Skip to main content
Log in

Laparoscopic anterior hepatic transection for resecting lesions originating in the paracaval portion of the caudate lobe (with videos)

  • Dynamic Manuscript
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The paracaval portion of the caudate lobe is located in the core of the liver. Lesions originating in the paracaval portion often cling to or even invade major hepatic vascular structures. The traditional open anterior hepatic transection approach has been adopted to treat paracaval-originating lesions. With the development of laparoscopic surgery, paracaval-originating lesions are no longer an absolute contraindication for laparoscopic liver resection. This study aimed to evaluate the safety and feasibility of laparoscopic anterior hepatic transection for resecting paracaval-originating lesions.

Methods

This study included 15 patients who underwent laparoscopic anterior hepatic transection for paracaval-originating lesion resection between August 2017 and April 2020. The perioperative indicators, follow-up results, operative techniques and surgical indications were retrospectively evaluated.

Results

All patients underwent laparoscopic anterior hepatic transection for paracaval-originating lesion resection. The median operation time was 305 min (220–740 min), the median intraoperative blood loss was 400 ml (250–3600 ml), and the median length of postoperative hospital stay was 9 days (5–20 days). No conversion to laparotomy or perioperative deaths occurred. Six patients had Clavien grade III–IV complications (III/IV, 5/1). Two patients developed tumor recurrence after 13 months and 8 months.

Conclusion

Although technically challenging, laparoscopic anterior hepatic transection is still a safe and feasible procedure for resecting paracaval-originating lesions in select patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kumon M (2017) Anatomical study of the caudate lobe with special reference to portal venous and biliary branches using corrosion liver casts and clinical application. Liver Cancer 6:161–170

    Article  Google Scholar 

  2. Asahara T, Dohi K, Hino H, Nakahara H, Katayama K, Itamoto T, Ono E, Moriwaki K, Yuge O, Nakanishi T, Kitamoto M (1998) Isolated caudate lobectomy by anterior approach for hepatocellular carcinoma originating in the paracaval portion of the caudate lobe. J Hepatobiliary Pancreat Surg 5:416–421

    Article  CAS  Google Scholar 

  3. Yamamoto J, Kosuge T, Shimada K, Yamasaki S, Takayama T, Makuuchi M (1999) Anterior transhepatic approach for isolated resection of the caudate lobe of the liver. World J Surg 23:97–101

    Article  CAS  Google Scholar 

  4. Chaib E, Ribeiro MA Jr, Souza YE, D’Albuquerque LA (2009) Anterior hepatic transection for caudate lobectomy. Clinics (Sao Paulo) 64:1121–1125

    Article  Google Scholar 

  5. Kondo S, Katoh H, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T (2003) Isolated paracaval subsegmentectomy of the caudate lobe of the liver. Langenbecks Arch Surg 388(3):163–166

    Article  Google Scholar 

  6. Wang Y, Zhang LY, Yuan L, Sun FY, Wei TG (2010) Isolated caudate lobe resection for hepatic tumor: surgical approaches and perioperative outcomes. Am J Surg 200:346–351

    Article  Google Scholar 

  7. Wang ZG, Lau W, Fu SY, Liu H, Pan ZY, Yang Y, Zhang J, Wu MC, Zhou WP (2015) Anterior hepatic parenchymal transection for complete caudate lobectomy to treat liver cancer situated in or involving the paracaval portion of the caudate lobe. J Gastrointest Surg 19:880–886

    Article  Google Scholar 

  8. Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964

    Article  Google Scholar 

  9. Araki K, Kubo N, Watanabe A, Kuwano H, Shirabe K (2018) Systematic review of the feasibility and future of laparoscopic liver resection for difficult lesions. Surg Today 48:659–666

    Article  Google Scholar 

  10. Yoon YS, Han HS, Cho JY, Kim JH, Kwon Y (2013) Laparoscopic liver resection for centrally located tumors close to the hilum, major hepatic veins, or inferior vena cava. Surgery 153:502–509

    Article  Google Scholar 

  11. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  12. Nishigaki Y, Tomita E, Hayashi H, Suzuki Y, Iritani S, Kato T, Yamada T (2013) Efficacy and safety of radiofrequency ablation for hepatocellular carcinoma in the caudate lobe of the liver. Hepatol Res 43:467–474

    Article  CAS  Google Scholar 

  13. Shibata T, Maetani Y, Ametani F, Kubo T, Itoh K, Konishi J (2002) Efficacy of nonsurgical treatments for hepatocellular carcinoma in the caudate lobe. Cardiovasc Intervent Radiol 25:186–192

    Article  Google Scholar 

  14. Eiriksson K, Fors D, Rubertsson S, Arvidsson D (2011) High intra-abdominal pressure during experimental laparoscopic liver resection reduces bleeding but increases the risk of gas embolism. Br J Surg 98:845–852

    Article  CAS  Google Scholar 

  15. Stratopoulos C, Soonawalla Z, Brockmann J, Hoffmann K, Friend PJ (2007) Central hepatectomy: the golden mean for treating central liver tumors? Surg Oncol 16:99–106

