Recognition of the caudate lobe and reflections on related issues / 中华消化外科杂志

The hepatic caudate lobe is located in the deep back area of the liver. Due to the unique anatomical position of hepatic caudate lobe, surgical treatment for tumor of hepatic caudate lobe is particularly difficult. Non-surgical treatment, such as ablation, transarterial embolization, etc, is also challenging for tumor of hepatic caudate lobe, and the therapeutic effect is inferior to that of surgery. Therefore, surgical resection is the only treatment for tumor of hepatic caudate lobe. The authors discuss the research history of hepatic caudate lobe, the problems of laparoscopic technique in hepatic caudate lobe resection, etc, in order to provide a theoretical basis for improving the concept of accuracy of laparoscopic caudate lobectomy.

Analysis of imaging-guided thermal ablation puncture routes for tumors of the hepatic caudate lobe

Aims: The goal of this study was to analyze the puncture routes of imaging-guided thermal ablation for tumors of the hepatic caudate lobe. Materials and Methods: The imaging-guided thermal ablation puncture routes of 12 cases of hepatic caudate lobe tumors were collected in our hospital from January 2013 to February 2019. The puncture routes were retrospectively analyzed, and the experience of thermal ablation therapy for hepatic caudate lobe tumors was summarized. Results: Among the 12 cases of hepatic caudate lobe tumors, puncture routes were divided into the anterior (through the left lobe of the liver) approach (six cases), the right hepatic approach (five cases), and the transthoracic approach (one case). Different ablation electrodes were selected according to the puncture route and method of guiding. No serious postoperative complications were noted. Conclusion: The hepatic caudate lobe is surrounded by the inferior vena cava, hepatic vein, and hepatic hilum, leading to great difficulties and risks in performing minimally invasive treatment of hepatic caudate lobe malignancies. Therefore, selecting an appropriate puncture route is an important factor in the success of the treatment

Ultrasound-guided percutaneous radiofrequency ablation in treatment of caudate lobe liver tumor / 中国医师进修杂志

Objective@#To investigate the safety, efficacy and the key points of ultrasound-guided percutaneous radiofrequency ablation (RFA) in treatment of caudate lobe liver tumor.@*Methods@#The clinical data of 30 patients with caudate lobe liver tumor (57 lesions, 33 caudate lobe lesions) in the Affiliated Tumor Hospital of Zhengzhou University from January 2017 to December 2018 were retrospectively analyzed. All the patients were treated with ultrasound-guided percutaneous radiofrequency ablation. The puncture approach and single-needle or double-needle radiofrequency ablation were chosen according to the lesion location. The efficacy after treatment was evaluated according to the imaging examination. The deadline of follow-up was January 31, 2019, and the median follow-up time was 10 (1 to 20) months. After ablation, CT/MR was performed to evaluate whether the lesions were completely ablated. The effect of treatment and short-term complication were recorded.@*Results@#Thirty patients were successfully treated with ultrasound-guided percutaneous radiofrequency ablation. Among the 33 caudate lobe lesions, complete ablation rate at one time was 81.8% (27/33); local tumor progression rate after treatment was 12.1% (4/33), and the median time was 2.5 months. The new lesion rate was 26.7% (8/30), and the median time was 3.0 months. Two patients had significant abdominal pain, 1 patient had fever, 1 patient had hypoxemia during the ablation, and total incidence of complication was 13.3% (4/30). There was no bile leakage, gastrointestinal tract injury, uncontrollable bleeding and other serious complications and related deaths.@*Conclusions@#For the caudate lobe liver tumor, ultrasound-guided percutaneous radiofrequency ablation is safe and effective. It is necessary to select the appropriate puncture approach, avoid the intrahepatic duct reasonably and master the key points of ablation.

