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Al-Ameri AAM, Zheng S. Survival outcomes after caudate lobectomy for hepatocellular carcinoma: systematic review and meta-analysis. ANZ J Surg 2024; 94:335-341. [PMID: 38193603 DOI: 10.1111/ans.18860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Caudate lobectomy (CLB) remains the most effective treatment for caudate lobe hepatocellular carcinoma (CL-HCC). However, there is controversy regarding the survival after CLB. This meta-analysis aims to investigate the survival outcomes following CLB for the treatment of CL-HCC. METHODS In line with PRISMA and MOOSE guidelines, a search for all eligible studies was performed. The pooled estimates of survival rates and hazard ratios (HRs) with their 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. RESULTS Sixteen studies comprising 864 patients met the inclusion criteria. The pooled estimates of 3- and 5-year overall survival (OS) rates were 62.3% and 42.9% respectively and the pooled estimate of 3- and 5-year recurrence-free survival (RFS) rates were 39.3% and 24.4% respectively. CL-HCC showed inferior OS (HR:1.39, 95% CI: 0.91-1.88, P < 0.001) and RFS (HR:1.33, 95% CI: 1.10-1.56, P < 0.001) than other sites HCC. Isolated CLB showed better OS (HR:0.9, 95% CI:0.39-1.41, p < 0.001) and RFS (HR:0.76, 95% CI: 0.03-1.5, P = 0.04) than combined CLB. CONCLUSIONS The survival outcomes for CL-HCC after CLB are lower compared to other sites HCC. Isolated CLB offers better survival outcomes compared to combined CLB. However, choosing isolated or combined approaches should be prioritized according to patient and tumour characteristics.
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Affiliation(s)
- Abdulahad Abdulrab Moahmmed Al-Ameri
- Department of Hepatobiliaryand Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China
- National Health Commission Key Laboratory of Combined Multi-organ Transplantation, Hangzhou, China
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment For Hepatobiliary and Pancreatic Cancer, Chinese Academy of Medical Sciences, Hangzhou, China
- Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Hangzhou, China
| | - Shusen Zheng
- Department of Hepatobiliaryand Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China
- National Health Commission Key Laboratory of Combined Multi-organ Transplantation, Hangzhou, China
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment For Hepatobiliary and Pancreatic Cancer, Chinese Academy of Medical Sciences, Hangzhou, China
- Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Hangzhou, China
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Miyayama S. Radiological Vascular Anatomy of the Caudate Lobe of the Liver Required for Transarterial Chemoembolization of Hepatocellular Carcinoma. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:118-129. [PMID: 38020459 PMCID: PMC10681755 DOI: 10.22575/interventionalradiology.2022-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/23/2023] [Indexed: 12/01/2023]
Abstract
The caudate lobe is located between the bilateral hepatic lobes and is divided into three subsegments: the Spiegel lobe, paracaval portion, and caudate process. The caudate artery arises from various sites of the bilateral hepatic arteries as an independent branch, common trunk, or arcade. Extrahepatic arteries can enter the caudate lobe mainly by the right inferior phrenic artery. The caudate artery also supplies the main bile duct and posterior aspect of segment IV. Although catheterization into the caudate artery is occasionally difficult because of its small size and sharp angulation, selective embolization of a tumor feeder is a significant prognostic factor in patients with hepatocellular carcinoma originating there. Therefore, we should recognize the peculiarity of its vascular anatomy and should be familiar with catheterization and embolization techniques.
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Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Japan
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3
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Xue S, Jin Z, Zeng Y, Huang J. Rupture and hemorrhage of a large primary liver tumor in caudate lobe. Asian J Surg 2023; 46:3833-3834. [PMID: 37012155 DOI: 10.1016/j.asjsur.2023.03.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Affiliation(s)
- Shuai Xue
- Department of Liver Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Zhaoxing Jin
- Department of Liver Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Yong Zeng
- Department of Liver Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Jiwei Huang
- Department of Liver Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China.
