Caudate Hepatocellular Carcinoma Research Articles

Fogarty-assisted flow redirection during conventional transarterial chemoembolization for caudate lobe hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. Approximately 8% of patients with HCC are not suitable candidates for curative options. Caudate lobe HCC presents technical challenges for interventional radiologists. Caudate lobe HCC has higher local recurrence and poorer survival rate than other segments. Transarterial treatments of caudate HCC are difficult due to extreme variation of arterial supply. We present a case of a caudate lobe HCC with supply from the proper hepatic artery, which underwent successful conventional transcatheter arterial chemoembolization (cTACE) by utilizing a Fogarty catheter to direct the embolic material. The patient presented 5 days following the procedure with duodenitis and pancreatitis, which were managed conservatively. Follow-up imaging at 1 month showed significant improvement of the ischemic duodenitis/pancreatitis with successful cTACE.

Surgical Strategy for Resecting Hepatocellular Carcinoma in the Caudate Lobe: Isolated or Combined Lobectomy? A Single-Center Study and Meta-Analysis.

BackgroundResection of hepatocellular carcinoma (HCC) originating in the caudate lobe remains challenging, while the optimal extent of resection is debated. We aimed to evaluate the relative benefits of combined caudate lobectomy (CCL) versus isolated caudate lobectomy (ICL) for caudate HCC.MethodsPatients who underwent curative-intent resection for caudate HCC between January 2010 and December 2018 were identified from a single-center database. Surgical outcomes of the two strategy groups were analyzed before and after propensity score matching. A systematic review with meta-analysis was also performed to compare outcomes of CCL versus ICL for caudate HCC.ResultsA total of 28 patients were included: 11 in the CCL and 17 in the ICL group. Compared with ICL, the CCL group contained patients with larger tumors and a higher incidence of vascular invasion. After propensity score matching, 6 pairs of patients were selected. In the well-matched cohort, CCL demonstrated significantly improved recurrence-free survival (RFS) (P = 0.047) compared with ICL; no significant differences were noted for overall survival (OS), operation time, blood loss and morbidity rate. A total of 227 patients from nine eligible studies and ours were involved in the systematic review. Meta-analysis revealed that CCL provided better RFS (hazard ratio 0.54, 95% confidence interval 0.31–0.92) than ICL; no significant differences were observed in OS, operation time, blood loss and morbidity rate.ConclusionCCL confers superior RFS over ICL without compromise of perioperative outcomes and should be prioritized for patients with caudate HCC when feasible, especially for those with large-sized tumors.

Treatment of Small Hepatocellular Carcinoma (≤2 cm) in the Caudate Lobe with Sequential Transcatheter Arterial Chemoembolization and Radiofrequency Ablation

To evaluate technical feasibility and treatment results of sequential transcatheter arterial chemoembolization (TACE) and cone-beam computed tomography-guided percutaneous radiofrequency ablation (CBCT-RFA) for small hepatocellular carcinoma (HCC) in the caudate lobe. Institutional review board approved this retrospective study. Radiologic database was searched for the patients referred to perform TACE and CBCT-RFA for small caudate HCCs (≤2cm) between February 2009 and February 2014. A total of 14 patients (12 men and 2 women, mean age; 61.3years) were included. Percutaneous ultrasonography-guided RFA (pUS-RFA) and surgery were infeasible due to poor conspicuity, inconspicuity or no safe electrode pathway, and poor hepatic reserve. Procedural success (completion of both TACE and CBCT-RFA), technique efficacy (absence of tumor enhancement at 1month after treatment), and complication were evaluated. Treatment results including local tumor progression (LTP), intrahepatic distant recurrence (IDR), overall survival (OS), and progression-free survival (PFS) were analyzed. Procedural success and technique efficacy rates were 78.6% (11/14) and 90.9% (10/11), respectively. Average follow-up period was 45.3months (range, 13.4-64.6months). The 1-, 3-, and 5-year LTP probabilities were 0, 12.5, and 12.5%, respectively. IDR occurred in seven patients (63.6%, 7/11). The 1-, 3-, and 5-year PFS probabilities were 81.8, 51.9, and 26%, respectively. The 1-, 3-, and 5-year OS probabilities were 100, 80.8, and 80.8%, respectively. Combination of TACE and CBCT-RFA seems feasible for small HCC in the caudate lobe not amenable to pUS-RFA and effective in local tumor control.

Chemoembolization of extrahepatic collateral arteries for treatment of hepatocellular carcinoma in the caudate lobe of the liver.