Ultrasound-guided percutaneous radiofrequency ablation in treatment of caudate lobe liver tumor / 中国医师进修杂志

Objective To investigate the safety, efficacy and the key points of ultrasound-guided percutaneous radiofrequency ablation (RFA) in treatment of caudate lobe liver tumor. Methods The clinical data of 30 patients with caudate lobe liver tumor (57 lesions, 33 caudate lobe lesions) in the Affiliated Tumor Hospital of Zhengzhou University from January 2017 to December 2018 were retrospectively analyzed. All the patients were treated with ultrasound- guided percutaneous radiofrequency ablation. The puncture approach and single-needle or double-needle radiofrequency ablation were chosen according to the lesion location. The efficacy after treatment was evaluated according to the imaging examination. The deadline of follow-up was January 31, 2019, and the median follow-up time was 10 (1 to 20) months. After ablation, CT/MR was performed to evaluate whether the lesions were completely ablated. The effect of treatment and short-term complication were recorded. Results Thirty patients were successfully treated with ultrasound-guided percutaneous radiofrequency ablation. Among the 33 caudate lobe lesions, complete ablation rate at one time was 81.8% (27/33); local tumor progression rate after treatment was 12.1% (4/33), and the median time was 2.5 months. The new lesion rate was 26.7% (8/30), and the median time was 3.0 months. Two patients had significant abdominal pain, 1 patient had fever, 1 patient had hypoxemia during the ablation, and total incidence of complication was 13.3% (4/30). There was no bile leakage, gastrointestinal tract injury, uncontrollable bleeding and other serious complications and related deaths. Conclusions For the caudate lobe liver tumor, ultrasound-guided percutaneous radiofrequency ablation is safe and effective. It is necessary to select the appropriate puncture approach, avoid the intrahepatic duct reasonably and master the key points of ablation.

Can we delineate preoperatively the right and ventral margins of caudate lobe of the liver?

PURPOSE: Complete removal of the caudate lobe, which is sometimes necessary, is accomplished via isolated caudate lobectomy or hepatectomy that includes the caudate lobe. It is impossible, however, to confirm the right and ventral margins of the caudate lobe by preoperative imaging. This study was undertaken to determine whether we could identify the right and ventral margins of the caudate lobe preoperatively using Synapse 3D visualization software. METHODS: Ninety-four preoperative 3-dimensional (3D) computed tomographic images (1-mm slices) of the liver from candidate donors were examined. The images of the caudate lobe were subjected to a counter-staining method according to Synapse 3D to delineate their dimensions. We first examined whether the right margin of the caudate lobe exceeded the plane formed by the root of the right hepatic vein (RHV) and the right side of the inferior vena cava (IVC). Second, we determined whether the ventral margin of the caudate lobe exceeded the plane formed by the root of the middle hepatic vein (MHV) and the root of the RHV. RESULTS: For the right margin, 17 cases (18%) exceeded the RHV-IVC plane by a mean of 10.2 mm (range, 2.4–27.2 mm). For the ventral margin, 28 cases (30%) exceeded the MHV-RHV plane by a mean of 17.4 mm (range, 1.2–49.1 mm). CONCLUSION: Evaluating the anatomy of caudate lobe using Synapse 3D preoperatively could be helpful for more precise anatomical resection of the caudate lobe.

Ultrasound-guided percutaneous radiofrequency ablation to treat hepatocellular carcinoma in the caudate lobe / 中华肝胆外科杂志

Objective To study the feasibility,efficacy and safety of ultrasound-guided percutaneous radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) in the caudate lobe.Methods From November 2006 to June 2017,31 patients with 31 HCCs located in the caudate lobe were treated with percutaneous RFA at the First Affiliated Hospital of Sun Yat-sen University.The treatment efficacy,complications,and the local tumor progression (LTP),disease-free survival (DFS) and overall survival (OS) rates were analyzed.Results Residual tumors were detected in 5 patients after the first treatment.Complete necrosis was achieved in all the patients after the second treatment.The mean number of ablation sessions was 1.16±0.37.At a follow-up period which ranged from 3 to 65 months,19 patients had died,10 patients were still alive,and 2 patients were lost to follow-up.The 1-,2-,3-,and 5-years OS rates were 78.4％,48.5％,12.1％ and 12.1％,respectively.On follow-up,9 caudate lobe HCC lesions were detected to have LTP.The 1-,2-,and 3-years LTP rates were 21.5％,41.6％ and 41.6％,respectively;while the 1-,2-,and 3-years DFS rates were 22.3％,11.2％ and 11.2％,respectively.Ablationrelated complications were detected in 4 patients.Conclusions Ultrasound-guided percutaneous RFA was safe and effective for patients with HCC in the caudate lobe.These patients should be followed-up closely to detect LTP.