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Mukund A, Tripathy TP, Patel RK, Chandel K, Patidar Y, Jindal A, Sarin SK. Percutaneous ablative therapies for hepatocellular carcinoma in the caudate lobe of the liver: efficacy and outcome. Br J Radiol 2023; 96:20220086. [PMID: 37227887 PMCID: PMC10392663 DOI: 10.1259/bjr.20220086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To assess the efficacy and outcomes of percutaneous ablative therapies for hepatocellular carcinoma (HCC) in the caudate lobe. METHODS Patients within Milan criteria, who underwent thermal ablation (RFA/MWA) for HCC were analyzed. Based on the inclusion-criteria, patients were categorized in two groups. Group-1 (caudate-lobe HCC) and Group-2 (non-caudate-lobe HCC). Both the groups were analyzed for technical success (TS), local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) were compared between both the groups. Predictive factors for LTP, DFS, or OS in the study cohort were analyzed using appropriate statistical analyses. RESULTS Twenty-one patients qualified to be in Group-1 while 130 patients fulfilled the criteria for Group-2. TS of 90.5 and 97.7% was seen after the first session of ablation for Group-1 and group-2 respectively, while a TS of 95.2% (Group-1) and 100% (Group-2) was achieved after second session. The right-intercostal-approach was used in 66.7% (n = 14) and the anterior-epigastric-approach was used in 33.3% (n = 7) of patients having caudate-lobe HCC. Procedure-related complications in both the groups were comparable. Although, statistically insignificant, LTP in the Group-1 (19.5%, n = 4) was twice that of non-caudate lobe HCC (8.5%, n = 11). The cumulative DFS rate was better in Group-2 while OS in both groups were comparable. Multivariate analysis showed: tumor size and ablative margin of 5 mm being independent predictors of LTP after percutaneous-ablation of caudate-lobe HCC. CONCLUSION Ablative therapies for HCC in caudate lobe is feasible and safe with comparable LTP and OS to non-caudate lobe HCC. Tumor size >2 cm and lack of 5 mm ablative margin are independent predictors of LTP. ADVANCES IN KNOWLEDGE 1. Percutaneous ablation of caudate lobe HCC is feasible using anterior epigastric approach or right intercostal approach. 2. These approaches may allow a safe and effective ablation of caudate lobe HCC with results comparable to non-caudate HCC ablation.
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Affiliation(s)
- Amar Mukund
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
| | | | | | - Karamvir Chandel
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Ankur Jindal
- Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India
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5
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Xu M, Xu D, Deng Z, Tian G, Jiang T. Long-term outcomes of endoscopic ultrasound-guided laser ablation for liver tumors in the caudate lobe: 5 years of experience. Scand J Gastroenterol 2022; 58:558-564. [PMID: 36415178 DOI: 10.1080/00365521.2022.2148833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Liver tumor in the caudate lobe is challenging to treat, partly due to its deep location. Endoscopic ultrasound-guided laser ablation (EUS-LA) is a new attractive option for tumors in high-risk or difficult-to-reach locations. This prospective study investigated the long-term efficacy of EUS-LA for tumors in the caudate lobe, and factors that predict outcomes. METHODS From June 2016 to July 2021, twenty consecutive patients (aged 56.95 ± 10.06 years) with 25 caudate lobe tumors (15.64 ± 6.37 mm) underwent EUS-LA. Treatment outcomes were assessed and predictive factors were calculated via univariate and multivariate analyses. RESULTS Twenty-five tumors achieved complete ablation after the first or second session of EUS-LA. The treatment effectiveness was 100%. During a median follow up of 27 months (3-60), four tumors (16%) developed local tumor progression and 15 patients (75%) experienced intrahepatic distant recurrence. According to univariate and multivariate analyses, the significant prognostic factor of local tumor progression was tumor size >2 cm (p = 0.047). Significant prognostic factors of intrahepatic distant recurrence were: tumor number, alpha-fetoprotein level, and total bilirubin level (p = 0.020, 0.019, 0.010, respectively). No adverse events related to EUS-LA were observed. CONCLUSION EUS-LA is a viable, safe, and effective treatment option for patients with liver tumor in the caudate lobe. Tumor size >2 cm increases the risk of post-procedural local tumor progression. Intrahepatic tumor number, and pretreatment alpha-fetoprotein level and total bilirubin level are associated with intrahepatic distant recurrence. REGISTRATION Clinicaltrials.gov, ID: NCT02816944(June 29, 2016).
