Hepatocellular Carcinoma In Caudate Lobe Research Articles

Laparoscopic liver resection versus radiofrequency ablation for caudate lobe solitary hepatocellular carcinoma: A propensity score matching study.

This study aimed to compare the clinical efficacy of laparoscopic liver resection (LLR) and radiofrequency ablation (RFA) in treating solitary hepatocellular carcinoma (HCC) of the hepatic caudate lobe. Patients with hepatic caudate lobe HCC who underwent LLR or RFA at three hospitals in China between February 2015 and February 2021 were included. In total, 112 patients met the inclusion criteria, of whom 52 underwent RFA and 60 underwent LLR. The outcomes of the two groups were compared and analyzed using propensity score matching (PSM) method. There were no significant differences between the two groups in terms of sex, HBV/HCV positivity, AFP positivity (>100 ng/mL), tumor position, Child-Pugh score, or preoperative liver function tests (ALT, AST, TBIL, ALB, and PT) (p > 0.05). Compared to the LLR group, the RFA group had a shorter operation time, less intraoperative bleeding, and shorter postoperative hospital stay (p < 0.05). There was no statistically significant difference in overall postoperative complications between the two groups (p > 0.05). Despite the larger tumor size, the LLR group had better postoperative recurrence-free survival (RFS) (p = 0.00027) and overall survival (OS) (p = 0.0023) than the RFA group. After one-to-one PSM, 31 LLR patients and 31 RFA patients were selected for further analyses. The advantages of LLR over RFA were observed in terms of RFS (p < 0.0001) and OS (p = 0.00029). LLR should probably be recommended as the preferred method for solitary caudate lobe HCC.

Survival outcomes after caudate lobectomy for hepatocellular carcinoma: systematic review and meta-analysis.

Caudate lobectomy (CLB) remains the most effective treatment for caudate lobe hepatocellular carcinoma (CL-HCC). However, there is controversy regarding the survival after CLB. This meta-analysis aims to investigate the survival outcomes following CLB for the treatment of CL-HCC. In line with PRISMA and MOOSE guidelines, a search for all eligible studies was performed. The pooled estimates of survival rates and hazard ratios (HRs) with their 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. Sixteen studies comprising 864 patients met the inclusion criteria. The pooled estimates of 3- and 5-year overall survival (OS) rates were 62.3% and 42.9% respectively and the pooled estimate of 3- and 5-year recurrence-free survival (RFS) rates were 39.3% and 24.4% respectively. CL-HCC showed inferior OS (HR:1.39, 95% CI: 0.91-1.88, P < 0.001) and RFS (HR:1.33, 95% CI: 1.10-1.56, P < 0.001) than other sites HCC. Isolated CLB showed better OS (HR:0.9, 95% CI:0.39-1.41, p < 0.001) and RFS (HR:0.76, 95% CI: 0.03-1.5, P = 0.04) than combined CLB. The survival outcomes for CL-HCC after CLB are lower compared to other sites HCC. Isolated CLB offers better survival outcomes compared to combined CLB. However, choosing isolated or combined approaches should be prioritized according to patient and tumour characteristics.

Percutaneous ablative therapies for hepatocellular carcinoma in the caudate lobe of the liver: efficacy and outcome.