Treatment experience and efficacy of precise surgery for hepatic caudate lobe involved lesions / 中华消化外科杂志

Objective To explore the treatment experience and efficacy of precise surgery for hepatic caudate lobe involved lesions.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 127 patients with hepatic caudate lobe involved lesions who were admitted to Hunan Provincial People's Hospital between January 2012 and December 2016 were collected,including 71 of malignant tumors,52 of benign lesions and 4 of other diseases.Anatomical hepatectomy was performed in patients via left approach,right approach,anterior approach,left combined with right approach,left and right combined with anterior approach,left and right combined with para-liver hanging tape approach,anterior combined with left approach,retrograde approach according to their conditions.Observation indicators:(1) intraoperative and postoperative recovery situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was done to detect postoperative survival of patients up to February 2018.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Kaplain-Meier method was used to calculate survival rate.Results (1) Intraoperative and postoperative recovery situations:all the 127 patients underwent successful operation without perioperative death,including 111 of open surgery and 16 of laparoscopic surgery.Of 127 patients,single total caudate lobectomy and partial caudate lobectomy were performed in 2 and 13 patients,single hepatic segmentectomy combined with total caudate lobectomy,double hepatic segmentectomy combined with total caudate lobectomy,hepatic trisegmentectomy combined with total caudate lobectomy,left hemitectomy combined with total caudate lobectomy,left hepatic trilobectomy combined with total caudate lobectomy,right hemitectomy combined with total caudate lobectomy,right hepatic trilobectomy combined with total caudate lobectomy were performed in 6,4,5,1,1,30,3 patients respectively,single hepatic segmentectomy combined with partial caudate lobectomy,double hepatic segmentectomy combined with partial caudate lobectomy,left hemitectomy combined with partial caudate lobectomy,left hepatic trilobectomy combined with partial caudate lobectomy,right hemitectomy combined with partial caudate lobectomy,right hepatic trilobectomy combined with partial caudate lobectomy were performed in 3,3,41,2,5,8 patients respectively,including 78 via left approach,29 via right approach,2 via anterior approach,7 via left combined with right approach,2 via left and right combined with anterior approach,6 via left and right combined with para-liver hanging tape approach,1 via anterior combined with left approach,2 via retrograde approach.The operation time,time of first hepatic hilum occlusion,volume of intraoperative blood loss and duration of postoperative hospital stay were 285 minutes (range,188-670 minutes),47 minutes(range,30-150 minutes),294 mL(range,20-2 500 mL) and 10 days (range,6-27 days) respectively.Thirty-four patients had postoperative complications,including 21 with abdominal ascites,20 with pleural effusion,6 with incisional infection,5 with hemorrhage,4 with bile leakage,2 with pulmonary infection (1 patient combined with multiple complications).One patient underwent reoperation after ineffective conservative treatment for hemorrhage within postoperative 24 hours and other 33 were cured by conservative treatment.(2) Follow-up and survival situations:of 127 patients,124 including 68 of malignant tumors and 56 of non-malignant tumors were followed up for 2-71 months with a median time of 33 months.During the follow-up,1-,3-,5-year overall survival rates were 83.1％,63.4％,22.5％ in 68 patients with malignant tumors,89.3％,71.4％,57.1％ in 28 patients with hilar cholangiocarcinoma and 76.9％,46.2％,23.1％ in 26 with hepatocellular carcinoma.All the 56 patients with non-malignant tumors survived well.Conclusions Anatomical hepatectomy using precise surgery is safe and feasible.Preoperative precise evaluation and surgical procedure design,intraoperative vascular control and surgical plane mastering are keys to success.