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Affiliation(s)
- Min Xu
- Department of Ultrasound Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Danxia Xu
- Department of Ultrasound Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhuang Deng
- Department of Ultrasound Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guo Tian
- Department of Ultrasound Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian'an Jiang
- Department of Ultrasound Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Arora M, Toskich BB, Lewis AR, Padula CA, Montazeri SA, Ritchie C, Frey G, Paz-Fumagalli R, McKinney JM, Devcic Z. Radiation Segmentectomy for the Treatment of Primary Hepatic Malignancies of the Caudate Lobe: A Case Series. Cardiovasc Intervent Radiol 2022; 45:1485-1493. [PMID: 36028573 DOI: 10.1007/s00270-022-03250-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/06/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Tumors involving the caudate lobe present a unique therapeutic challenge due to their complex anatomy and the safety and efficacy of locoregional therapy can be variable. The purpose of this study is to analyze the outcomes of radiation segmentectomy for primary caudate lobe tumors. MATERIALS AND METHODS Eight patients [5 women and 3 men; median age = 69 y (range 50-79)] that underwent transarterial radioembolization (TARE) using yttrium-90 (Y90) glass microspheres for primary caudate lobe tumors (hepatocellular carcinoma = 6, intrahepatic cholangiocarcinoma = 2) from August 2017 to March 2021 were retrospectively analyzed. Descriptive statistics, treatment parameters, tumor response (using modified response evaluation criteria in solid tumors), adverse events [using common terminology criteria for adverse events (CTCAE)], and survival outcomes were evaluated. RESULTS Eight primary caudate lobe tumors with a median size of 2.2 cm [interquartile range (IQR), 1.7-3.3] and Child-Pugh class A liver function underwent TARE of the caudate lobe. The median radiation dose was 596 Gy (IQR 356-1585), median total activity was 0.84 GBq (IQR 0.56-1.31), median specific activity was 473 Bq/sphere (IQR 226-671), and the median number of Y90 microspheres used was 1.4 million (IQR 1.2-3.4). All complications were CTCAE grade 1, and no clinically significant hilar plate complications were observed. In targeted tumors, complete response was seen in all patients. At a median follow-up period of 16.6 months (IQR 6.6-21.6) 75% (6/8) of patients were alive with no in-field progression. CONCLUSION Radiation segmentectomy of primary caudate lobe tumors appears effective and is well tolerated in this limited case series within the described treatment parameters. LEVEL OF EVIDENCE Level 4, Case Series.
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Affiliation(s)
- Manasi Arora
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - Beau B Toskich
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - Andrew R Lewis
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - Carlos A Padula
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - Seyed Ali Montazeri
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - Charles Ritchie
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - Gregory Frey
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - Ricardo Paz-Fumagalli
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - J Mark McKinney
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - Zlatko Devcic
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA.