To assess the efficacy and outcomes of percutaneous ablative therapies for hepatocellular carcinoma (HCC) in the caudate lobe. Patients within Milan criteria, who underwent thermal ablation (RFA/MWA) for HCC were analyzed. Based on the inclusion-criteria, patients were categorized in two groups. Group-1 (caudate-lobe HCC) and Group-2 (non-caudate-lobe HCC). Both the groups were analyzed for technical success (TS), local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) were compared between both the groups. Predictive factors for LTP, DFS, or OS in the study cohort were analyzed using appropriate statistical analyses. Twenty-one patients qualified to be in Group-1 while 130 patients fulfilled the criteria for Group-2. TS of 90.5 and 97.7% was seen after the first session of ablation for Group-1 and group-2 respectively, while a TS of 95.2% (Group-1) and 100% (Group-2) was achieved after second session. The right-intercostal-approach was used in 66.7% (n = 14) and the anterior-epigastric-approach was used in 33.3% (n = 7) of patients having caudate-lobe HCC. Procedure-related complications in both the groups were comparable. Although, statistically insignificant, LTP in the Group-1 (19.5%, n = 4) was twice that of non-caudate lobe HCC (8.5%, n = 11). The cumulative DFS rate was better in Group-2 while OS in both groups were comparable. Multivariate analysis showed: tumor size and ablative margin of 5 mm being independent predictors of LTP after percutaneous-ablation of caudate-lobe HCC. Ablative therapies for HCC in caudate lobe is feasible and safe with comparable LTP and OS to non-caudate lobe HCC. Tumor size >2 cm and lack of 5 mm ablative margin are independent predictors of LTP. 1. Percutaneous ablation of caudate lobe HCC is feasible using anterior epigastric approach or right intercostal approach. 2. These approaches may allow a safe and effective ablation of caudate lobe HCC with results comparable to non-caudate HCC ablation.

Advances in the interventional therapy of hepatocellular carcinoma originating from the caudate lobe

Hepatocellular carcinoma originating from the caudate lobe, also known as segment I hepatocellular carcinoma, is difficult to treat because of its special location, complex vascular supply, and the proximity of important vessels, bile ducts, and organs. This research is conducted to examine the efficacy and safety of interventional therapy for hepatocellular carcinoma in the caudate lobe. ConclusionSuperselective chemoembolization and ablation techniques for the treatment of caudate lobe hepatocellular carcinoma still need to be improved. The combination of multiple interventional methods and the application of multiple imaging techniques can improve the effectiveness and safety of interventional therapy for hepatocellular carcinoma in the caudate lobe. Multidisciplinary treatment is also essential to improve the prognosis of patients with caudate lobe hepatocellular carcinoma.

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.

Comparison of percutaneous microwave ablation and surgical resection for hepatocellular carcinoma in the caudate lobe.

This study aims to compare the clinical efficacy and safety between ultrasound (US)-guided percutaneous microwave ablation (MWA) assisted with a three-dimensional (3D) visualization preoperative planning system and surgical resection (SR) for hepatocellular carcinoma (HCC) in the caudate lobe. Forty-nine patients diagnosed with caudate lobe HCC, who underwent US-guided percutaneous MWA (29 patients) or SR (20 patients), were enrolled between November 2005 and December 2018. Follow-up was performed at 1, 3, 6, 12, 18, 24, and 36 months after ablation or resection. The follow-up endpoint was recurrence or patient death. Overall survival (OS) and progression-free survival (PFS) were the primary outcomes, whereas local tumor progression (LTP), intrahepatic recurrence, and extrahepatic metastasis were the secondary ones. The mean age of the two groups was 61.4 ± 9.1 (MWA) and 53.1 ± 6.8 (SR), respectively, with a significant difference (P < 0.01). There were no significant differences in OS (69.0% in the MWA group and 75.0% in the SR group) and PFS (62.1% in the MWA group and 35.3% in the SR group). LTP, intrahepatic recurrence, and extrahepatic recurrence were 6.9% (2/29), 31.0% (9/29), and 20.7% (6/29) in the MWA group and 5.0% (1/20), 60.0% (12/20), and 5.0% (1/20) in the SR group. The MWA group was more cost-effective and required less hospitalization time. No major complications were observed. US-guided percutaneous MWA for HCC in the caudate lobe assisted with a 3D visualization preoperative planning system is an optional treatment with less expenses and shorter hospitalization than SR.

