patients were divided into three groups according to the lobectomy location: left dorsal segment lobectomy (Spiegel lobectomy), right dorsal segment lobectomy (caudate process or paracaval portion lobectomy), and complete caudate lobectomy. General information and perioperative results of the three groups were compared and analyzed.
Among the 32 patients, none had conversion to laparotomy, three received intraoperative blood transfusion (9.38%), and none had complications of Clavien-Dindo grade III or higher or died in the perioperative period. Among them, 17 patients (53.13%) underwent Spiegel lobectomy, 7 (21.88%) underwent caudate process or paracaval portion lobectomy, and 8 (25.00%) underwent complete caudate lobectomy. The operative time and blood loss in the left dorsal segment lobectomy group were significantly better than those in the right dorsal segment lobectomy and complete caudate lobectomy groups (operative time: P = 0.010 and P = 0.005; blood loss: P = 0.005 and P = 0.017, respectively). The postoperative hospital stay in the left dorsal segment lobectomy group was significantly shorter than that in the complete caudate lobectomy group (P = 0.003); however, there was no difference in the postoperative hospital stay between the left dorsal segment lobectomy group and right dorsal segment lobectomy group (P = 0.240).
Robotic isolated partial and complete caudate lobectomy is safe and feasible. Spiegel lobectomy is relatively straightforward and suitable for beginners.
Isolated caudate lobectomy: Left-sided approach. Case reports
2017, International Journal of Surgery Case Reports
Citation Excerpt :
Therefore, it has been considered a dangerous operation. The characteristic of the tumor, location, size and the hepatic functional reserve are factors that should be taken into account when we choose the approach [1,3,5]. Some approaches have been described to access and resect tumors of the caudate lobe, including the left-sided approach, right-sided approach, combined left- and right-sided approach and the anterior transhepatic approach.
The caudate lobe is a distinct liver lobe and surgical resection requires expertise and precise anatomic knowledge. Left-sided approach was described for resection of small tumors originated in the Spiegel lobe but now the procedure has been performed even for tumors more than five centimeters. The aim of this study is to present three cases of tumor of caudate lobe underwent isolated lobectomy by left-sided approach.
Three patients with metastasis of colorectal cancer, carcinoma hepatocellular and metastasis of neuroendocrine tumor underwent resection. After modified Makuuchi incision, early control of short hepatic e short portal veins before hepatectomy was performed. The operative time was 200, 270 and 230 min respectively. No blood transfusion was used and no postoperative complications were observed. The length of stay was 7, 11 and 5 days respectively.
Some approaches have been described to access and resect tumors of the caudate lobe, including the left-sided approach, right-sided approach, combined left- and right-sided approach and the anterior transhepatic approach. For liver resection in patients with malignant disease, parenchymal preservation is important in order to avoid postoperative liver failure or due to the risk of second hepatectomy. In these patients isolated caudate lobectomy is a safe option.
Isolated caudate lobectomy is a feasible procedure. Left-sided approach can be preformed even for tumors larger than 5 cm.
Three-dimensional volumetry in 107 normal livers reveals clinically relevant inter-segment variation in size
2014, HPB
Citation Excerpt :
The single exception to Couinaud's definitions applied to the calculation of the volume of segment I. Couinaud's definition of the caudate lobe is an exception as it is based not on portal perfusion, but on morphological segmentation. Therefore, Kumon's definition of the caudate lobe was applied, in which segment I consists of the Spiegel lobe, paracaval portion and caudate process according to portal perfusion.26,27 The branches of the paracaval portion were defined as the branches arising from the first-order branches of the portal vein and running toward the cranial side, along with the inferior vena cava, and were differentiated from the aberrant P7 which arose from the first-order branch and ran toward the dorsal side.
The anatomic resection of Couinaud's segments is one of the key techniques in liver surgery. However, the territories and volumes of the eight segments are not adequately assessed based on portal branching.
Three-dimensional (3D) perfusion-based volumetry was performed in 107 normal livers. Based on Couinaud classification, the portal branches were identified and the volumes of each segment were calculated. The relationships between branching patterns of the portal veins and segmental volumes were assessed.
In descending order of volume, median volumes of segments VIII, VII, IV, V, III, VI, II and I were recorded. Segment VIII was the largest, accounting for a median of 26.1% (range: 11.1–38.0%) of total liver volume (TLV), whereas segments II and III each represented <10% of TLV. In 69.2% of subjects, the portal branches of segment V diverged from the trunk of the branches of segment VIII. No relationship was found between branching type and segment volume.
The territories and volumes of Couinaud's segments vary among segments, as well as among individuals. Detailed 3D volumetry is useful for preoperative evaluations of the dissection line and of future liver remnant volume in anatomic segmentectomy.
Resection of the Caudate Lobe
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ReviewCaudate lobectomy: tumor location, topographic classification, and technique using right- and left-sided approaches to the liver

Abstract

Background

Methods

Results

Conclusions

Section snippets

Patients and Methods

Results

Comments

Acknowledgments

Surgery

Surgery

J Am Coll Surg

Resection of the caudate lobe of the liver

Surg Gynecol Obstet

Anatomy of the caudate lobe with special reference to portal vein and bile duct

Acta Hepatol Jap

The paracaval segments of the liver

J Hep Bil Pancr Surg