Top

World Journal of Surgical Oncology

Published in:

Open Access 01-12-2013 | Technical innovations

Mesohepatectomy with total caudate lobectomy of the liver for hepatocellular carcinoma

Authors: Hiromichi Ishii, Shinpei Ogino, Koki Ikemoto, Atsushi Toma, Kenji Nakamura, Tsuyoshi Itoh, Toshiya Ochiai

Published in: World Journal of Surgical Oncology | Issue 1/2013

Abstract

Background

Mesohepatectomy with total resection of the caudate lobe and extrahepatic bile duct is sometimes performed for hilar cholangiocarcinoma or gallbladder carcinoma; however, only a few reports on mesohepatectomy with total caudate lobectomy of the liver for hepatocellular carcinoma are available.

Methods

A 71-year-old woman was preoperatively diagnosed with hepatocellular carcinoma in the central bisections (Couinaud’s segments 4, 5, and 8) and the paracaval portion of the caudate lobe. Mesohepatectomy with total caudate lobectomy of the liver permitted the removal of tumors to provide a cancer-free raw surface of the liver. Mobilization of the caudate lobe is an important procedure in this surgery. Before the liver parenchyma was dissected, all short hepatic veins were ligated and divided from the left to the right side as the left lateral section was retracted to the right, and the caudate lobe branches of the portal vein and hepatic artery were ligated and divided. After the liver parenchymal dissection, both between the left lateral and medial sections and between the right anterior and posterior sections, the Glissonean branches of the caudate lobe were ligated and divided as the central bisections were anteriorly retracted. Finally, liver parenchymal dissection was performed between the caudate lobe and the right posterior section, which was along the right side of the inferior vena cava.

Results

The surgery time was 538 minutes and blood loss was 1,207 mL. No blood transfusions were required during or after surgery. The postoperative course was uncomplicated. The patient is still alive 25 months after hepatectomy.

Conclusion

Although mesohepatectomy with total caudate lobectomy of the liver is technically more difficult than mesohepatectomy of the liver because the caudate lobe must be completely detached from the inferior vena cava and the hilar plate, it is a safe and effective treatment method in selected patients with hepatocellular carcinoma located at both the central bisections and the paracaval portion of the caudate lobe.

Available only for authorised users

Kumon M: Anatomy of the caudate lobe with special reference to portal vein and bile duct. Acta Hepatol Jpn. 1985, 26: 1193-1199. 10.2957/kanzo.26.1193.CrossRef

Couinaud C: The paracaval segments of the liver. J Hep Bil Pancr Surg. 1994, 2: 145-151.CrossRef

Nimura Y, Hayakawa N, Kamiya J, Kondo S, Nagino M, Kanai M: Hilar cholangiocarcinoma-surgical anatomy and curative resection. J Hep Bil Pancr Surg. 1995, 2: 239-248. 10.1007/BF02350905.CrossRef

Couinaud C: Lobe et segments hepatiques. Presse Med. 1954, 62: 709-712.PubMed

Yanaga K: Central bisectionectomy (bisegmentectomy) of the liver (with video). J Hepatobiliary Pancreat Sci. 2012, 19: 44-47. 10.1007/s00534-011-0449-7.CrossRefPubMed

Takayama T, Tanaka T, Higaki T, Katou K, Teshima Y, Makuuchi M: High dorsal resection of the liver. J Am Coll Surg. 1994, 179: 72-75.PubMed

Peng SY, Li JT, Mou YP, Liu YB, Wu YL, Fang HQ, Cao LP, Chen L, Cai XJ, Peng CH: Different approaches to caudate lobectomy with “curettage and aspiration” technique using a special instrument PMOD: a report of 76 cases. World J Gastroenterol. 2003, 9: 2169-2173.PubMed

Liver Cancer Study Group of Japan: The General Rules for the Clinical and Pathological Study of Primary Liver Cancer. 2003, Tokyo: Kanehara Press, 2 English

Sobin LH, Wittekind C: TMN Classification of Malignant Tumors. 2002, New York: Wiley-Liss, 6

10.

