Surgical outcomes of patients with hepatocellular carcinoma originating in the caudate lobe: a case-matched comparative study

Abstract

Objective To study the outcomes of surgical treatment for hepatocellular carcinoma (HCC) originating in the caudate lobe.Methods Between January 2001 and January 2007,114 consecutive patients underwent hepatic resection for HCC in the caudate lobe.From our prospectively collected database,114 patients with HCC in other locations of the liver and with comparable demographic details and tumor characteristics were selected for comparison.Their operative outcomes,recurrence and survival outcomes were analyzed.Results Patients with HCC in the caudate lobe had significantly longer operation time (mean,181.9 vs.124.6 minutes),longer vascular clamping time (mean,30.3 vs.22.4 minutes) and more intraoperative blood loss (mean,713.6 vs.321.4 ml).There was no significant difference in the complication rate (22.8％ vs.20.2％).Both groups had no in-hospital mortality.At a median follow-up of 47.8 months after surgery,53.5％ of patients with HCC in the caudate lobe developed tumor recurrence.At a median follow-up of 48.3 months after surgery,35.1％ of patients with HCC in other locations of the liver developed tumor recurrence.There were significant differences in the rates of tumor recurrence,but there were no significant differences in tumor recurrence patterns and time intervals of recurrence between the 2 groups of patients.The 1-,3-,and 5-year overall survival rates were 76.1％,54.7％,and 31.8％,respectively,for patients with HCC in the caudate lobe and 87.9％,77.5％,and 56.3％,respectively,for patients with HCC in other locations of the liver.The 1-,3,and 5-year disease-free survival rates were 65.7％,38.1％,and 18.4％,respectively,for patients with HCC in the caudate lobe and,78.2％,63.6％,and 44.7 ％,respectively,for patients with HCC in other locations of the liver.The differences in overall and disease-free survival rates between the 2 groups were significant (P=0.0001 and P=0.0012).Conclusions Caudate lobectomy with clear surgical margins remains a technical challenge.With adequate surgical resection,HCC in the caudate lobe had significantly different survival outcomes from HCC in other locations of the liver. Key words: Hepatocellular carcinoma; Caudate lobe; Hepatectomy; Prognosis