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High dorsal resection for hepatocellular carcinoma: surgical plane and outcomes
Shintaro Yamazaki1, Tadatoshi Takayama1, Masaru Aoki1
1Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
Insights
High dorsal resection (HDR) is a complex liver surgery for caudate lobe cancer. This study shows HDR can be performed safely with good survival rates, despite its challenging nature.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Liver anatomy
Background:
- High dorsal resection (HDR) is a specialized liver resection technique.
- It is indicated for hepatocellular carcinoma (HCC) in the caudate lobe.
- HDR is infrequently performed due to technical difficulty and patient factors.
Purpose of the Study:
- To evaluate the safety and efficacy of HDR for caudate lobe HCC.
- To analyze operative outcomes and long-term survival following HDR.
Main Methods:
- Retrospective review of 9 patients who underwent HDR between 2002 and 2012.
- Data collected included operation time, blood loss, morbidity, mortality, and hospitalization duration.
Main Results:
- Median operation time was 534 minutes; median blood loss was 430 mL.
- Severe morbidity rate was 11.1% with no operative mortality.
- Median hospitalization was 13 days; overall survival was 49.7 months.
Conclusions:
- High dorsal resection (HDR) is a feasible and safe procedure for caudate lobe hepatocellular carcinoma.
- Despite anatomical challenges, HDR offers good survival outcomes.
- This technique can be considered for select HCC cases in the caudate lobe.
Abstract:
High dorsal resection (HDR) of the liver is a systematic resection technique for hepatocellular carcinoma (HCC) arising in the caudate lobe. HDR is rarely performed, as the procedure requires a high level of operative skill, knowledge of liver anatomy and is performed in patients with limited hepatic function. Between 2002 and 2012, we performed HDR on 9 patients. The median operation time was 534 min (range, 349-903 min), and the median blood loss volume was 430 mL (range, 94-4,530 mL). The severe morbidity rate was 11.1%, but there was no operative mortality, and the median hospitalization was 13 days (range, 8-93 days). The overall survival was 49.7 months (range, 3.1-89.0 months). Despite the hard-to-approach anatomic location, HDR can be carried out safely with good survival compared to other segments.