This study was designed to evaluate the efficacy and safety in performing chemoembolization of extrahepatic collateral arteries (EHC) for hepatocellular carcinoma (HCC) located in the caudate lobe. Between January 2006 and November 2013, chemoembolization via EHC was performed in 35 patients with 35 caudate HCCs. Preprocedural and follow-up CT or MR scans, angiographic images, and medical records were reviewed retrospectively in consensus. Chi-square analysis was used to evaluate the relationship between tumor characteristics and type of EHC and that between tumor response and the characteristics of the tumor and chemoembolization. In 31 (88.6 %) patients, EHCs supplying the caudate HCC originated from the right inferior phrenic artery (RIPA). The remaining four HCCs were supplied by the gastroduodenal artery, dorsal pancreatic artery, and right and left gastric arteries. Superselective catheterization of tumor-feeding vessels from the EHC was achieved in 27 patients (77.1 %). There were no major complications. Individual tumor response supplied by the EHC at follow-up contrast-enhanced CT were as follows: complete response (n = 18), partial response (n = 9), stable disease (n = 3), and progressive disease (n = 3). Non-RIPA EHCs were significantly more common in patients who had previously received chemoembolization via the RIPA (50 %) than those who had not (6.5 %; P = 0.01). There was no significant predictive factor associated with tumor response. HCC in the caudate lobe can be supplied by several EHCs. Chemoembolization via these arteries can be performed safely and effectively.

Role of C-Arm CT in Identifying Caudate Arteries Supplying Hepatocellular Carcinoma

PurposeTo evaluate the role of C-arm computed tomography (CT) performed at the proper hepatic artery or equivalent in patients with caudate-lobe hepatocellular carcinoma (HCC) for the detection of tumor-feeding arteries during chemoembolization. Materials and MethodsFrom July 2009 to June 2012, 1,785 patients received initial chemoembolization at a single institution. Among them, 52 patients with caudate HCC underwent initial chemoembolization with the use of C-arm CT. C-arm CT images were obtained at the proper hepatic artery or equivalent. Two radiologists reviewed the C-arm CT scans and angiograms in consensus. The cumulative local recurrence rate was calculated by the Kaplan–Meier method. ResultsTumor-feeding arteries were single (n = 31), double (n = 12), triple (n = 6), and quadruple (n = 3). Seventy-nine tumor-feeding arteries and their origins in 48 patients were demonstrated on C-arm CT. In four patients (7.7%), five tumor-feeding arteries were not clearly indicated on C-arm CT because of poor image quality caused by failure of the patients to hold their breath. Selective chemoembolization via tumor-feeding arteries was successful in 45 patients (87%). The cumulative local recurrence rates at 6 months, 1 year, and 3 years were 19.4%, 32.8%, and 35.8%, respectively. Nonselective chemoembolization of tumor-feeding arteries of caudate-lobe HCC was a significantly important factor in higher cumulative local recurrence rates (hazard ratio, 3.916; 95% confidence interval, 1.367–11.216; P = .011). ConclusionC-arm CT obtained at the proper hepatic artery or equivalent level can demonstrate most tumor-feeding arteries supplying HCCs in the caudate lobe.

Retrohepatic vena cava deroofing in living donor liver transplantation for caudate hepatocellular carcinoma

The removal of tumor together with the native liver in living donor liver transplantation for hepatocellular carcinoma is challenged by a very close resection margin if the tumor abuts the inferior vena cava. This is in contrast to typical deceased donor liver transplantation where the entire retrohepatic inferior vena cava is included in total hepatectomy. Here we report a case of deroofing the retrohepatic vena cava in living donor liver transplantation for caudate hepatocellular carcinoma. In order to ensure clear resection margins, the anterior portion of the inferior vena cava was included. The right liver graft was inset into a Dacron vascular graft on the back table and the composite graft was then implanted to the recipient inferior vena cava. Using this technique, we observed the no-touch technique in tumor removal, hence minimizing the chance of positive resection margin as well as the chance of shedding of tumor cells during manipulation in operation.

Laparoscopic radiofrequency ablation of solitary small hepatocellular carcinoma in the caudate lobe

Surgical resection in the treatment of hepatocellular carcinoma (HCC) originating in the caudate lobe is challenging because of its deep location in the liver and possibly worse prognosis. We evaluated the overall survival of patients with solitary caudate small HCC who underwent laparoscopic radiofrequency ablation (RFA). This is a retrospective study on patients who underwent laparoscopic RFA (RFA) for solitary small HCC. Twenty-seven (27) patients underwent laparoscopic caudate lobe RFA for solitary small HCC. The average tumor size was 2.8 cm. The overall survival rates were 96.3%, 88.9%, 74.1%, 74.1% and 62.9% at 1, 2, 3, 4 and 5 years respectively. The disease-free survival after RFA was 92.6%, 52.9%, 44.4%, 33.3% and 33.3% at 1, 2, 3, 4 and 5 years respectively. Most common postoperative complication was pleural effusion (7/27, 25.9%), and followed by transient hemoglobinuria (2/27, 7.4%). Laparoscopic RFA for caudate lobe small HCC is a safe and feasible procedure without perioperative mortality. Through a systematic review of other therapeutic options on caudate HCC, its overall outcome is comparable to that of surgical resection.

