Treatment experience and efficacy of precise surgery for hepatic caudate lobe involved lesions

Abstract

Objective To explore the treatment experience and efficacy of precise surgery for hepatic caudate lobe involved lesions. Methods The retrospective cross-sectional study was conducted. The clinico-pathological data of 127 patients with hepatic caudate lobe involved lesions who were admitted to Hunan Provincial People′s Hospital between January 2012 and December 2016 were collected, including 71 of malignant tumors, 52 of benign lesions and 4 of other diseases. Anatomical hepatectomy was performed in patients via left approach, right approach, anterior approach, left combined with right approach, left and right combined with anterior approach, left and right combined with para-liver hanging tape approach, anterior combined with left approach, retrograde approach according to their conditions. Observation indicators: (1)intraoperative and postoperative recovery situations; (2) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was done to detect postoperative survival of patients up to February 2018. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range). Kaplain-Meier method was used to calculate survival rate. Results (1) Intraoperative and postoperative recovery situations: all the 127 patients underwent successful operation without perioperative death, including 111 of open surgery and 16 of laparoscopic surgery. Of 127 patients, single total caudate lobectomy and partial caudate lobectomy were performed in 2 and 13 patients, single hepatic segmentectomy combined with total caudate lobectomy, double hepatic segmentectomy combined with total caudate lobectomy, hepatic trisegmentectomy combined with total caudate lobectomy, left hemitectomy combined with total caudate lobectomy, left hepatic trilobectomy combined with total caudate lobectomy, right hemitectomy combined with total caudate lobectomy, right hepatic trilobectomy combined with total caudate lobectomy were performed in 6, 4, 5, 1, 1, 30, 3 patients respectively, single hepatic segmentectomy combined with partial caudate lobectomy, double hepatic segmentectomy combined with partial caudate lobectomy, left hemitectomy combined with partial caudate lobectomy, left hepatic trilobectomy combined with partial caudate lobectomy, right hemitectomy combined with partial caudate lobectomy, right hepatic trilobectomy combined with partial caudate lobectomy were performed in 3, 3, 41, 2, 5, 8 patients respectively, including 78 via left approach, 29 via right approach, 2 via anterior approach, 7 via left combined with right approach, 2 via left and right combined with anterior approach, 6 via left and right combined with para-liver hanging tape approach, 1 via anterior combined with left approach, 2 via retrograde approach. The operation time, time of first hepatic hilum occlusion, volume of intraoperative blood loss and duration of postoperative hospital stay were 285 minutes (range, 188-670 minutes), 47 minutes(range, 30-150 minutes), 294 mL(range, 20-2 500 mL) and 10 days (range, 6-27 days) respectively. Thirty-four patients had postoperative complications, including 21 with abdominal ascites, 20 with pleural effusion, 6 with incisional infection, 5 with hemorrhage, 4 with bile leakage, 2 with pulmonary infection (1 patient combined with multiple complications). One patient underwent reoperation after ineffective conservative treatment for hemorrhage within postoperative 24 hours and other 33 were cured by conservative treatment. (2) Follow-up and survival situations: of 127 patients, 124 including 68 of malignant tumors and 56 of non-malignant tumors were followed up for 2-71 months with a median time of 33 months. During the follow-up, 1-, 3-, 5-year overall survival rates were 83.1%, 63.4%, 22.5% in 68 patients with malignant tumors, 89.3%, 71.4%, 57.1% in 28 patients with hilar cholangiocarcinoma and 76.9%, 46.2%, 23.1% in 26 with hepatocellular carcinoma. All the 56 patients with non-malignant tumors survived well. Conclusions Anatomical hepatectomy using precise surgery is safe and feasible. Preoperative precise evaluation and surgical procedure design, intraoperative vascular control and surgical plane mastering are keys to success. Key words: Liver neoplasms; Cholelithiasis; Caudate lobe; Precision hepatic surgery; Anatomal hepatectomy; Hepatectomy; Surgical approach; Complications