Isolated caudate lobe resection: technical challenges

Sastha Ahanatha Pillai; Jeswanth Sathyanesan; Senthilkumar Perumal; Srinivasan Ulagendra Perumal; Anand Lakshmanan; Sukumar Ramaswami; Ravi Ramasamy; Ravichandran Palaniappan; Surendran Rajagopal

Authors Sastha Ahanatha Pillai, Jeswanth Sathyanesan, Senthilkumar Perumal, Srinivasan Ulagendra Perumal, Anand Lakshmanan, Sukumar Ramaswami, Ravi Ramasamy, Ravichandran Palaniappan, Surendran Rajagopal.

Abstract

Background Isolated caudate lobe resection remains a technical challenge even in the best hands. This is due to the difficult approach and its location between major vessels. This retrospective study aims to analyze our experience with isolated caudate lobe resections.

Methods Of the 402 patients who underwent liver resections between January 2002 and December 2011, we identified 13 caudate lobectomies. We analyzed the operative parameters, hospital stay, morbidity and follow up of these patients.

Results There were nine males and four females, age ranging between 30 and 72 years. The indications were hepatocellular carcinoma in nine patients, hilar cholangiocarcinoma in two, solitary fibrous tumor in one, and a regenerative nodule in one patient. Left-sided approach was employed in seven cases, right-sided approach in three cases and a combined approach in three cases. Operating time ranged between 125 and 225 min and blood loss ranged between 210 and 630 mL. There was no mortality in the post-operative period. No local recurrence was noted in the follow-up period ranging from 6 months to 7 years.

Conclusion Caudate lobe resections, although technically challenging, can be successfully performed with minimal blood loss. Surgery offers potential cure in isolated caudate lobe tumors. The location and size of the tumor decides the approach.

Keywords Caudate lobe tumors, isolated caudate lobe resection, hilar cholangiocarcinoma, hepatocellular carcinoma