    Article  Google Scholar 

  16. Matsui Y, Terakawa N, Satoi S, Kaibori M, Kitade H, Takai S, Kwon AH, Kamiyama Y (2007) Postoperative outcomes in patients with hepatocellular carcinomas resected with exposure of the tumor surface: clinical role of the no-margin resection. Arch Surg 142:596–602

    Article  Google Scholar 

  17. Sakamoto Y, Nara S, Hata S, Yamamoto Y, Esaki M, Shimada K, Kosuge T (2011) Prognosis of patients undergoing hepatectomy for solitary hepatocellular carcinoma originating in the caudate lobe. Surgery 150:959–967

    Article  Google Scholar 

  18. Lai EC, Ng IO, Ng MM, Lok AS, Tam PC, Fan ST, Choi TK, Wong J (1990) Long-term results of resection for large hepatocellular carcinoma: a multivariate analysis of clinicopathological features. Hepatology 11:815–818

    Article  CAS  Google Scholar 

  19. Lockwood DS, Yeadon TM, Clouston AD, Crawford DG, Fawcett J, Callaghan SA, Gotley DC (2003) Tumor progression in hepatocellular carcinoma: relationship with tumor stroma and parenchymal disease. J Gastroenterol Hepatol 18:666–672

    Article  Google Scholar 

  20. Ng IO, Lai EC, Fan ST, Ng MM, So MK (1995) Prognostic significance of pathologic features of hepatocellular carcinoma. A multivariate analysis of 278 patients. Cancer 76:2443–2448

    Article  CAS  Google Scholar 

  21. Portolani N, Coniglio A, Ghidoni S, Giovanelli M, Benetti A, Tiberio GA, Giulini SM (2006) Early and late recurrence after liver resection for hepatocellular carcinoma: prognostic and therapeutic implications. Ann Surg 243:229–235

    Article  Google Scholar 

  22. Oikawa T, Ojima H, Yamasaki S, Takayama T, Hirohashi S, Sakamoto M (2005) Multistep and multicentric development of hepatocellular carcinoma: histological analysis of 980 resected nodules. J Hepatol 42:225–229

    Article  Google Scholar 

  23. Yu W, Wang W, Rong W, Wang L, Xu Q, Wu F, Liu L, Wu J (2014) Adjuvant radiotherapy in centrally located hepatocellular carcinomas after hepatectomy with narrow margin (< 1 cm): a prospective randomized study. J Am Coll Surg 218:381–392

    Article  Google Scholar 

  24. Shibayama Y (1987) The role of hepatic venous congestion and endotoxaemia in the production of fulminant hepatic failure secondary to congestive heart failure. J Pathol 151:133–138

    Article  CAS  Google Scholar 

  25. Kaneko T, Kaneko K, Sugimoto H, Inoue S, Hatsuno T, Sawada K, Ando H, Nakao A (2000) Intrahepatic anastomosis formation between the hepatic veins in the graft liver of the living related liver transplantation: observation by Doppler ultrasonography. Transplantation 70:982–985

    Article  CAS  Google Scholar 

  26. Suh SW, Lee JM, You T, Choi YR, Yi NJ, Lee KW, Suh KS (2014) Hepatic venous congestion in living donor grafts in liver transplantation: is there an effect on hepatocellular carcinoma recurrence? Liver Transpl 20:784–790

    Article  Google Scholar 

  27. Canet J, Sabaté S, Mazo V, Gallart L, de Abreu MG, Belda J, Langeron O, Hoeft A, Pelosi P, PERISCOPE group, (2015) Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: a prospective, observational study. Eur J Anaesthesiol 32:458–470

    Article  Google Scholar 

  28. Yang CK, Teng A, Lee DY, Rose K (2015) Pulmonary complications after major abdominal surgery: National Surgical Quality Improvement Program analysis. J Surg Res 198:441–449

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by the Technology Innovation Project Foundation for Key Areas of the First Affiliated Hospital, Army Medical University, China (No. SWH2016ZDCX2015) and the National Natural Science Foundation of China (81972303).

Funding

This study was supported by Technology Innovation Project Foundation for Key Areas of the First Affiliated Hospital, Army Medical University, China (No. SWH2016ZDCX2015). National Natural Science Foundation of China (81972303).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shu-guo Zheng.

Ethics declarations

Disclosures

Tian-ge Sun, Xiao-jun Wang, Li Cao, Jian-wei Li, Jian Chen, Xue-song Li, Ke-xi Liao, Yong Cao, Shu-guo Zheng have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MOV 324639 kb)

Supplementary file2 (MOV 342103 kb)

Supplementary file3 (MOV 238851 kb)

Supplementary file4 (MP4 293192 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sun, Tg., Wang, Xj., Cao, L. et al. Laparoscopic anterior hepatic transection for resecting lesions originating in the paracaval portion of the caudate lobe (with videos). Surg Endosc 35, 5352–5358 (2021). https://doi.org/10.1007/s00464-021-08455-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08455-5

Keywords

Navigation