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Wang Z, Linn YL, Chong Y, Chung AY, Chan CY, Goh BKP. Laparoscopic versus open caudate lobe liver resections: a 1:2 propensity score-matched controlled study based on a single institution experience. ANZ J Surg 2022; 92:2157-2162. [PMID: 35692120 DOI: 10.1111/ans.17849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/10/2022] [Accepted: 05/30/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Despite the wide use of laparoscopy for liver resection, laparoscopic caudate lobe resections(L-CLR) remain technically challenging, only attempted by experts in the field. The primary objective of this study was to determine the safety and compare the perioperative outcomes of L-CLR with O-CLR based on our single institution experience in a 1:2 propensity score-matched controlled study based on our single institution experience. METHODS Between 2004 and 2020, 67 consecutive patients who underwent CLR at Singapore General Hospital were identified. Propensity score matching (PSM) of laparoscopic versus open caudate lobe resections(O-CLR) was performed in a 1:2 ratio with no replacements using nearest neighbour matching method. RESULTS L-CLR was associated with a significantly decreased median blood loss (150 mL versus 500 mL, P = 0.001) and a decreased median post-operative stay (3 days versus 7.5 days, P = <0.01) in the unmatched cohorts. After 1:2 propensity score matching, these results were again demonstrated with a significantly lower blood loss (150 mL versus 400 mL, P = 0.016) and a shorter postoperative stay (3 days versus 7 days, P = <0.01) in favour of L-CLR. 30-day readmission and major morbidity (Clavien-Dindo grade > 2) rates were all in favour of L-CLR as well but could not reach statistical significance. CONCLUSION L-CLR can be safely performed by experienced surgeons. It is associated with decreased blood loss and shorter perioperative stay compared to O-CLR.
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Affiliation(s)
- Zhongkai Wang
- Department of Hepatopancreatobiliary and Transplant Surgery, Division of Surgery, Singapore General Hospital and Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Department of General Surgery, Woodlands Health, Singapore
| | - Yun-Le Linn
- Department of Hepatopancreatobiliary and Transplant Surgery, Division of Surgery, Singapore General Hospital and Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Yvette Chong
- Department of Hepatopancreatobiliary and Transplant Surgery, Division of Surgery, Singapore General Hospital and Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Alexander Y Chung
- Department of Hepatopancreatobiliary and Transplant Surgery, Division of Surgery, Singapore General Hospital and Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore.,Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore
| | - Chung-Yip Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Division of Surgery, Singapore General Hospital and Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore.,Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Division of Surgery, Singapore General Hospital and Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore.,Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore
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8
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Xu ZG, Zhang FH, Sun DW, Zheng QT, Ji GW, Wang K. Surgical Strategy for Resecting Hepatocellular Carcinoma in the Caudate Lobe: Isolated or Combined Lobectomy? A Single-Center Study and Meta-Analysis. J Hepatocell Carcinoma 2022; 9:13-25. [PMID: 35118017 PMCID: PMC8802904 DOI: 10.2147/jhc.s349335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Resection of hepatocellular carcinoma (HCC) originating in the caudate lobe remains challenging, while the optimal extent of resection is debated. We aimed to evaluate the relative benefits of combined caudate lobectomy (CCL) versus isolated caudate lobectomy (ICL) for caudate HCC. Methods Patients who underwent curative-intent resection for caudate HCC between January 2010 and December 2018 were identified from a single-center database. Surgical outcomes of the two strategy groups were analyzed before and after propensity score matching. A systematic review with meta-analysis was also performed to compare outcomes of CCL versus ICL for caudate HCC. Results A total of 28 patients were included: 11 in the CCL and 17 in the ICL group. Compared with ICL, the CCL group contained patients with larger tumors and a higher incidence of vascular invasion. After propensity score matching, 6 pairs of patients were selected. In the well-matched cohort, CCL demonstrated significantly improved recurrence-free survival (RFS) (P = 0.047) compared with ICL; no significant differences were noted for overall survival (OS), operation time, blood loss and morbidity rate. A total of 227 patients from nine eligible studies and ours were involved in the systematic review. Meta-analysis revealed that CCL provided better RFS (hazard ratio 0.54, 95% confidence interval 0.31–0.92) than ICL; no significant differences were observed in OS, operation time, blood loss and morbidity rate. Conclusion CCL confers superior RFS over ICL without compromise of perioperative outcomes and should be prioritized for patients with caudate HCC when feasible, especially for those with large-sized tumors.
