Abstract
BackgroundIsolated anatomic total caudate lobectomy is indicated in patients who have liver tumors limited to the caudate lobe. However, isolated caudate lobe resection is a challenging surgical procedure that required safe and reliable techniques. All portal and hepatic veins that connect this area originate from the first branch of the portal vein or vena cava; therefore, the operator must be cautious of the potential for massive bleeding.MethodsThe important points regarding the safety of our procedure include creating an optimal surgical view and preparing for accidental bleeding before parenchymal dissection. Sufficient mobilization and removal of Spiegel’s lobe from the left to the right side of the vena cava allows the operator to perform parenchymal dissection under a right- or front-side view.ResultsWe have performed this technique in two patients with HCC and one patient with primary cystadenocarcinoma. The average operative time and amount of blood loss were 435 min and 1137 ml, respectively. No operative mortalities or postoperative complications were observed in any of the patients. Our three patients are currently doing well without any recurrence.ConclusionOur modified high dorsal resection procedure can be used to safely remove the entire caudate lobe.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-016-0896-3) contains supplementary material, which is available to authorized users.
Highlights
Isolated anatomic total caudate lobectomy is indicated in patients who have liver tumors limited to the caudate lobe
We describe a safe technique for performing anatomic total caudate lobectomy of high dorsal resection approach
High dorsal resection requires a relatively long operative time, and a significant amount of intraoperative bleeding can occur compared with limited resection, the first priority is the postoperative prognosis of the patient
Summary
Patient Case 1 A small hepatocellular carcinoma (HCC) (diameter 5 mm) was detected in the paracaval caudate lobe of a 63-yearold female patient during a regular follow-up magnetic resonance imaging examination in 2012 (Fig. 2). Her indocyanine green retention rate at 15 min was 6 %. The caudate lobe was normally located in a deep area of the abdomen, the cutting line was moved upward due to the technique, and the parenchyma could be dissected from the front or right side under an optimal surgical view.
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