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Caudate lobe resection: an Egyptian center experience
Mohamed Abdel Wahab1, Abdul Razzak Oluwagbemiga Lawal, Ehab EL Hanafy
1Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt. wahab_m_eg@yahoo.com
Insights
Caudate lobe resection is a complex surgical procedure. Isolated caudate lobe resection is safe for select patients, but risks increase when combined with major hepatectomy.
Area of Science:
- Hepatobiliary Surgery
- Surgical Anatomy
- Oncology
Background:
- Caudate lobe resection is the most challenging aspect of hepatic resection.
- Thorough anatomical knowledge is crucial for safe caudate lobe resection.
Purpose of the Study:
- To analyze the safety and outcomes of caudate lobe resection.
- To compare outcomes of isolated caudate lobe resection (ICLR) versus caudate lobe resection as part of major hepatectomy.
Main Methods:
- Retrospective analysis of 54 patients who underwent caudate lobe resection between January 2000 and August 2007.
- Extraction and analysis of demographic, clinicopathological, and perioperative data.
- Comparison of outcomes between ICLR and major hepatectomy involving the caudate lobe.
Main Results:
- Caudate lobe resection was performed in 10.8% of 500 hepatic resections.
- Indications for ICLR included hepatocellular carcinoma, carcinoid tumor, hemangioma, and adenoma.
- ICLR had no mortality and low complication rates (bile leak, wound infection), while major hepatectomy with caudate resection had 7.8% mortality and higher complication rates.
Conclusions:
- Caudate lobe resection is technically demanding.
- ICLR is a safe procedure with good outcomes in carefully selected patients.
- Combining caudate lobe resection with major hepatectomy increases perioperative risks.
Background Data:
Hepatectomy is a technically challenging surgery, and of all aspects of hepatic resection, caudate lobe resection is the most difficult. Knowledge of the anatomy of the caudate lobe is necessary to achieve safe caudate lobe resection.
Methodology:
Hospital records of 54 patients, who had caudate lobe resection in our center from January 2000 to August 2007, were retrieved. The demographic data, clinicopathological features, and perioperative events were extracted and analyzed.
Results:
Out of a total of 500 patients who had various forms of hepatic resection during the period in question, only 54 had caudate lobe resection (10.8%). Isolated caudate lobe resection (ICLR) was performed in 16 (29.6%) patients while the remainder had caudate lobe resection as a part of a major hepatectomy. Indications for hepatectomy in patients with ICLR include hepatocellular carcinoma, primary hepatic carcinoid tumor, cavernous hemangioma, and adenoma. Mean operative time for ICLR was 230 +/- 50 min while it was 240 +/- 50 min for right hepatectomy and 245 +/- 55 min for left hepatectomy. The associated mean blood loss was 1200 +/- 200, 1300 +/- 350, and 1350 +/- 350 ml, respectively. None of these were statistically significant. In patients who had ICLR, there was no mortality while three patients developed postoperative complications (bile leak in two patients and one patient with wound infection). Various forms of perioperative complications were noticed in six patients. All these patients, who also showed 7.8% mortality, had major hepatectomy.
Conclusions:
Caudate lobe resection is a technically challenging procedure. Isolated caudate lobe resection is a safe procedure with good outcome in well selected patients. It is, however, associated with increased perioperative risks when associated with major hepatectomy.