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Affiliation(s)
- Zheng-Gang Xu
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, People’s Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, People’s Republic of China
| | - Fei-Hong Zhang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, People’s Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, People’s Republic of China
| | - Dong-Wei Sun
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, People’s Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, People’s Republic of China
| | - Qi-Tong Zheng
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, People’s Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, People’s Republic of China
| | - Gu-Wei Ji
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, People’s Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, People’s Republic of China
| | - Ke Wang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, People’s Republic of China
- NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, People’s Republic of China
- Correspondence: Ke Wang; Gu-Wei Ji, Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People’s Republic of China, Tel +86 18061675088; +86 15951758275, Fax +86 68136450, Email ;
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9
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Abstract
OBJECTIVE To propose an algorithm for resecting hepatocellular carcinoma (HCC) in the caudate lobe. BACKGROUND Owing to a deep location, resection of HCC originating in the caudate lobe is challenging, but a plausible guideline enabling safe, curable resection remains unknown. METHODS We developed an algorithm based on sublocation or size of the tumor and liver function to guide the optimal procedure for resecting HCC in the caudate lobe, consisting of 3 portions (Spiegel, process, and caval). Partial resection was prioritized to remove Spiegel or process HCC, while total resection was aimed to remove caval HCC depending on liver function. RESULTS According to the algorithm, we performed total (n = 43) or partial (n = 158) resections of the caudate lobe for HCC in 174 of 201 patients (compliance rate, 86.6%), with a median blood loss of 400 (10-4530) mL. Postoperative morbidity (Clavien grade ≥III b) and mortality rates were 3.0% and 0%, respectively. After a median follow-up of 2.6 years (range, 0.5-14.3), the 5-year overall and recurrence-free survival rates were 57.3% and 15.3%, respectively. Total and partial resection showed no significant difference in overall survival (71.2% vs 54.0% at 5 yr; P = 0.213), but a significant factor in survival was surgical margin (58.0% vs 45.6%, P = 0.034). The major determinant for survival was vascular invasion (hazard ratio 1.7, 95% CI 1.0-3.1, P = 0.026). CONCLUSIONS Our algorithm-oriented strategy is appropriate for the resection of HCC originating in the caudate lobe because of the acceptable surgical safety and curability.
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10
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Yamazaki S, Takayama T, Aoki M, Yoshida N, Higaki T. High dorsal resection for hepatocellular carcinoma: surgical plane and outcomes. Quant Imaging Med Surg 2021; 11:3792-3796. [PMID: 34341750 DOI: 10.21037/qims-20-964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/18/2021] [Indexed: 11/06/2022]
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.
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Affiliation(s)
- Shintaro Yamazaki
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masaru Aoki
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Nao Yoshida
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tokio Higaki
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
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11
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Iizumi T, Okumura T, Sekino Y, Takahashi H, Tsai YL, Takizawa D, Ishida T, Hiroshima Y, Nakamura M, Shimizu S, Saito T, Numajiri H, Mizumoto M, Nakai K, Sakurai H. Long-term clinical outcomes of patients receiving proton beam therapy for caudate lobe hepatocellular carcinoma. JOURNAL OF RADIATION RESEARCH 2021; 62:682-687. [PMID: 34036362 PMCID: PMC8273797 DOI: 10.1093/jrr/rrab040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/27/2021] [Indexed: 05/09/2023]
Abstract
Hepatocellular carcinoma (HCC) located in the caudate lobe (caudate HCC) is rare; however, patients with this type of tumour have poorer prognoses than those with HCC in other segments. Despite many published reports on the clinical usefulness of proton beam therapy (PBT) for HCC, data on the clinical outcomes of patients undergoing PBT for caudate HCC remain scarce. Therefore, the present study aimed to investigate the outcomes of this group of patients. Thirty patients with caudate HCC who underwent definitive PBT between February 2002 and February 2014 were retrospectively analysed. The total irradiation doses ranged from 55 to 77 (median 72.6) Gy relative biological dose. The median follow-up period was 37.5 (range, 3.0-152.0) months. The overall survival (OS) rates at one, three and five years were 86.6%, 62.8% and 46.1%, respectively. According to univariate and multivariate analyses, Child-Pugh A (P < 0.01), having a single tumour (P = 0.02) and a low serum alpha-fetoprotein level (AFP; P < 0.01) were significant factors predicting longer survival. The local control (LC) rates at one, three and five years were 100%, 85.9% and 85.9%, respectively, while the corresponding progression-free survival (PFS) rates were 65%, 27.5% and 22%, respectively. No grade 3 or worse adverse events were observed. PBT is effective and safe for the treatment of caudate HCC, and should therefore be considered a feasible option for intervention in patients with this disease.