Microwave ablation therapy of hepatocellular carcinoma in the caudate lobe : reports of 11 cases / 实用医学杂志

Objective To investigate the value of microwave ablation in the treatment of hepatocellular carcinoma in the caudate lobe.Methods We retrospectively analyzed the data of patients with hepatocellular carcinoma in the caudate lobe treated primarily by microwave ablation from January 2011 to May 2016 in our department,and explore the safety,efficacy of microwave ablation (MWA).Results The 11 patients had been treated with microwave ablation procedure in 13 lesions,through caudate lobe epigastric puncture in 9 cases and intercostal puncture in 2 cases.A total of 2 cases did not reach the technical success due to one case treated by radiation therapy,and the other treated by repeated MWA.However,the repeated MWA of that patient failed to reach the technical success.And the effective rate of treatment was 81.8％ (9/11).Following up to October 2016,the average follow-up time was (31.5±15.4) months.There were 1 patient with extrahepatic metastasis and 4 cases of patients with intrahepatic distant recurrence,among which 3 cases underwent MWA treatment again and 1 case underwent radiotherapy.Conclusion Microwave ablation is a safe and effective therapy option for the Caudate Lobe tumor.

Laparoscopic hepatic caudate lobe resection: a report of 7 patients / 中华肝胆外科杂志

Objective To study the feasibility and safety of laparoscopic hepatic caudate lobe resec tion.Methods The clinical data of seven patients who underwent laparoscopic hepatic caudate lobe resection in our hospital were retrospective analyzed.There were 3 male and 4 female patients.The mean age was 45.3 years.The primary diseases included hepatic haemangioma (n =2),metastatic liver cancer (n =2),hepatocellular carcinoma (n =1),recurrent hepatocellular carcinoma (n =1) and hepatic adenoma (n =1).The total blood loss,operation time,hospital stay after surgery and complication were analyzed.Results The surgery was successful in all these 7 patients and no patients required any conversion to open surgery.Five patients underwent partial caudate lobe resection,and the remaining 2 underwent combined left hemi hepatectomy with partial caudate lobe resection.The operation time ranged from 200 to 250 minutes with a mean of 235 minutes.The intraoperative blood loss ranged from 40 to 600 ml with a mean of 188 ml.There was no postoperative bleeding and bile leakage.The resections were all R0 resections.Conclusions Laparoscopic hepatic caudate lobe resection was safe and feasible in appropriate patients.Familiarity with anatomy of the liver caudate lobe and skilled laparoscopic techniques are important to carry out this surgery.

Transcatheter hepatic arterial chemoembolization combined with CT guided radiofrequency ablation for treatment of primary liver cancer in caudate lobe / 中国介入影像与治疗学

Objective To evaluate the efficacy and safety of transcatheter hepatic arterial chemoembolization (TACE) combined with CT guided radiofrequency ablation (RFA) for primary liver cancer in the caudate lobe.Methods Sixteen patients with primary liver cancer in the caudate lobe were treated with combination therapy of TACE and RFA.Complet ablation rate,overall and recurrence-free survival,and complications were evaluated.Results A total of 15 cases achieved complet ablation,complet ablation rate was 93.75％ (15/16).Recurrence-free survival time was 19.35 months,overall survival time was 44.62 months.Overall survival rates were 88.23％,66.65％ and 33.18％ at 1,3,5 years after therapy,respectively.Conclusion TACE combined with RFA is a safe and useful therapeutic option for treatment of primary liver cancer in the caudate lobe.