High dorsal resection for recurrent hepatocellular carcinoma originating in the caudate lobe

Standards that enable surgeons to balance radical operative procedures with functional preservation for recurrent hepatocellular carcinoma (HCC) in the caudate lobe have not yet been established. A 54-year-old man with recurrent HCC originating in the caudate lobe was readmitted to our hospital. The combined resection of the adjacent hepatic parenchyma may have carried a risk of postoperative liver failure. The anterior transhepatic approach may have caused massive bleeding due to the presence of scarring from the previous hepatectomy. Therefore, we performed an isolated total caudate lobectomy, i.e., a "high dorsal resection" as a second hepatectomy. The postoperative course of the patient was uneventful, and there has been no local recurrence 1 year after the repeat hepatectomy. Indeed a "high dorsal resection" is rarely required, but it is still ingenious, and this surgical modality can balance the curability with the hepatic functional reserve even for recurrent caudate HCC in patients with liver cirrhosis.

Hepatocellular Carcinoma in the Caudate Lobe of the Liver: Angiographic Analysis of Tumor-feeding Arteries According to Subsegmental Location

To investigate the tumor-feeding arteries in hepatocellular carcinoma (HCC) arising in the caudate lobe of the liver. From January 1998 to March 2004, 140 patients with 146 caudate HCCs underwent chemoembolization. Subsegmental location of the caudate HCC and the origin of the tumor-feeding arteries was determined with computed tomography and hepatic arteriography. On follow-up angiography at 6-96 months (mean, 24 months), changes in the tumor-feeding arteries were recorded. A total of 175 tumor-feeding arteries were identified. The tumors in the Spiegel lobe (n = 72) were supplied by tumor-feeding arteries derived from the right hepatic artery (RHA; n = 45), left hepatic artery (LHA; n = 30), and proper hepatic artery (PHA) or common hepatic artery (CHA; n = 6; P = .083, right vs left). In tumors in the paracaval portion (n = 42), the tumor-feeding arteries were derived more frequently from the RHA (n = 46) than the LHA (n = 3) or PHA/CHA (n = 2; P < .001). All the feeding arteries (n = 43) of the caudate process tumors (n = 32) were derived from the RHA (P < .001). During the follow-up period, there were replacements of the tumor-feeding arteries in 16 patients with recurrent tumors. An extrahepatic collateral supply for the recurrent tumors developed in 10 patients. The distribution of the origin of tumor-feeding arteries supplying caudate HCC is different according to tumors' subsegmental locations. When treating recurrent caudate HCC, it is important to identify replacement of tumor-feeding arteries and extrahepatic collateral supply.

Surgical outcome of patients with hepatocellular carcinoma originating in the caudate lobe

Background Hepatocellular carcinoma (HCC) originating in the caudate lobe is rare, and the treatment for this type of carcinoma is difficult because of its unique anatomic location. Methods This retrospective study assessed the surgical outcome of patients with caudate lobe HCC. There were 20 cases of HCC originating in the caudate lobe among 435 patients with primary HCC who underwent hepatic resection in our department from 1990 to 2002. The caudate tumors were located in the Spiegel lobe in 3 patients, the paracaval portion in 15 patients, and the caudate process in 2 patients. Surgical procedures consisted of limited resection of the caudate lobe in 6 patients and extended caudate lobectomy in 14 patients. Recurrence was recognized in 12 patients, including 8 patients with multiple intrahepatic recurrences, 1 with peritoneal dissemination, and 1 with lymph node metastasis. Results There was no significant difference in postoperative survival rate between patients who underwent limited resection of the caudate lobe and those who underwent extended caudate lobectomy. Compared with 415 patients with HCC originating in other locations, the 20 patients with caudate lobe HCC showed significantly more intraoperative blood loss ( P < .05), longer operation time ( P < .0001), and more postoperative complications ( P < .005). Intrahepatic recurrence was more frequent in the caudate lobe HCC compared with HCC originating in other locations (40% vs 17.6%; P < .05). There was a significantly poor survival rate in the postoperative patients with caudate HCC (25.9% vs 54.1% for five-year survival; P = .01). Intrahepatic multiple recurrences were frequently recognized in the patients with caudate lobe HCC, indicating no significance for extended caudate lobectomy. Conclusions Because of the relatively poor prognosis in patients with caudate lobe HCC, adjuvant therapy combined with surgical operation should be considered.

Efficacy of nonsurgical treatments for hepatocellular carcinoma in the caudate lobe.

To evaluate the efficacy of nonsurgical treatments for caudate hepatocellular carcinoma (HCC). Between January 1994 and February 2001, 25 patients were treated for HCCs with percutaneous ethanol injection (PEI), and/or transcatheter arterial embolization (TAE). PEI was performed for 19 caudate HCCs, combined treatment with PEI and TAE for 4 nodules, and TAE for 2 nodules. During follow-up periods ranging from 3 to 60 months (mean 21.3 months), 18 patients had no local recurrence. Local recurrence was seen in 7 patients, and recurrence in the other segments of the liver in 15 patients. Thirteen patients were alive, ranging from 6 to 60 months, and 12 patients died of multiple HCCs, hepatic failure, or rupture of esophageal varix. The 1-, 2-, 3-, and 5-year survival rates of the 25 patients were 70.6%, 60.2%, 48.1%, and 16.0%, respectively. PEI, PEI and TAE, or TAE would be an effective alternative treatment for HCC in the caudate lobe.