Abstract
Previously, isolated caudate lobectomy was rarely performed and the caudate lobe was usually resected along with other segments. Isolated caudate lobe resection is a challenging procedure even for an experienced surgeon. Our aim was to evaluate the feasibility, safety and outcomes of laparoscopic isolated caudate lobectomy and to compare these with the open technique. We retrospectively analyzed 21 patients who underwent isolated caudate lobectomy between January 2005 and December 2018 at Seoul National University Bundang Hospital. Patients who underwent either anatomical or non-anatomical resection of the caudate lobe were included. Patients were divided into two groups according to whether they underwent laparoscopic or open surgery. Intra-operative and postoperative outcomes were compared with a median follow-up of 43 months (4–149). A total of 21 patients were included in the study. Of these, 12 (57.14%) underwent laparoscopic and nine (42.85%) underwent open caudate lobectomy. Median operation time (204.5 vs. 200 minutes, p = 0.397), estimated blood loss (250 vs. 400 ml, p = 0.214) and hospital stay (4 vs. 7 days, p = 0.298) were comparable between laparoscopy and open group. The overall post operative complication rate was similar in both groups (p = 0.375). The 5-year disease free survival rate (42.9% vs 60.0%, p = 0.700) and the 5-year overall survival rate (76.2% vs 64.8%, p = 0.145) was similar between laparoscopy and open group. Our findings demonstrate that with increasing surgical expertise and technological advances, laparoscopic isolated caudate lobectomy can become a feasible and safe in selected patients.
Highlights
Isolated caudate lobectomy was rarely performed and the caudate lobe was usually resected along with other segments
Isolated caudate lobectomy is being increasingly performed because the caudate lobe is often the only site of involvement by metastases and hepatocellular carcinoma (HCC)
22 patients underwent isolated caudate lobectomyand were selected for this study
Summary
Isolated caudate lobectomy was rarely performed and the caudate lobe was usually resected along with other segments. For many years, isolated caudate lobectomy was rarely performed because surgeons preferred to resect the caudate lobe together with other liver segments. This is because isolated caudate lobectomy is technically challenging, even for experienced surgeons. The difficulty of this procedure is related to the deep, complex anatomic location of the caudate lobe and its proximity to major vessels, including the inferior vena cava (IVC), the ligamentum venosum, the middle and Right hepatic vein, and the left portal v ein[2] (Fig. 1). There is limited data comparing the outcomes of laparoscopic and open caudate lobectomy, primarily because isolated caudate lobectomy is rarely performed and is technically demanding. We analyzed and compared the short- and long-term outcomes between laparoscopic and open caudate lobectomy
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