Percutaneous Radiofrequency Ablation Treatment of Hepatocellular Carcinoma in Caudate Lobe Using Expandable Electrodes

Objective: To evaluate the outcome of radiofrequency (RF) ablation using expandable electrodes in the treatment of hepatocellular carcinoma (HCC) located in the caudate lobe. Materials and Methods: Between January 2011 and April 2017, 29 consecutive patients with HCC at the caudate lobe were treated with RF ablation using expandable electrodes. The electrodes were placed on the targeted tumor under combined ultrasound and computed tomography (CT) guidance for each tumor in all the patients. Out of the 29 cases, 19 (65.5%) were accessed via the left hepatic lobe. The technical success, primary efficacy, local tumor progression, secondary efficacy, overall survival, and complications were evaluated. Univariate analysis was performed of the various prognostic factors for technical success, primary efficacy, and local tumor progression. Results: The technical success rate was 86.2%, primary efficacy was 89.7%, and secondary efficacy was 82.8%. The local tumor progression (LTP) rate was 12.3% at one year and 31.5% at two years. The median time of LTP was 6.9 months. The overall survival rate was 85.8% at one year and 57.1% at two years. Ten patients died during the follow-up period (mean 22.5 months; with a range of 3.6–53.2 months). A minor complication of asymptomatic biloma was found in one patient (3.5%). Small-sized tumors (≤2 cm) and Spiegel’s lobe location had significantly better treatment outcomes (p = 0.007 and 0.045, respectively). Conclusion: Radiofrequency ablation using expandable electrodes is feasible and safe in treating HCCs located in the caudate lobe, especially for small-sized tumors (≤2 cm).

Curative effect analysis of ultrasound-guided percutaneous radiofrequency ablation for caudate lobe hepatocellular carcinoma

Objective: To investigate the safety and efficacy of ultrasound-guided percutaneous radiofrequency ablation (RFA) for caudate lobe hepatocellular carcinoma (HCC) and the failure factors of incomplete tumor ablation. Methods: Twenty-four cases with caudate lobe hepatocellular carcinoma who underwent ultrasound-guided percutaneous RFA in the Affiliated Tumor Hospital of Zhengzhou University from January 2017 to October 2019 were enrolled. The ablation effect and complications conditions were recorded, and the primary technical effectiveness and local tumor progression (LTP) were evaluated. Results: Among 24 cases, 20 cases had complete ablation at one session, 4 cases had incomplete ablation, and after supplementary radiofrequency ablation all cases had achieved complete ablation. There was no evidence of local tumor progression in 24 cases after one-month postoperative evaluation. The primary technical effectiveness rate was 100%. The postoperative follow-up was 2 to 29 months (median follow-up time was 18 months). Of the 24 cases after ablation, LTP were detected in 11 cases, of which only 3 cases had distant intrahepatic recurrence, 1 case had distant intrahepatic recurrence and distant metastasis, and 5 cases had only distant metastasis, 2 cases died, and 4 cases had SIR grade B complications related to ablation. Conclusion: Ultrasound-guided percutaneous radiofrequency ablation was safe and effective for caudate lobe hepatocellular carcinoma. In addition, the distance between the tumor and the inferior vena cava < 0.5cm is a suspected risk factor for incomplete ablation of caudate lobe hepatocellular carcinoma (P < 0.05).

Long-term clinical outcomes of patients receiving proton beam therapy for caudate lobe hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) located in the caudate lobe (caudate HCC) is rare; however, patients with this type of tumour have poorer prognoses than those with HCC in other segments. Despite many published reports on the clinical usefulness of proton beam therapy (PBT) for HCC, data on the clinical outcomes of patients undergoing PBT for caudate HCC remain scarce. Therefore, the present study aimed to investigate the outcomes of this group of patients. Thirty patients with caudate HCC who underwent definitive PBT between February 2002 and February 2014 were retrospectively analysed. The total irradiation doses ranged from 55 to 77 (median 72.6) Gy relative biological dose. The median follow-up period was 37.5 (range, 3.0–152.0) months. The overall survival (OS) rates at one, three and five years were 86.6%, 62.8% and 46.1%, respectively. According to univariate and multivariate analyses, Child-Pugh A (P < 0.01), having a single tumour (P = 0.02) and a low serum alpha-fetoprotein level (AFP; P < 0.01) were significant factors predicting longer survival. The local control (LC) rates at one, three and five years were 100%, 85.9% and 85.9%, respectively, while the corresponding progression-free survival (PFS) rates were 65%, 27.5% and 22%, respectively. No grade 3 or worse adverse events were observed. PBT is effective and safe for the treatment of caudate HCC, and should therefore be considered a feasible option for intervention in patients with this disease.

