Combined caudate lobectomy in Klatskin tumor： a systematic review / 中华肝胆外科杂志

Objective To systematically review the risks and effectiveness of combined caudate lobectomy in Klatskin tumor.Methods A systematic literature search was conducted on PubMed,Embase,Cochrane Library,Scopus,CNKI databases and Chinese Bio Medical Literature (CBM).A systematic review and meta-analysis of the current literatures were conducted based on the PRISMA guideline.Odds ratios were calculated using the Mantel-Haenszel method.The primary outcome variables included safety,effectiveness of combined caudate lobectomy and its impact on long-term survival.Results Nine out of 312 articles were included.Results showed caudate lobectomy did not increase the incidence of postoperative complications (OR ＝ 1.15；95 ％ CI 0.74-1.81；P ＞ 0.05),but improved R0 resection rate (OR ＝ 4.81；95 ％ CI 2.72 ～ 8.53；P ＜ 0.01) and long-term survival in these patients (OR ＝ 0.20；95％ CI 0.11 ～ 0.39；P ＜0.01).Conclusion Combined caudate lobe resection is a safe and effective treatment for Klatskin tumor.

Total Laparoscopic Liver Resection for a Metastatic Lesion Located in the Caudate Lobe

Isolated resection of the caudate lobe of the liver is a technically demanding operation because of its unique anatomical location. Moreover the laparoscopic approach for this operative procedure has been rarely attempted. We report on a total laparoscopic liver resection of the caudate lobe including Spiegel lobe and most of paracaval portion that was performed in a 63-year-old male with a colorectal liver metastasis. The operative procedure was performed using five trocars with the patient placed in the lithotomy position. The operative time was 170 minutes. Blood loss was 350 ml and no perioperaive transfusion was needed. The patient was discharged on postoperative day 4 without any significant complications. This case shows that total laparoscopic liver resection of the caudate lobe is a feasible operation and that laparoscopic approach may be a useful option for the lesion located in Spiegel lobe in selected cases.

S4a+S5 with Caudate Lobe (S1) Resection as a Parenchyma-preserving Liver Resection for a Patient with Type IIIb Hilar Bile Duct Cance

The prognosis of hilar bile duct cancer has been improved by extensive curative resection, but massive hepatectomy can result in surgical and medical complications in high-risk patients. We report a case of type IIIb hilar bile duct cancer undergone S4a S5 with caudate lobe (S1) resection as a parenchyma-preserving hepatectomy. The operation was a modified type of Taj Mahal liver resection omitting parencymal transection between S4b and S8. Such an extent of hepatectomy combined with bile duct resection made 3 right and 3 left intrahepatic segmental duct openings, which were reconstructed as a whole at each side of transection plane after ductoplasty. The patient recovered uneventfully. Although surgical technique for S4a+S5+S1 must be more complex comparing with other anatomical hepatectomy, but it could be accepted as a safe curative resection for some selected patients with advanced hilar bile duct cancer, by which favorable recovery of the liver function may lead to prevention of postoperative complications. Comprehension to the anatomy of the intrahepatic ducts is a prerequisite for S4a+S5+S1 resection, thus we discussed it in detail.

Isolated Caudate Lobectomy with Bile Duct Resection Performed in a Patient with Type IV Hilar Bile Duct Cancer

The prognosis of hilar bile duct cancer has been improved by extensive curative resection, but limited functional reserve of the liver occasionally does not permit such a major hepatectomy. We report a type IV hilar bile duct cancer case undergone isolated caudate lobectomy as a limited but curative resection, in whom the indocyanine green retention test at 15 minutes revealed 23.9% despite long-term biliary decompression and the whole liver was rather atrophic. Complete removal of the Spiegel lobe, paracaval portion, and caudate process combined with hilar bile duct resection made 3 right and 4 left intrahepatic duct openings, which were reconstructed as a whole at each side of transection plane after ductoplasty. The patient recovered uneventfully. Although surgical technique for isolated caudate lobectomy must be more difficult comparing with other anatomical hepatectomy, but it can be a ultimate technique of limited curative resection for advanced hilar bile duct cancer patients with decreased hepatic reserve. Comprehension to the anatomy of the caudate lobe is a prerequisite for its resection, thus we discussed it in detail.