Makuuchi M, Mori T, Gunven P, Yamazaki S, Hasegawa H: Safety of hemihepatic vascular occlusion during resection of the liver. Surg Gynecol Obstet. 1987, 164: 155-158.PubMed

11.

Uesaka K: Left hepatectomy or left trisectionectomy with resection of the caudate lobe and extrahepatic bile duct for hilar cholangiocarcinoma (with video). J Hepatobiliary Pancreat Sci. 2012, 19: 195-202. 10.1007/s00534-011-0474-6.CrossRefPubMed

12.

Wu CC, Ho WL, Chen JT, Tang CS, Yeh DC, Liu TJ, P’eng FK: Mesohepatectomy for centrally located hepatocellular carcinoma: an appraisal of rare procedure. J Am Coll Surg. 1999, 188: 508-515. 10.1016/S1072-7515(99)00026-5.CrossRefPubMed

13.

Scudamore CH, Buczkowski AK, Shayan H, Ho SG, Legiehn GM, Chung SW, Owen DA: Mesohepatectomy. Am J Surg. 2000, 179: 356-360. 10.1016/S0002-9610(00)00374-3.CrossRefPubMed

14.

Mehrabi A, Mood Z, Roshanaei N, Fonoumi H, Muller SA, Schmied BM, Hinz U, Weitz J, Buchler MW, Schmidt J: Mesohepatectomy as an option for the treatment of central liver tumors. J Am Coll Surg. 2008, 207: 499-509. 10.1016/j.jamcollsurg.2008.05.024.CrossRefPubMed

15.

Strasberg SM: Nomenclature of hepatic anatomy and resection: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg. 2005, 12: 351-355. 10.1007/s00534-005-0999-7.CrossRefPubMed

16.

Lee JG, Choi SB, Kim KS, Choi JS, Lee WJ, Kim BR: Central bisectionectomy for centrally located hepatocellular carcinoma. Br J Surg. 2008, 95: 990-995. 10.1002/bjs.6130.CrossRefPubMed

17.

Stratopoulos C, Soonnawalla Z, Brockmann J, Hoffmann K, Friend PJ: Central hepatectomy: the golden mean for treating central liver tumors?. Surg Oncol. 2007, 16: 99-106. 10.1016/j.suronc.2007.05.002.CrossRefPubMed

18.

Hasegawa H, Makuuchi M, Yamazaki S, Gunven P: Central bisegmentectomy of the liver: experience in 16 patients. World J Surg. 1989, 13: 786-790. 10.1007/BF01658437.CrossRefPubMed

19.

Ogura Y, Matsuda S, Sakurai H, Kawarada Y, Mizumoto R: Central bisegmentectomy of the liver plus caudate lobectomy for carcinoma of the gallbladder. Dig Surg. 1998, 15: 218-223. 10.1159/000018617.CrossRefPubMed

20.

Lang H, Sotiropoulos GC, Malago M, Broelsch CE: Mesohepatectomy, caudate lobectomy and resection of hilar bifurcation with biliary reconstruction by 6 hepaticojejunostomies for Klatskin tumor. Hepatogastroenterology. 2003, 50: 1327-1329.PubMed

21.

Nagino M, Nimura Y, Kamiya J, Kanai M, Uesaka K, Hayakawa N, Yamamoto H, Kondo S, Nishio H: Segmental liver resections for hilar cholangiocarcinoma. Hepatogastroenterology. 1998, 45: 7-13.PubMed

22.

Sakoda M, Ueno S, Kudo F, Hiwatashi K, Tateno T, Kurahara H, Mataki Y, Shinchi H, Natsugoe S: Surgery for hepaticellular carcinoma located in the caudate lobe. World J Surg. 2009, 33: 1922-1926. 10.1007/s00268-009-0110-7.CrossRefPubMed

23.