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Affiliation(s)
- Takashi Iizumi
- Corresponding author. Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan. TEL: +81-29-853-7100; FAX: +81-29-853-7102; E-mail:
| | - Toshiyuki Okumura
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Yuta Sekino
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Hiroaki Takahashi
- Department of Diagnostic Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Yu-Lun Tsai
- Department of Radiation Oncology, Cathay General Hospital, Taipei, 106, Taiwan
| | - Daichi Takizawa
- Department of Radiation Oncology, Hitachi General Hospital, Ibaraki, 317-0077, Japan
| | - Toshiki Ishida
- Department of Radiation Therapy, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Ibaraki, 309-1793, Japan
| | - Yuichi Hiroshima
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Masatoshi Nakamura
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Shosei Shimizu
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Takashi Saito
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Kei Nakai
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
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Yan L, Chen L, Qian K, Kan X, Zhang H, Liang B, Zheng C. Caudate Lobe Hepatocellular Carcinoma Treated with Sequential Transarterial Chemoembolization and Iodine 125 Seeds Implantation: A Single-Center Retrospective Study. Cancer Manag Res 2021; 13:3901-3912. [PMID: 34012296 PMCID: PMC8128345 DOI: 10.2147/cmar.s309310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/20/2021] [Indexed: 01/05/2023] Open
Abstract
Purpose Resection of the hepatocellular carcinoma (HCC) in the caudate lobe (CL) is challenging even for accomplished surgeons. This retrospective study evaluated the safety and efficacy of transarterial chemoembolization (TACE) and iodine 125 seeds implantation (ISI) for unresectable or “ablation unsuitable” HCC-CL detected at the initial presentation in clinical practice. Patients and Methods A total of 20 HCC-CL patients undergoing sequential TACE and ISI from January 2014 to October 2018 were enrolled in this study. The overall survival (OS), progression-free survival (PFS), tumor response rate, and complication rates were analyzed and compared to non-caudate lobe (NCL) HCC patients. Multivariate analyses for potential clinical and radiological factors were performed using the Cox proportional hazard model. Results The technical success rate was 100%, as all the patients received 28 ISI treatments. The median OS was 35 months. The 1-, 3-, and 5-year OS rates were 100%, 63.2%, and 11.1%, respectively. The median PFS was 16 months. The objective response rate was 60.0%. The puncture tract bleeding (2/20) and pneumothorax (1/20) were the most common complications in operation, but no operation-related deaths occurred. One year after the surgery, biliary tract injury occurred in 1 patient, necessitating percutaneous biliary intervention. No statistical difference was observed between the CL and NCL groups. Multivariable analysis revealed that Barcelona Clinic Liver Cancer stage B and tumor size >3 cm were two significant factors associated with OS. Conclusion Sequential TACE and ISI were associated with the survival benefits in HCC-CL and should be considered as a reliable therapy for surgeons and interventional radiologists.