Resection of caudate lobe hepatocellular carcinoma with enbloc IVC resection and replacement

Presenter: Iswanto Sucandy MD | AdventHealth Tampa Background: This video describes how we undertook the resection of the caudate lobe for hepatocellular carcinoma with enbloc IVC resection and replacement. Methods: The patient is a 74-year-old man who present with a 6 cm caudate lobe mass. Patient has a history of Hepatitis C with liver cirrhosis (Child A). Workup included an MRI which showed the caudate lobe mass circumferentially invading the IVC. A percutaneous biopsy confirmed hepatocellular carcinoma. Results: The operation began with a complete mobilization of the left hemiliver. The falciform ligament was taken down to the hepatocaval confluence. The gastrohepatic ligament was then opened in a stellate fashion along the Arantius ligament, which was dissected all the way up to the origin of the left hepatic vein. Dissection along the caudal border of the tumor was undertaken by following the common hepatic artery, which was displaced by the tumor mass. The common hepatic artery lymph nodes were removed. The pancreas was then exposed and retracted caudally. The left gastric artery was involved by the tumor; therefore, it was isolated and transected with a laparoscopic vascular load stapler. The minor curvature of the stomach was dissected all the way up to the crus. The pars flaccida was open to show the anatomical landmarks of this operation. The gallbladder was then removed. Next, the Arantius ligament was ligated and divided. The hepatic artery and portal vein branches to the caudate lobe were isolated and divided. The duodenum was widely kocherized to access the retroduodenal IVC just above the left renal vein. The right gonadal vein was preserved. The entire retrohepatic IVC was removed after applying cross-clamping on the IVC (proximal vascular clamp was placed immediately caudal to the root of the hepatic veins and the distal vascular clamp was placed through the retroduodenal space behind the head of the pancreas). A 16mm woven Dacron vascular conduit was used for the IVC replacement. Once the graft-IVC anastomosis was completed, the IVC was unclamped. A vascular Doppler was utilized to check the flow within the vena cava conduit. Conclusion: Patient tolerated the procedure well and had an uneventful recovery. Pathology confirmed a 10 cm enbloc mass containing caudate lobe hepatocellular carcinoma and retrohepatic IVC. There was an absence of lymphatic invasion. Patient was discharged on post-operative day 4 after ambulating and tolerating oral diet.

The Clinical Efficacy of Surgical Removal of Hepatocellular Carcinoma in Caudate Lobe in the Chinese Population: A Case-control Study.

Our aims were to compare the therapeutic efficacy of surgical resection of caudate lobe hepatocellular carcinoma and noncaudal lobe hepatocellular carcinoma in the Chinese population. The study group consisted of 220 patients undergoing caudate lobe hepatectomy during the period spanning from January 2003 to November 2017, and 220 patients with caudate lobe hepatectomy were selected as the control group. There were 142 cases (64.5%) of surgical margin of R0 in patients with caudate lobe liver cancer, and 178 cases (80.9%) of surgical margins in patients with noncaudal lobe liver cancer, and the difference was statistically significant (P<0.01) between the 2 groups. Compared with noncaudal lobe liver cancer patients, caudate lobe liver cancer patients had significantly longer operation time (186.65±81.36 vs. 118.85±69.23, P<0.01), longer vessel block time (29.93±11.96 vs. 22.76±10.74, P<0.01), more intraoperative blood loss (709.73±108.39 vs. 329.74±85.76, P<0.01), and there was no significant difference in the incidence of complications (53.4% vs. 46.6%, P>0.05). Significantly different therapeutic efficacy was found between the caudate lobe hepatocellular carcinoma group and the noncaudal lobe hepatocellular carcinoma group, which may be due to the lack of resection margin of caudate-leaf liver cancer surgery and more intraoperative bleeding.