Present statues and progresses of interventional therapy of hepatocellular carcinoma in caudate lobe / 中国介入影像与治疗学

Recently,with the recognition of blood supply and anatomy of the liver caudate lobe,the intervention therapies of hepatocellular carcinoma in caudate lobe were enriched.However,because of the complex anatomy,the treatment of hepatocellular carcinoma in caudate lobe is still controversial.The interventional methods for hepatocellular carcinoma in caudate lobe were mainly included transcatheter arterial chemoembolization (TACE),percutaneous ethanol injection (PEI),transcatheter arterial embolization (TAE),radioembolization,radiofrequency ablation (RFA) and endoscopic ultrasound-guided ethanol injection.The present statues and progresses of interventional therapy of hepatocellular carcinoma in caudate lobe were reviewed in this article.

Study on the caudate lobe vein in patients with Budd-Chiari syndrome using contrast-enhanced MRI and its clinical significance / 实用放射学杂志

Objective To study the clinical significance of the caudate lobe vein in patients with Budd-Chiari syndrome (BCS) by contrast-enhanced magnetic resonance imaging(MRI).Methods Contrast-enhanced MRI data of 46 patients with BCS, 30 patients with cirrhosis due to hepatitis B virus (HBV) and 49 healthy people in our institution were analyzed retrospectively.The presence and diameter of the caudate lobe vein among the three groups were measured.Among the BCS group, in which the caudate lobe vein could be seen, andpatients were divided into two groups according to disease duration and patency of inferior vena cava (IVC), respectively.And comparative study of diameter between two groups was performed.Results ①The caudate lobe vein was noted in 76.1% of patients with BCS, in 30.0% of patients with cirrhosis due to HBV,and in 36.7% of healthy subjects.The diameter of caudate lobe vein in BCS group was larger than that in both cirrhosis group and healthy group(P0.05).②Among BCS group,the caudate vein was shown in 35 patients, with mean diameter of(4.21±1.66)mm.For 35 BCS,the diameter of caudate lobe vein in chronic group was larger than that in acute group(P<0.05).The diameter of caudate lobe vein in IVC obstruction group was larger than that in IVC open group(P<0.05).Conclusion The demonstration of the caudate lobe vein on contrast-enhanced MRI is of great significance in the diagnosis and treatment of BCS.

Morphometric Study of Caudate Lobe of Liver.

Background: To study the morphology of the caudate lobe of liver. The caudate lobe is visible on the posterior surface, bounded on the left by the fissure for the ligamentum venosum, below by the porta hepatis and on the right by the groove for the inferior vena cava. Above, it continues into the superior surface on the right of the upper end of the fissure for the ligamentum venosum. Below and to the right, it is connected to the right lobe by a narrow caudate process, which is immediately behind the porta hepatis and above the epiploic foramen. Below and to the left, the caudate lobe has a small rounded papillary process. Taking into consideration clinical importance of this lobe in metastasis, cirrhosis and hepatic resections a morphological study was carried out on caudate lobe. Methods: This study was undertaken on 36 cadaveric livers available in the Department of Anatomy of Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly to study the morphometery of caudate lobe of liver using vernier caliper. Results: Various shapes of the caudate lobe were observed, rectangular being the commonest. Conclusion: Knowledge of variations of caudate lobe may be important to anatomists and morphologists for new variant, embryologists for new developmental defect, clinicians for diseases, surgeons for planning surgery involving liver, and imagery specialists for avoiding misinterpretation of CT and MRI.

Isolated complete resection of hepatic caudate lobe：a clinical experience of 14 patients / 中华肝胆外科杂志

Correspondinga uthor:Wan Chun, Email:mdchunwan@163.com [Absrt act] Obj ective To summarize the clinical experience with isolated complete resection of he-patic caudate lobe in 14 patients. Mte hods The clinical data of 14patients with isolated complete resection of hepatic caudate lobe carried out in our hospital from December 2007 to March 2015 were retrospectively analyzed .During the operation , selective hepatic vascular occlusion slings , and supra-and infra-hepatic in-ferior vena cava slings were placed after full mobilization of the liver .Isolated complete resection of the he-patic caudate lobe was performed through the left and /or the right , the anterior liver-splitting or the retro-grade approaches .Results The mean operation time was (227 ±64) min.The mean amount of blood loss was (530 ±325) ml.The mean vascular occlusion time was (19.5 ±18.6) min.The mean diameter of ne-oplasm was (15 4.±9 .2) cm. All the operations were successfully carried out .There were no massive hem-orrhage, bile leakage or perioperative death .Hydrothorax occurred in 3 patients and ascites in 2.The mean stay in hospital was (21 ±9) days.All the patients were cured and discharged home .Conclusion Isolated complete resection of hepatic caudate lobe was feasible in clinical practice .

