Laparoscopic Isolated Caudate Lobectomy for Rectal Cancer Liver Metastasis

Abstract

Summary: Metastatic tumor in the caudate lobe is difficult to manage and laparoscopic caudate lobectomy is regarded as a difficult procedure because of the deep location of the caudate lobe and its proximity to great vessels. Isolated caudate lobectomy is still rare and technically challenging. Therefore, we present a Case of a female patient who underwent laparoscopic isolated caudate lobectomy for liver metastasis of rectal cancer. A 58-year-old female was visited due to change in stool caliber. On the colonoscopy, mid rectal cancer was found. Surveillance computed tomography and magnetic resonance imaging showed 2cm metastatic liver mass in caudate lobe. We performed laparoscopic isolated caudate lobectomy for liver metastasis and laparoscopic low anterior resection for rectal cancer cooperatively. The caudate lobe was freed from the IVC and venous ligament. The short hepatic veins and the portal branches to the caudate lobe were ligated with clips. The procedure was completed totally laparoscopic technique. The operative time was 125 minutes. The intraoperative blood loss was minimal and the patient was safely discharged on the seventh postoperative day without perioperative complication. Pathology analysis showed a 2.4 × 2.1 × 2.1 cm metastatic adenocarcinoma with tumor-free resection margin. CT scan at 3 months after the operation showed complete removal of the caudate lobe with no evidence of recurrence. Our experience lobectomy demonstrated that laparoscopic caudate lobectomy is safe and feasible in patients with malignancy in caudate lobe.