Yamamoto M, Katagiri S, Ariizumi S, Kotera Y, Takahashi Y: Glissonean pedicle transection method for liver surgery (with video). J Hepatobiliary Pancreat Sci. 2012, 19: 3-8. 10.1007/s00534-011-0443-0.PubMedCentralCrossRefPubMed

24.

Machado MA, Herman P, Machado MC: Intrahepatic Glissonian approach for pedicle control during anatomic mesohepatectomy. Surgery. 2007, 141: 533-537. 10.1016/j.surg.2006.07.023.CrossRefPubMed

25.

Yamashita Y, Hamatsu T, Rikimaru T, Tanaka S, Shirabe K, Shimada M, Sugimachi K: Bile leakage after hepatic resections. Ann Surg. 2001, 233: 45-50. 10.1097/00000658-200101000-00008.PubMedCentralCrossRefPubMed

26.

Ishii H, Ochiai T, Murayama Y, Komatsu S, Shiozaki A, Kuriu Y, Ikoma H, Nakanishi M, Ichikawa D, Fujiwara H, Okamoto K, Kokuba Y, Sonoyama T, Otsuji E: Risk factors and management of postoperative bile leakage after hepatectomy without bilioenteric anastomosis. Dig Surg. 2011, 28: 198-204. 10.1159/000324042.CrossRefPubMed

27.

Rahbari NN, Koch M, Zimmermann JB, Elbers H, Bruckner T, Contin P, Reissfelder C, Schmidt T, Weigand MA, Martin E, Buchler MW, Weitz J: Infrahepatic inferior vena cava clamping for reduction of central venous pressure and blood loss during hepatic resection. Ann Surg. 2011, 253: 1102-1110. 10.1097/SLA.0b013e318214bee5.CrossRefPubMed

28.

Chen XP, Zhang ZW, Zhang BX, Chen YF, Huang ZY, Zhang WG, He SQ, Qiu FZ: Modified technique of hepatic vascular exclusion: effect on blood loss during complex mesohepatectomy in hepatocellular carcinoma patients with cirrhosis. Langenbecks Arch Surg. 2006, 391: 209-215. 10.1007/s00423-006-0043-7.CrossRefPubMed

29.

Wang WD, Liang LJ, Huang XQ, Yin XY: Low central venous pressure reduces blood loss in hepatectomy. World J Gastroenterol. 2006, 12: 935-939.PubMedCentralPubMed

30.

Yoon YS, Han HS, Cho JY, Ahn KS: Totally laparoscopic central bisectionectomy for hepatocellular carcinoma. J Laparoendosc Adv Surg Tech A. 2009, 19: 653-656. 10.1089/lap.2009.0012.CrossRefPubMed

31.

Machado MA, Kalil AN: Glissonian approach for laparoscopic mesohepatectomy. Surg Endosc. 2011, 25: 2020-2022. 10.1007/s00464-010-1483-2.CrossRefPubMed

32.

Kokkalera U, Ghellai A, Vandermeer TJ: Laparoscopic hepatic caudate lobectomy. J Laparoendosc Adv Surg Tech A. 2007, 17: 36-38. 10.1089/lap.2006.05062.CrossRefPubMed

Title: Mesohepatectomy with total caudate lobectomy of the liver for hepatocellular carcinoma
Authors: Hiromichi Ishii
Shinpei Ogino
Koki Ikemoto
Atsushi Toma
Kenji Nakamura
Tsuyoshi Itoh
Toshiya Ochiai
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2013
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/1477-7819-11-82

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Mesohepatectomy with total caudate lobectomy of the liver for hepatocellular carcinoma

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2013

Primary malignant melanoma of the esophagus: a rare and aggressive disease

Osteosarcoma metastasis causing ileo-ileal intussusception

Single-incision video-assisted thoracoscopic resection of a pedunculated solitary fibrous tumor of the pleura: case report

Surgical outcomes in patients with small cell lung cancer: comparative analysis of computed tomograpy-detected patients with others

Vertical platysma myocutaneous flap that sacrifices the facial artery and vein

Cortactin is a sensitive biomarker relative to the poor prognosis of human hepatocellular carcinoma