Treatment of hepatic carcinoma located caudate lobe / 国际外科学杂志

Primary hepatic carcinoma is one of the common digestive tract tumors.Surgical operation in clinic is still the most effective way to treat it so far.The caudate lobe has often been considered the forbidden zone of hepatic operation in the past due to complicated anatomy.In resent years,with the deepening of knowledge of anatomy and advanced radiological technology,many new operative approachs and operation methods have been explored to improve the situation of caudate lobectomy which is already not rare in clinic now.This article summarized the anatomy of caudate lobe and reviewed the therapy progress of the hepatic carcinomas located caudate lobe.

Intra Hepatic Pattern of Portal Vein in Dog's Liver: A Corrosion Cast Study.

Introduction: The variations in the intrahepatic pattern of portal vein within liver are mandatory factors while dealing with hepatic surgery. The variations in the intrahepatic portal vein branching need to be recognized when contemplating for ligation of the vessel at the porta hepatis during partial hepatectomy. Materials and Methods: This study was done in 50 dogs liver specimen by corrosion cast technique. Results and Discussion: In this study in the entire cases bifurcation pattern was found and in all the cases left branch of portal vein extended transversly to the left and turned in the caudolateral direction and divided into transverse portion and oblique portion and right divided into superior and inferior branch. In 88% cases caudate process received branch from the right portal trunk while the papillary process received branch from the left portal trunk. Conclusion: The knowledge of the portal vein and its intrahepatic branching is important to ensure surgical success pertaining to different surgical procedures.

Tumor hepático con vías biliares normales en un paciente con síndrome de Alagille: a propósito de un caso / Liver mass containing normal bile ducts in an Alagille patient: a case report

En este artículo se informa el caso de un paciente con síndrome de Alagille, que desarrolló una lesión de crecimiento rápido en el lóbulo caudado del hígado cirrótico. Se realizó el seguimiento riguroso del tumor aunque, desde el punto de vista radiológico, no parecía ser maligno. En el estudio por resonancia magnética (RM), no se observó ningún criterio diagnóstico de carcinoma hepatocelular; no obstante, se realizó una biopsia de la lesión y del hígado debido al rápido crecimiento del tumor. Los resultados del informe anatomopatológico indicaron desarrollo normal de los conductos biliares en el tumor y escasez de conductos biliares en la segunda muestra del hígado. Describiremos este caso y propondremos una interpretación de estos resultados.

This manuscript reports a case of a patient with Alagille syndrome who developed a rapidly growing lesion in the caudate segment of his cirrhotic liver. This mass was closely monitored but did not seem malignant from a radiological point of view. An MRI showed no criteria in favour of a hepatocarcinoma, however, the rapid growth lead to a biopsy of both the lesion and the cirrhotic liver. The pathology results indicated normal development of the bile ducts in the mass and paucity of the biliary ducts in the second liver specimen. We will describe this case and propose an interpretation of these findings.

Morphological Variations of Caudate Lobe of the Liver and their Clinical Implications.