Blood supply to the caudate lobe of the liver from the right inferior phrenic artery: observation by cone-beam computed tomography during arteriography.

To retrospectively evaluate blood supply to the caudate lobe of the liver from the right inferior phrenic artery (RIPA) using cone-beam computed tomography during arteriography (CBCTA-RIPA). CBCTA-RIPA examinations during transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) were collected from 2448 procedures in 787 patients. The exclusion criteria were (1) major artifacts, (2) TACE of hepatic arterial branches before performing CBCTA-RIPA, and (3) repeated CBCTA-RIPA studies in the same patient. Blood supply to three subsegments, the Spiegel lobe (SP), paracaval, and caudate process, was evaluated on CBCTA-RIPA images. The origins and routes of branches supplying the caudate lobe were also evaluated by three-dimensional vessel-tracking software. Forty-seven CBCTA-RIPA examinations in 47 patients (38 with a history of TACE [repeated TACE group] and nine without it [initial TACE group]) were eligible, including five who had previously undergone hepatectomy. Seven had caudate lobe HCCs. Blood supply to the caudate lobe was demonstrated in 21 (44.7%) patients: in 50% (19/38) and 22.2% (2/9) of the repeated and initial TACE groups, respectively. The caudate arteries had previously been embolized in eight patients, the RIPA branch in three, and both in one. Forty-one proximal branches mainly supplied the dorsal part of the SP. All branches but five reached there through the inferior vena cava (IVC) ligament. The RIPA supplied eight of nine caudate lobe HCCs, totally (n = 7) or partially (n = 1). The proximal RIPA branches mainly supply the dorsal SP through the IVC ligament, especially in the repeated TACE group.

The resection of hepatocellular carcinoma in caudate lobe with metastasis of lymph node: case report

Introduction: A 49 years old female woman, presented with a 2-months history of mild upper abdominal pain . Investigation revealed AFP 55 ng/ml, and hepatitis B DNA positive. Ultrasound showed a heterogenous mass between the liver and stomach. Computed Tomography (CT) showed a large exogenous heterogenous enhancing mass arising from the spiegelian lobe, and lymph node enlargement of group VIII/IX/XII. Method: The diagnosis was hepatocellular carcinoma with lymph node metastasis, the liver function was Child-Pugh grade A, the Barcelona Clinic Liver Cancer (BCLC) advanced stage ( stage C ), and she should receive sorafenib therapy only. According to the APASL (the Asian-Pacific association of the society of liver ) guideline 2017, the patient also can only receive systemic therapy. Due to the young age and good function, the patients received surgery because it was felt that this is the best chance of cure for her. The tumor was removed and radical lymph node dissection was done. Result: The patient recovered fast and AFP decreased to 18 ng/ml 2 weeks after the operation, and she is now still free form relapse with normal AFP and having an active life nearly 1 year after the surgery. Conclusion: This case revealed that personalized treatment not in accord with guideline recommendation may get better results in some carefully chosen patients.

Selective Chemoembolization of Caudate Lobe Hepatocellular Carcinoma: Anatomy and Procedural Techniques

