Treatment for hepatocellular carcinoma in the caudate lobe: a report of 13 cases

Abstract

INTRODUCTIONPrimary hepatocellular carcinoma (HCC) is one of the most common digestive tract tumors, and surgical resection is the preferred therapeutic method of HCC. However, as caudate lobe is located in the middle of the back of liver, surrounded by a large number of large vessels, it is difficult and risky to resect.1 Many doctors attempted to adopt TACE-based non-operative method for the treatment of HCC located in the caudate lobe, but its clinical effects are controversial. In addition, with the continuous improvement of surgical approach, surgical method and surgical instruments, there are more and more reports on caudate lobe resection, but the long-term ABSTRACT Background: To investigate therapies of hepatocellular carcinoma in the caudate lobe, surgical approach and method, surgical outcome of hepatic caudate lobotomy. Methods: Clinical data of 13 patients with hepatocellular carcinoma in the caudate lobe who received surgical treatment in the Department of Hepatobiliary Surgery of the Second Affiliated Hospital of Chongqing Medical University from Jan 2010 to Jan 2014 was retrospectively analyzed. Results: Two patients selected TACE therapy. However, tumor metastasis was observed on them in short term, and the therapeutic effect was poor after several times of treatment. Nine patients received surgical treatment. Surgical approaches included left approach, right approach and combined approaches from the left and right side; surgical method was part or complete caudate lobe resection combining with other liver segments. The operation time was 220.0-350.0 minutes, with the average value of 259.4 minutes. The vascular clamping time was 21.0-45.0 minutes, with the average value of 30.2 minutes. The bleeding volume was 400.0-1800.0 ml, with the average value of 844.4 ml. In all patients, there was no perioperative death and no postoperative liver failure happened, and 4 patients who suffered from interrelated complications were cured or got better by conservative treatments. All patients were followed up for 24 months. The recurrent rates of 1 and 2-year were 44.4%, 88.9% respectively, and the survival rates of 1 and 2 year were 66.7%, 44.4% respectively after surgical resection. Conclusions: Resection is still the preferred therapeutic method for hepatocellular carcinoma in the caudate lobe. However, long-term outcomes of the therapy for hepatocellular carcinoma in the caudate lobe need further improvement.

Carbon ion radiotherapy for patients with hepatocellular carcinoma in the caudate lobe

“…In addition, they reported that HCCCL was associated with significantly more frequent intrahepatic recurrence and a poorer survival rate. Zhang et al 9 . reported similar findings of poorer prognosis of HCCCL patients.…”

“…In addition, they reported that HCCCL was associated with significantly more frequent intrahepatic recurrence and a poorer survival rate. Zhang et al 9 reported similar findings of poorer prognosis of HCCCL patients. Moreover, Sakamoto et al 24 reported that, despite no significant decrease in survival, HCCCL was associated with a longer operative time and higher blood loss than HCC in other locations.…”

“…The Wilcoxon signed-rank test showed no significant change in the Child-Pugh score from the pretreatment assessment to that at 3 months after C-ion RT (p ¼ 0.705) and from the pretreatment assessment to that at 6 months after C-ion RT (p ¼ 0.317).However, one patient (patient 2) experienced progression in the Child-Pugh score from 7 to 9 within 6 months. Zhang et al9 reported similar findings of poorer prognosis of HCCCL patients. Moreover, Sakamoto et al24 reported that, despite no significant decrease in survival, HCCCL was associated with a longer operative time and higher blood loss than HCC in other locations.…”

“…4 Because of its deep location in the liver and adjacent major vessels, both surgery and tumor ablation for hepatocellular carcinoma in the caudate lobe (HCCCL) is technically challenging. [5][6][7][8][9][10][11][12] Furthermore, transarterial therapy for HCCCL proves challenging because the tumor is frequently fed by a complex system of vessels from different origins that are difficult to identify. [12][13][14] Therefore, the optimal treatment strategy for HCCCL has not been established until now.…”

“…Hepatocellular carcinoma in the caudate lobe has a poorer prognosis than HCCs arising from other lobes mainly because of its close proximity to the portal trunk and because inferior vena cava facilitates early systemic spread 4 . Because of its deep location in the liver and adjacent major vessels, both surgery and tumor ablation for hepatocellular carcinoma in the caudate lobe (HCCCL) is technically challenging 5–12 . Furthermore, transarterial therapy for HCCCL proves challenging because the tumor is frequently fed by a complex system of vessels from different origins that are difficult to identify 12–14 .…”