Background: Knowledge of normal and variant anatomy of the caudate lobe of the liver is a prerequisite for better surgical outcome. Morphology of the caudate lobe has significance in diagnostic imaging and also minimally invasive surgical approaches. So we have taken up this study to know the detailedmorphology of the caudate lobe. Materials andmethods: Themorphology of caudate lobe was studied in 100 formalin fixed adult livers obtained from the department of anatomy, Kempegowda institute of medical sciences and Bangalore medical college, Bangalore. The livers were studied for the morphological variations of the caudate lobe. Results: Various shapes of the caudate lobe were noticed. Vertical fissure extending upwards from lower border was seen in 30%. Prominent papillary process was seen in 21%. Prominent caudate process was seen in 9%. Discussion: Various shapes of the caudate lobe were encountered in the present study. Sahni et aland Joshi SD et al also reported a variety of shapes of the caudate lobe. Vertical fissure extending upwards from the inferior border was seen in 30% of the livers. Kogure et al noticed the notch in approximately half of the patients undergoing hepatectomy. Kogure et al also noted that the external notch may be a vestige of the portal segmentation of the caudate lobe. Prominent papillary process was observed in 21%of the livers. Joshi SD et al have also found prominent papillary process in 33% of the livers in their study. Auh et al observed that on CT (Computed Tomography), a normal or small papillary process may be mistaken for enlarged porta hepatis lymph nodes. When enlarged papillary process extends on to left side it can mimic pancreatic body mass. Conclusion: The incidence of morphological variations of caudate lobe is very high in this study. The papillary process of caudate lobe is a potential source of pitfalls in interpretation of CT images at and just below the porta hepatis. Knowledge of these variations is important for radiologists to achieve correct diagnosis and for surgeons to plan for surgery and to achieve good surgical outcome.

Surgical efficacy of benign tumor of liver in the caudate lobe / 中华消化外科杂志

Objective To evaluate the surgical efficacy of benign tumor of liver in the caudate lobe.Methods The clinical data of 112 patients with benign tumor of liver in the caudate lobe who were admitted to the Eastern Hepatobiliary Surgery Hospital from January 2003 to April 2014 were retrospectively analyzed.The leftsided approach,right-sided approach,bilateral approach,central anterior approach and retrograde caudate lobectomy were selected according to the location and size of the tumor.All the patients were followed up by outpatient examination and telephone interview up to October 2014.Results Of all the 112 patients who received complete resection of tumor,33 patients received caudate lobectomy (22 by bilateral approach,11 by left-sided approach),28 received left hemihepatectomy + caudate lobectomy (by left-sided approach),21 received mesohepatectomy + caudate lobectomy (by central anterior approach),19 received partial right hepatectomy + caudate lobectomy (by right-sided approach),11 received right hemihepatectomy + candate lobectomy (9 by right-sided approach,2 by retrograde caudate lobectomy).During the operation,72 patients received vascular inflow occlusion,29 received vascular inflow occlusion combined with hepatic veins occlusion,6 received total hepatic vascular exclusion and 5 did not receive vascular inflow occlusion.The operation time,mean time of vascular inflow occlusion,mean volume of intraoperative blood loss,cases of blood transfusion,mean volume of blood transfusion and duration of postoperative hospital stay were (192 ± 69)minutes,28 minutes (range,0-94 minutes),590 mL (range,100-12 000 mL),68,600 mL (range,200-10 000mL) and (8.2 ± 2.7) days,respectively.Thirty-one patients had postoperative complications,including 21 with bile leakage,7 with medium and above volume of pleural effusion,2 with postoperative bleeding and 1 with hepatic failure.The complications were cured after symptomatic treatment.No patient died perioperatively.All the 112 patients were followed up for a median time of 12 months (range,6-24 months).All patients were survived well and without tumor recurrence during the follow-up.Conclusions Surgical treatment is an effective method for benign tumor of liver in the caudate lobe,with the good recovery of patients and definitive surgical efficacy.The key factors of surgical treatment include strictly following operative indication,rationally optimizing surgical approach,suitably selecting vascular inflow occlusion and the accurate operation.

Hepatic Papillary Process - An Anatomic Variant of Liver.

Hepatic Papillary process is an anatomic variant of liver. When large can simulate mass lesion in pancreatic head region or periportal lymphnode on imaging however liver tissue characteristics and continuity of the process with the caudate lobe facilitate the differentiation between extrahepatic portocaval mass and papillary process. CT is the modility of choice for the right diagnosis of liver anatomical variants.