Transarterial chemoembolization is the most common treatment for unresectable hepatocellular carcinomas (HCCs). However, when an HCC is located in the caudate lobe, many interventional radiologists are reluctant to perform chemoembolization and percutaneous ablation owing to the tumor's complex vascular supply and deep location. With the advent of C-arm CT, rendering the three-dimensional display of the hepatic artery and detecting the tumor-feeding vessels are possible and can help guide interventional radiologists to the tumor. The common origins of the caudate artery include the right hepatic artery, left hepatic artery, right anterior hepatic artery, and right posterior hepatic artery. The origins of the tumor-feeding arteries of a caudate lobe HCC can vary depending on the tumor's subsegmental location. Caudate lobe HCCs are commonly fed by multiple caudate arteries that are connected. In addition, extrahepatic collateral arteries frequently supply recurrent tumors in the caudate lobe. The caudate artery can supply portal vein thrombi or biliary tumor thrombi in patients with HCC. Several techniques such as preshaping the microcatheter or using the shepherd's hook technique are needed to catheterize the caudate artery in complex cases. Although uncommon, bile duct stricture is a serious complication following selective chemoembolization through the caudate artery. Identification and catheterization of the caudate artery have become possible in most patients by using C-arm CT and a fine microcatheter system, respectively. The authors review the anatomy of the caudate artery with C-arm CT and describe basic technical considerations in selective chemoembolization for caudate lobe HCCs. Unusual circumstances that require catheterization and techniques used for catheterizing the caudate artery are also described. Online supplemental material is available for this article. ©RSNA, 2019.

Ultrasound-guided percutaneous radiofrequency ablation to treat hepatocellular carcinoma in the caudate lobe

Objective To study the feasibility, efficacy and safety of ultrasound-guided percutaneous radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) in the caudate lobe. Methods From November 2006 to June 2017, 31 patients with 31 HCCs located in the caudate lobe were treated with percutaneous RFA at the First Affiliated Hospital of Sun Yat-sen University. The treatment efficacy, complications, and the local tumor progression (LTP), disease-free survival (DFS) and overall survival (OS) rates were analyzed. Results Residual tumors were detected in 5 patients after the first treatment. Complete necrosis was achieved in all the patients after the second treatment. The mean number of ablation sessions was 1.16±0.37. At a follow-up period which ranged from 3 to 65 months, 19 patients had died, 10 patients were still alive, and 2 patients were lost to follow-up. The 1-, 2-, 3-, and 5-years OS rates were 78.4%, 48.5%, 12.1% and 12.1%, respectively. On follow-up, 9 caudate lobe HCC lesions were detected to have LTP. The 1-, 2-, and 3-years LTP rates were 21.5%, 41.6% and 41.6%, respectively; while the 1-, 2-, and 3-years DFS rates were 22.3%, 11.2% and 11.2%, respectively. Ablation-related complications were detected in 4 patients. Conclusions Ultrasound-guided percutaneous RFA was safe and effective for patients with HCC in the caudate lobe. These patients should be followed-up closely to detect LTP. Key words: Hepatocellular carcinoma; Caudate lobe of liver; Radiofrequency ablation

Laparoscopic Extended Left Hemi-Hepatectomy plus Caudate Lobectomy for Caudate Lobe Hepatocellular Carcinoma

BackgroundLaparosopic hepatectomy for caudate lobe is classified as one of the most difficult procedures to perform.1 For malignant caudate lobe tumor which is close to hepatic veins, extended hemi-hepatectomy may be more suitable. MethodsA 60-year-old man was diagnosed with hepatitis B virus infection-related hepatocellular carcinoma (HCC). His liver function was Child-Pugh A and ICG-15 test was 2.1%. Abdominal CT showed a 5 × 6 cm mass located in caudate lobe with middle and left hepatic vein encroached. Caudate lobectomy was not adopted because of the suspicious hepatic vein invasion by HCC. Instead, laparoscopic extended left hemi-hepatectomy plus caudate lobectomy was planned. ResultsThe patient was placed in supine position. Three 12-mm trocars and two 5-mm trocars were used. After fully mobilization, the caudate lobe was exposed. The third porta hepatis was dissected before parenchyma transection.. The cutline was along the right side of middle hepatic vein. Pringle maneuver (15 min clamping and 5 min release, total Pringle time was 60 min with 4 times clamping) was performed during transection. The superficial tissue was divided using ultrasonic shears, while the deeper tissue was divided using LigaSure. The left pedicle was dissected and transected meticulously. The main trunk of right hepatic vein was continuously exposed from the caudal side. A linear stapler was used to transect the middle and left hepatic vein from the root. Bipolar was used for hemostasis. The specimen was removed from suprapubic incision. The operation time was 200 min and estimated blood loss was 100 ml. HCC was confirmed by postoperative pathological examination. The postoperative course was uneventful. ConclusionsLaparoscopic extended left hemi-hepatectomy plus caudate lobectomy is feasible and safe for caudate lobe HCC with suspicious hepatic veins invasion.

