Caudate Iobectomy for huge liver neoplasms: a comparative study / 中华肝胆外科杂志

ABSTRACT

Objective To evaluate the optimal surgical approach for huge liver neopiasms in the caudate lobe.Methods Thirty-three patients with huge liver neplasms（≥10cm) underwent caudate lobectomy at a single tertiary referral center between January 2001 and June 2007.The surgical out-comes of pateints who underwent isolated caudate lobectomy or caudate lobectomy combined with partial hepatectomy were compared.Result Fifteen（45.5％）of 33 patients underwent isolated total or partial caudate lobectomy（group A）,whereas 18（54.5％) had total or partial caudate lobectomy cellular carcinoma (HCC) (51.5％),followed by hemangioma(21.2％),intrahepatic cholangiocarcinoma(9.1％),angiomyolipoma(6.1％),hepatic adenoma (3％),focal nodular hyperplasia(3％),colorectal liver metastases(3％)and sarcoma(3％).The median diameter of the tumour was 12.3 (range,10.2-21)cm.Patients in group A had significantly longer operative time (280 minutes vs.170 minutes),longer length of hospital stay (17 days vs.12 days)and more blood loss(1250 ml vs.670 ml) than patients in group B.There was no perioperative death in the 2 groups of pateints.Complication rates in group A and group B were 26.7％ and 16.7％ respectively.There was no disease-related death in patients with benign lesions.The1-,3- and 5-year disease-free survivals of patients with malignant lesions in group A and group B were 25.9％,0％,0％and 74.3％,46.7％,31.2％,respectively.The 1-,3- and 5-year overrall survivals were 68.6％,19.7％,0％ and 100％,66.5％,41.8％,respecively.Conclusion The approach to caudate lobectomy depends on the size and location of the lesion and the liver functional reserve.For patients with sufficient liver functional reserve,caudate lobectomy combined with partial hepatectomy is preferred because it is technically less demanding.For patienls with marginal liver functional reserve,isolated caudate lobectomy is the only viable surgical option.