Abstract: Objective:To explore the clinical efficacy of total caudate lobectomy via anterior hepatic transaction in treatment of hepatic tumor involving paracaval portion of caudate lobe.
Methods:The retrospective crosssectional study was conducted. The clinical data of 72 patients with hepatic tumor involving paracaval portion of caudate lobe who were admitted to the Eastern Hepatobiliary Hospital of Second Military Medical University from August 2004 to May 2014 were collected. Of 72 patients, 49 had malignant hepatic tumors and 23 had benign hepatic tumors. Tumors of 43 patients exceeded caudate lobe of the liver and tumors of 29 patients didn′t exceed caudate lobe of the liver. According to hepatic tumor involving range, total caudate lobectomy via anterior hepatic transaction or mesohepatectomy with total caudate lobectomy were selected. Observation indicators: (1) operation situations: surgical procedures, hepatic vascular occlusion, time of the first hepatic hilum occlusion, operation time, volume of intraoperative blood loss, number of patient with blood transfusion; (2) postoperative recovery situations: duration of hospital stay, postoperative complications; (3) postoperative pathological examinations: surgical margin of malignant hepatic tumor; (4) followup. Followup using outpatient examination and telephone interview was performed to detect postoperative survival of patients up to August 2016. Measurement data with skewed distribution were described as M (range). Survival rate was calculated by the KaplanMeier method.
Results: (1) Operation situations: all 72 patients received successful total caudate lobectomy via anterior hepatic transaction, without perioperative death. Of 17 patients undergoing single total caudate lobectomy, 2 underwent the first hepatic hilum occlusion, 13 underwent the first hepatic hilum occlusion combined with hepatic veins occlusion and 2 underwent total hepatic vascular occlusion. Of 42 patients undergoing hepatic segment Ⅳresection combined with total caudate lobectomy, 12 received the first hepatic hilum occlusion, 27 received the first hepatic hilum occlusion combined with selective hepatic veins occlusion and 3 received total hepatic vascular occlusion. Of 13 patients undergoing hepatic segment Ⅳ, Ⅴ and Ⅷ resection combined with total caudate lobectomy, 2 received the first hepatic hilum occlusion and 11 received the first hepatic hilum occlusion combined with selective hepatic veins occlusion. Operation time, time of the first hepatic hilum occlusion, volume of intraoperative blood loss and number of patients with blood transfusion were 205 minutes (range, 120-445 minutes), 49 minutes (range, 24-139 minutes), 800 mL (range, 200-5 000 mL), 41 in all the 72 patients and 245 minutes (range,140- 345 minutes), 52 minutes (range, 29-75 minutes), 700 mL (range, 200-3 000 mL), 10 in 17 patients undergoing single total caudate lobectomy and 200 minutes (range, 120-370 minutes), 48 minutes (range, 24-120 minutes), 675 mL (range, 200-36 00 mL), 21 in 42 patients undergoing hepatic segment Ⅳ resection combined with total caudate lobectomy and 210 minutes (range, 145-300 minutes), 50 minutes (range, 26- 139 minutes), 1 000 mL (range, 300-5 000 mL), 10 in 13 patients undergoing hepatic segment Ⅳ, Ⅴ and Ⅷ resection combined with total caudate lobectomy, respectively. (2) Postoperative recovery situations: duration of hospital stay was 9 days (range, 7-18 days) in 72 patients. Twentyfive patients had postoperative complications, including 7 with effusion at surgical area, 5 with intraabdominal effusion, 4 with bleeding, 4 with bile leakage, 4 with pleural effusion and 1 with pulmonary infection. Four patients with bleeding received reoperation haemostasis. Other patients with complications were improved by symptomatic treatment. (3) Postoperative pathological examinations: of 49 patients with malignant hepatic tumors, surgical margin >5 mm was detected in 9 patients and 1 mm< surgical margin <5 mm was detected in 11 patients. Twentyseven patients without surgical margin had complete excision of tumors, and 2 patients had tumor rupture during the operation. (4) Followup: all the 72 patients were followed up for 6-141 months, with a median time of 46 months. The 1, 3, 5year overall survival rates and 1, 3, 5year tumorfree survival rates were 83.5%, 61.1%, 36.4%, 66.3%, 40.7%, 27.1% in 49 patients with malignant tumor, respectively. Twentythree patients with benign hepatic tumor had healthy living.
Conclusion:Total caudate lobectomy via anterior hepatic transaction is safe and feasible in treatment of hepatic tumor involving paracaval portion of caudate lobe and middle lobe.