Treatment of hepatocellular carcinoma in the caudate lobe: US-guided percutaneous radiofrequency ablation combined with ethanol ablation

To evaluate the technical feasibility and treatment results of ultrasound (US)-guided percutaneous radiofrequency ablation (RFA) combined with ethanol ablation (EA) for hepatocellular carcinoma (HCC) in the caudate lobe. The institutional review board approved this retrospective study and the requirement for informed consent was waived. From October 2009 to June 2016, there were 49 patients with HCC in the caudate lobe underwent ablation. Among them, 14 patients (12 men and two women, mean age: 49.9±14.9 years) with 16 caudate lobe HCCs (mean size: 3±1.1cm) who underwent US-guided RFA-EA were identified. These patients were compared with patients who underwent RFA alone (n=17) and EA alone (n=18). HCCs in the RFA-EA group were larger than those in the EA-alone group (3±1.1 versus 2.1±0.7cm, p=0.028). In the RFA-EA group, all the patients achieved treatment success (14/14) and entered follow-up. After a follow-up period of 17.1±10.6 months (range, 5-36 months), local tumour progression (LTP) was detected in four tumours. The 1- and 2-year LTP rates after RFA-EA were 18.8% and 27.8%, respectively. The 1- and 2-year disease-free survival (DFS) rates were 35.7% and 13.4%. Six patients died, with the 1-, 2-, and 3-year overall survival (OS) rates of 85.1%, 63.1%, and 21%, respectively. There were no significant differences intheLTP, DFS, and OS rates between the RFA-EA group and RFA-alone or EA groups (p=0.363-0.733). US-guided percutaneous RFA-EA appears to be a feasible and effective treatment for HCC in the caudate lobe.

496 - Caudate Lobectomy with Extended Left Hepatectomy for Huge Hepatocellular Carcinoma in Caudate Lobe

496 - Caudate Lobectomy with Extended Left Hepatectomy for Huge Hepatocellular Carcinoma in Caudate Lobe

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.

8:27 AM; Abstract No. 83 - Caudate lobe hepatocellular carcinoma treated with selective chemoembolization : usefulness of C-arm CT performed at the proper hepatic artery or equivalent

Purpose: To evaluate the safety of outpatient-based transarterial chemoembolization (TACE) for hepatocellular carcinoma in patients with intermediate (Child-Pugh B) and advanced (Child-Pugh C) liver disease. Materials and Methods: This is a single-center retrospective review of all HCC patients with Child-Pugh B (intermediate) or Child-Pugh C (advanced) cirrhosis who underwent TACE over a 46-month period. Sixty-nine consecutive chemoembolizations in 26 patients with intermediate and advanced liver disease were reviewed. Patients were classified as outpatients if they were discharged on the day of the procedure or as inpatients if they were admitted overnight. A comprehensive database and chart review of post-procedure telephone interviews, clinic visits, and hospital admissions was performed. The end-points of the study were (1) re-admission to the hospital within 48 hours of discharge, or (2) an emergency department visit within 48 hours of discharge. Results: Between July 2009 and October 2011, inpatient TACE treatments were performed in 5 patients with advanced cirrhosis and 9 patients with intermediate disease. Outpatient TACE treatments were performed in 6 patients with intermediate disease. After October 2011, 49 consecutive outpatient TACE treatments were performed in patients with advanced (10) and intermediate (39) cirrhosis. Safety endpoints of an emergency department visit or hospital readmission were identified in a single Child-Pugh B outpatient who returned to the ED within 48 hours for symptoms related to ascites. No patients from either group required readmission.