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Affiliation(s)
- Liangliang Yan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Lei Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Kun Qian
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Xuefeng Kan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Hongsen Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Bin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, People's Republic of China
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13
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Okazaki S, Shibuya K, Shiba S, Okamoto M, Miyasaka Y, Osu N, Kawashima M, Kakizaki S, Araki K, Shirabe K, Ohno T. Carbon ion radiotherapy for patients with hepatocellular carcinoma in the caudate lobe carbon ion radiotherapy for hepatocellular carcinoma in caudate lobe. Hepatol Res 2021; 51:303-312. [PMID: 33350034 DOI: 10.1111/hepr.13606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/05/2020] [Accepted: 11/22/2020] [Indexed: 12/12/2022]
Abstract
AIM The treatment of hepatocellular carcinoma in the caudate lobe (HCCCL) is technically challenging. We aimed to investigate the efficacy and toxicity of carbon ion radiotherapy (C-ion RT) for HCCCL. METHODS Patients with HCCCL treated with C-ion RT at our hospital between January 2011 and December 2018 were evaluated. The total dose was 52.8 or 60 Gy (relative biological effectiveness) in four or 12 fractions depending on the distance between the tumor and the gastrointestinal tract. The survival outcome, the presence or absence of recurrence (local recurrence, intrahepatic recurrence outside the irradiation field, or extrahepatic recurrence), and acute/late adverse events were evaluated. RESULTS Nine patients were included. The median tumor size was 3.4 cm, and the median follow-up duration was 18.3 months for all patients. No patient developed local recurrence during follow-up. Five patients subsequently developed intrahepatic recurrence outside the irradiation field and two had extrahepatic metastasis. Five patients died of hepatocellular carcinoma. No acute adverse events of grade ≥2 were observed. Two patients experienced grade 2 or 3 late adverse events, including obstructive jaundice, hepatic encephalopathy, ascites, and edema. CONCLUSION Carbon ion radiotherapy for HCCCL achieved excellent local control with acceptable adverse events and can thus be a curative treatment option for HCCCL.
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Affiliation(s)
- Shohei Okazaki
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.,Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Kei Shibuya
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shintaro Shiba
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Masahiko Okamoto
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuhei Miyasaka
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Naoto Osu
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | | | - Satoru Kakizaki
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.,Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Kenichiro Araki
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ken Shirabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.,Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
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14
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Lee SU, Yoon SM, Cheng JCH, Kim TH, Kim BH, Park JH, Jung J, Tsai CL, Chiang Y, Park JW. Multi-Institutional Retrospective Study of Radiotherapy for Hepatocellular Carcinoma in the Caudate Lobe. Front Oncol 2021; 11:646473. [PMID: 33718247 PMCID: PMC7952981 DOI: 10.3389/fonc.2021.646473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background: No studies evaluating the clinical outcomes of radiotherapy (RT) for hepatocellular carcinoma (HCC) in the caudate lobe have been available to date. The purpose of this study was to evaluate the effectiveness and safety of RT for HCC in the caudate lobe. Material and Methods: Seventy patients with HCC in the caudate lobe treated with RT from a multi-institutional database were included in this study. The median equivalent dose in 2 Gy (EQD2) was 80.0 Gy10 (range, 31.3–99.3), and freedom from local progression (FFLP), progression-free survival (PFS), and overall survival (OS) rates were evaluated. Results: The median time of follow-up was 47.9 months (range, 3.4–127), and the 5-year FFLP, PFS, and OS rates were 80.6% [95% confidence interval (CI), 70.8–91.8], 13.8% (95% CI, 7.5–25.4), and 51.3% (95% CI, 39.9–66.1), respectively. In the multivariate analysis, the radiation dose was significantly associated with the FFLP rate [hazard ratio (HR), 0.57 per 10 Gy10 increase, p = 0.001], and the status of FFLP was significantly associated with OS (HR, 2.694, p = 0.014). The overall rate of ≥grade 3 adverse events was 5.7% (4 of 70), and RT-related mortality was not observed. Conclusion: RT for HCC in the caudate lobe showed promising FFLP and OS rates with safe toxicity profiles. These findings suggest that RT may be a promising treatment option for HCC in the caudate lobe.
