Elsevier

Surgery

Volume 150, Issue 5, November 2011, Pages 959-967
Surgery

Original Communication
Prognosis of patients undergoing hepatectomy for solitary hepatocellular carcinoma originating in the caudate lobe

https://doi.org/10.1016/j.surg.2011.03.005Get rights and content

Background

Operative and nonoperative treatment for hepatocellular carcinoma (HCC) originating in the caudate lobe is regarded as challenging because of its deep location in the liver and possibly worse prognosis than HCC in other sites in the liver. The objective of this study is to investigate the clinicopathologic factors and survival of patients who underwent hepatectomy for solitary HCC originating in the caudate lobe.

Methods

A retrospective review of 783 patients who underwent curative hepatectomy for solitary HCC between 1988 was performed. Clinicopathologic factors and survival rate of 46 (5.9%) patients with HCC originating in the caudate lobe were compared with those of 737 (94%) patients with HCC arising in other sites.

Results

The clinical backgrounds of patients with HCC in the caudate lobe and in other sites were comparable. Hepatectomy for HCC in the caudate lobe was associated with greater operative time and blood loss than for HCC in other sites of the liver. Pathologically, HCC in the caudate lobe was associated with less frequent intrahepatic metastasis, lesser operative margins, and more frequent tumor exposure than HCC in other sites. Overall and disease-free 5-year survival rates of the 46 patients with solitary HCC in the caudate lobe were 76% and 45%, respectively; no significant difference was observed in the overall or disease-free survival rates between the 2 groups (P = .07 and P = .77, respectively). Resection of HCC in the paracaval portion of the caudate lobe (n = 27) was associated with more frequent anatomic resection, greater operative time and blood loss, and a lesser operative margin than HCC in the Spiegel lobe or caudate process (n = 19).

Conclusion

Resection for HCC in the caudate lobe, especially in the paracaval portion, remains technically demanding. The prognosis of patients with solitary HCC in the caudate lobe, however, was as good as that of patients with solitary HCC in other sites in the liver.

Section snippets

Study population

Between 1988 and 2010, a total of 783 patients with solitary HCC underwent resection in the National Cancer Center Hospital, Tokyo. Patients with multiple HCCs found during preoperative imaging studies were excluded from the study, whether the HCCs represented intrahepatic metastases or multicentric occurrence. Included in the study were patients with macroscopically solitary HCC with intrahepatic metastases that could not be detected during preoperative imaging studies but were found during

Comparison of the resection outcomes of 46 patients with HCC in the caudate lobe and 737 patients with HCC in other sites in the liver

The background characteristics of patients with HCC in the caudate lobe and patients with HCC in other sites in the liver are shown in Table I. No significant difference in sex, hepatitis virus, hepatic function, laboratory data, and tumor markers were observed between the 2 groups. Operative and histopathologic parameters of all patients are shown in Table II.

Details of the operative procedures for HCC in the caudate lobe are summarized in Fig 1. The 46 patients underwent the following

Discussion

In the present study, no significant difference was observed in the background characteristics of patients who underwent hepatectomy for solitary HCC in the caudate lobe and in other sites. Hepatectomy for solitary HCC in the caudate lobe was more technically demanding than that for solitary HCC in other sites, a difference that was associated with greater operative times and blood loss, and lesser negative operative margins. Nevertheless, the 5-year overall and disease-free survival rates of

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    Supported in part by a grant-in-aid for scientific research from the Ministry of Health and Welfare of Japan.

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