Extended right hepatectomy with caudate lobe resection using the hilar “en bloc” resection technique with a modified hanging maneuver

Perini, Marcos Vinícius; Coelho, Fabrício Ferreira; Krüger, Jaime; Rocha, Flavio G.; Herman, Paulo

doi:10.1002/jso.24154

Cited by 6 publications

(3 citation statements)

References 18 publications

(21 reference statements)

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“…Though disputed, most of the researchers believe that caudate lobe dissection is necessary for Hilar C treatment [16,17]. The caudate lobe is located between the inferior vena cava and the portal vein, surrounded with dense and important blood vessels [18,19]. When dealing with the short hepatic vein, slight mistake might lead to tearing of the inferior vena cava and induce uncontrolled bleeding.…”

Section: Discussionmentioning

confidence: 99%

Application of Laparoscopic Radical Resection for Type III and IV Hilar Cholangiocarcinoma Treatment

Liu

et al. 2020

Gastroenterology Research and Practice

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Background. This study is aimed at investigating the feasibility and safety of the laparoscopic radical resection for treating type III and IV hilar cholangiocarcinoma (III/IV Hilar C). Methods. Six patients with III/IV Hilar C were enrolled in our hospital. All patients underwent total laparoscopic surgery, including basic surgery (laparoscopic gallbladder, hilar bile duct, and common bile duct resection and hepatoduodenal ligament lymph node dissection) combined with left hepatic and caudate lobe resection/portal resection. The tumor size, operation time, intraoperative blood loss, and postoperative complications were observed. The follow-up of the patients after discharge was recorded. Results. Surgery was successfully completed in 6 patients. We found that the tumor size of 6 patients ranged from 1.5 to 3.6 cm, with 4 lymph nodes. The operation time was 540-660 minutes, and the blood loss was 300-500 ml. One patient developed bile leakage after surgery, healed within 2 weeks after drainage. The postoperative hospital stay was 16 (13-24) days. There were 4 cases of negative bile duct margin tumor, 1 case was positive, and 1 case was not reported. All 6 patients were discharged smoothly without perioperative death. Regular examinations were conducted every 3 months after discharge, and the median duration was 7 months. Only 1 patient had a marginal dysplasia, and 5 patients had no obvious signs of recurrence. Conclusions. Application of laparoscopic radical resection for III/IV Hilar C is safe and feasible and has good short-term efficacy with adequate preoperative evaluation, appropriate case selection, and precise operative strategy.

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Section: Discussionmentioning

confidence: 99%

Application of Laparoscopic Radical Resection for Type III and IV Hilar Cholangiocarcinoma Treatment

Liu

et al. 2020

Gastroenterology Research and Practice

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“…3 and 5-year survival was superior in “en bloc” group (35% and 25% vs 65% and 58% respectively) without an increase in surgical complications. Other authors adopted this approach with reported comparable results[ 97 ]. The “en bloc resection” is not feasible in left hepatectomy because the no touch approach on hilum is impossible, unless resection and reconstruction of the right hepatic artery are being considered.…”

Section: Treatmentmentioning

confidence: 92%

Practical review for diagnosis and clinical management of perihilar cholangiocarcinoma

Dondossola

Ghidini

Grossi

et al. 2020

WJG

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Cholangiocarcinoma (CCC) is the most aggressive malignant tumor of the biliary tract. Perihilar CCC (pCCC) is the most common CCC and is burdened by a complicated diagnostic iter and its anatomical location makes surgical approach burden by poor results. Besides its clinical presentation, a multimodal diagnostic approach should be carried on by a tertiary specialized center to avoid miss-diagnosis. Preoperative staging must consider the extent of liver resection to avoid post-surgical hepatic failure. During staging iter, magnetic resonance can obtain satisfactory cholangiographic images, while invasive techniques should be used if bile duct samples are needed. Consistently, to improve diagnostic potential, bile duct drainage is not necessary in jaundice, while it is indicated in refractory cholangitis or when liver hypertrophy is needed. Once resecability criteria are identified, the extent of liver resection is secondary to the longitudinal spread of CCC. While in the past type IV pCCC was not considered resectable, some authors reported good results after their treatment. Conversely, in selected unresectable cases, liver transplantation could be a valuable option. Adjuvant chemotherapy is the standard of care for resected patients, while neoadjuvant approach has growing evidences. If curative resection is not achieved, radiotherapy can be added to chemotherapy. This multistep curative iter must be carried on in specialized centers. Hence, the aim of this review is to highlight the main steps and pitfalls of the diagnostic and therapeutic approach to pCCC with a peculiar attention to type IV pCCC.

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“…Liver resection (LR) of the caudate lobe is considered a radical treatment. However, surgical resection represents an enormous technical challenge, and there is greater recurrence in the hepatic caudate lobe than in other lobes [6][7][8][9]. Similarly, both percutaneous ethanol injection and percutaneous radiofrequency ablation are potential treatments for caudate lobe HCC.…”

Section: Introductionmentioning

confidence: 99%

Transarterial chemoembolization vs. liver resection as initial treatment for hepatocellular carcinoma occurring exclusively in caudate lobe: A retrospective propensity matching analysis

YANG¹,

YUAN²,

YANG³

et al. 2022

Oncology Research

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Treatment of hepatocellular carcinoma (HCC) in the caudate lobe is technically challenging. This retrospective study was designed to evaluate the clinical outcome of both superselective transcatheter arterial chemoembolization (TACE) and liver resection (LR) for HCC occurring exclusively in the caudate lobe. From January 2008 to September 2021, a total of 129 patients were diagnosed with HCC of the caudate lobe. The Cox proportional hazard model was used to analyze the potential clinical factors and established prognostic nomograms with interval validation. Of the total number of patients, 78 received TACE and 51 received LR. The overall survival (OS) rates (TACE vs. LR) at 1, 2,3, 4, and 5 years were 83.9% vs. 71.0%; 74.2% vs. 61.3%; 58.1% vs. 48.4%; 45.2% vs. 45.2%; and 32.3% vs. 25.0%, respectively. However, subgroup analysis revealed that TACE was superior to LR for treating patients with stage IIb Chinese liver cancer (CNLC-IIb) in the entire cohort (p = 0.002). Interestingly, no difference was found between TACE and LR in the treatment outcomes of CNLC-IIa HCC (p = 0.6). Based on Child-Pugh A and B calculations, TACE tended to lead to a better OS than LR (p = 0.081 and 0.16, respectively). Multivariate analysis showed that Child-Pugh score, CNLC stage, ascites, alpha fetoprotein (AFP), tumor size, and anti-HCV are related to OS.Predictive nomograms for 1, 2, and 3 years were performed. Based on this study, TACE may provide a longer OS than liver resection for patients with CNLC-IIb HCC of the caudate lobe. Because this suggestion is limited by the study design and relatively small sample size, additional randomized controlled trials are needed.

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Extended right hepatectomy with caudate lobe resection using the hilar “en bloc” resection technique with a modified hanging maneuver

Cited by 6 publications

References 18 publications

Application of Laparoscopic Radical Resection for Type III and IV Hilar Cholangiocarcinoma Treatment

Application of Laparoscopic Radical Resection for Type III and IV Hilar Cholangiocarcinoma Treatment

Practical review for diagnosis and clinical management of perihilar cholangiocarcinoma

Transarterial chemoembolization vs. liver resection as initial treatment for hepatocellular carcinoma occurring exclusively in caudate lobe: A retrospective propensity matching analysis

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