Caudate lobe malignant tumour: proposal of the morphological classification and correspondent liver resection

Abstract

Introduction: Caudate lobe resection is a difficult and challenging operation even with hepatobiliary surgeons because of its deep location in the hepatic parenchyma and vascular involvement (beneath the root of hepatic veins, above the confluence of hepatic pedicle and in front of the inferior vena cava). Caudate lobe resection may be performed in isolation (partial or complete) or in combination with other portions of the liver depending on its size, location and vascular involvement. Method: From 2004 to 2018, There were 23 patients of caudate lobe tumour resected. Among these, 14 patients resected due to malignant solitary tumour (12 hepatocellular carcinoma patients, 1 cholangiocarcinoma patient and 1 colorectal liver metastasis patient). We morphologically classified the caudate lobe malignant solitary tumour into 5 types, illustrated with the correspondent liver resection (images and videos) and evaluated postoperative result. Result: Type 1: Tumour located in Spiegel lobe (7 patients), Type 2: Tumour located in S1r or S1c, without invading to right or left glissonean pedicle and 3 hepatic veins (2 patients), Type 3 (Subtype A, B, C): Tumour located in S1r or S1c, without invading to right or left glissonean pedicle but invading to hepatic veins (4 patients), Type 4: tumour located in S1r or S1c invading to right or left glissonean pedicle (1 patient), Type 5: Tumour invading to both right and left glissonean pedicle – contraindication for liver resection. There were no major postoperative complications (bile leakage, hemorrhage, hepatic failure…). No postoperative blood transfusion. The average operation time and hospital stay was respectively 265 (110-350) minutes and 14 days (8-29 days). Conclusion: For radical liver resection, the resection of caudate lobe malignant tumour could be carried out the isolated caudate lobe resection (partial or complete) or in combination with other portions of liver and should be based on the location, size and vascular involvement.