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Updated: Jul 16, 2025
Laparoscopic Left Hemihepatectomy Combined with Caudate Lobe Resection
Published on: April 11, 2025
The value of total caudate lobe resection for hilar cholangiocarcinoma: a systematic review
Da Wang1, Fei Xiong, Guanhua Wu
1Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
Insights
Combined caudate lobe resection (CLR) improves outcomes for hilar cholangiocarcinoma (HCCA) by increasing R0 resection rates and survival. Total CLR is recommended for optimal results in HCCA surgery.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Hilar cholangiocarcinoma (HCCA) presents a significant challenge due to its poor prognosis.
- Radical resection is crucial for improving survival rates in HCCA patients.
- The role and extent of combined caudate lobe resection (CLR) in HCCA surgery remain debated.
Approach:
- This review synthesizes current clinical evidence on the necessity and impact of CLR in HCCA.
- It examines criteria for R0 resection, optimal hepatic resection extent, and surgical approaches.
- The discussion includes anatomical considerations and the potential of minimally invasive techniques.
Key Points:
- Combined CLR significantly enhances the R0 resection rate and postoperative survival for HCCA.
- The decision to include CLR for Bismuth types I and II depends on pathological findings.
- Total CLR is generally preferred over partial CLR for achieving higher R0 resection rates.
- A proximal ductal margin of at least 10 mm is associated with survival benefits in HCCA resection.
- Peng's resection line can guide right-sided liver resections in relation to the caudate lobe.
Conclusions:
- Combined CLR is a vital strategy for improving radical resection and survival in hilar cholangiocarcinoma.
- Laparoscopic CLR offers potential advantages in safety and minimally invasiveness but requires experienced surgeons.
Abstract:
Hilar cholangiocarcinoma (HCCA) is widely considered to have a poor prognosis. In particular, combined caudate lobe resection (CLR) as a strategy for radical resection in HCCA is important for improving the R0 resection rate. However, the criteria for R0 resection, necessity of CLR, optimal extent of hepatic resection, and surgical approach are still controversial. This review aimed to summarize the findings and discuss the controversies surrounding CLR. Numerous clinical studies have shown that combined CLR treatment for HCCA improves the R0 resection rate and postoperative survival time. Whether surgery for Bismuth type I or II is combined with CLR depends on the pathological type. Considering the anatomical factors, total rather than partial CLR is recommended to achieve a higher R0 resection rate. In the resection of HCCA, a proximal ductal margin greater than or equal to 10 mm should be achieved to obtain a survival benefit. Although there is no obvious boundary between the right side (especially the paracaval portion) and the right posterior lobe of the liver, Peng's resection line can serve as a reference marker for right-sided resection. Laparoscopic resection of the caudate lobe may be safer, more convenient, accurate, and minimally invasive than open surgery, but it needs to be completed by experienced laparoscopic doctors.
