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

Abstract

Background Resection 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. Methods Patients 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. Results A 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. Conclusion CCL 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.

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

“…Out of the total patients (n = 864), 44.8% survived (n = 387) and 55.2% (n = 477) died during the entire follow-up period. The pooled estimate of the 3-and 5-year OS rates were 62.3% (95% CI: 53.5-71) [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] and 42.9% (95% CI:31.7-54.2), [17][18][19][20][22][23][24][25][26][28][29][30][31] respectively (Fig. 2a,b).…”

“…Sixteen studies were included in the final analysis. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The selection process is depicted in Figure 1. The majority of studies originated from East Asian countries.…”

“…S1 and S2). The prognostic factors that were significantly associated with OS were; vascular invasion, 17,19,20,23 cirrhosis, 20,23,26 tumour size, 20,23,30 surgical margin, 26,30 total bilirubin, 20,23 age, 19 oesophageal varices, 19 blood loss, 30 combined resection, 23 tumour location, 26 and vascular reconstruction. 30 The recurrence rate of HCC was 42.4% (366 out of 864 patients).…”

“…2c,d). 17,18,20,22,23,[25][26][27]29,30,32 No significant publication bias , meta-analysis of RFS hazard ratio between caudate lobe HCC versus other sites HCC (f), meta-analysis of OS hazard ratio between isolated caudate lobectomy versus combined lobectomy (g), meta-analysis of RFS hazard ratio between isolated caudate lobectomy versus combined lobectomy (h).…”

“…S3 and S4). The prognostic factors that were significantly associated with RFS were: vascular invasion, 17,20,26 protein induced by vitamin K absence/antagonist-II (PIVKA-II), 20 total bilirubin, 26 alcohol, 19 multiple tumour, 19 tumour size, 20 cirrhosis, 20 combined resection 26 and the surgical margin. 26 Caudate lobe HCC versus other sites HCC…”