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Affiliation(s)
- Sung Uk Lee
- Center for Proton Therapy, National Cancer Center, Goyang, South Korea
| | - Sang Min Yoon
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jason Chia-Hsien Cheng
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tae Hyun Kim
- Center for Proton Therapy, National Cancer Center, Goyang, South Korea.,Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, South Korea
| | - Bo Hyun Kim
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, South Korea
| | - Jin-Hong Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinhong Jung
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chiao-Ling Tsai
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yun Chiang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Joong-Won Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, South Korea
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15
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Peng Y, Cui D, Li W, Ding M, Shi Y, Wang T, Shi D, Chi J, Li P, Zhai B. Ultrasound-guided percutaneous microwave ablation for hepatocellular carcinoma originating in the caudate lobe: A pilot clinical study. J Cancer Res Ther 2021; 17:764-770. [PMID: 34269311 DOI: 10.4103/jcrt.jcrt_1851_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective This study aimed to evaluate the efficacy, feasibility, and tolerability of ultrasound (US)-guided percutaneous microwave ablation (MWA) for treating hepatocellular carcinoma (HCC) originating in the caudate lobe. Materials and Methods The treatment and survival parameters of 32 patients with HCC in the caudate lobe, who met the inclusion criteria and had received US-guided percutaneous MWA in our department from November 2010 to October 2015, were retrospectively analyzed. Imaging examination (contrast-enhanced computed tomography or magnetic resonance) 1 month after MWA was used to evaluate the efficacy of US-guided MWA. Results Thirty-two patients underwent percutaneous MWA for caudate lobe HCC. The average tumor size was 3.42 ± 0.27 (range: 1-6.8) cm. The initial complete ablation (CA) rate was 87.5% (28/32), and the total CA rate was 96.88% (31/32). Furthermore, the median length of hospitalization was 4 days (range: 2-10 days), and no major complication was observed in this study. The overall survival rates were 87.5%, 50%, and 28.13% at 1, 2, and 3 years, respectively. The progression-free survival after MWA was 93.75%, 53.15%, and 28.13% at 6, 12, and 18 months, respectively. Conclusions US-guided percutaneous MWA was a safe and effective treatment. It is a promising alternative therapy for HCC originating in the caudate lobe.
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Affiliation(s)
- Yuan Peng
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dan Cui
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Weijian Li
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ming Ding
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yaoping Shi
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Tao Wang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Donghua Shi
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiachang Chi
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ping Li
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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16
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Schullian P, Laimer G, Putzer D, Effenberger M, Bale R. Stereotactic radiofrequency ablation of primary liver tumors in the caudate lobe. HPB (Oxford) 2020; 22:470-478. [PMID: 31591012 DOI: 10.1016/j.hpb.2019.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/04/2019] [Accepted: 09/14/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The encasement of the caudate lobe by a vascular ring of large vessels may apart from the technical difficulties in needle placement increase the probability of local recurrence after thermal ablation due to cooling effects. This single-center retrospective study evaluates the results after multiprobe stereotactic radiofrequency ablation (SRFA) of hepatocellular carcinoma (HCC) in the caudate lobe. METHODS Twenty patients underwent 24 multiple-probe SRFA sessions for the treatment of 24 HCCs in the caudate lobe. Eight of twenty patients had initially solitary tumors, the remaining 12 patients suffered from multifocal disease. RESULTS The median tumor size was 1.5 cm (range: 1-8 cm). After a mean follow-up of 21 months one local recurrence in the caudate lobe was observed resulting in a local recurrence rate of 4.2% (1/24). The overall survival rates at 1, 3, and 5 years from the date of the first SRFA were 95%, 59%, and 44%, respectively, with a median overall survival of 51.3 months. The disease-free survival after SRFA was 48%, 24% and 24%, at 1, 3 and 5 years, respectively. One patient suffering from Child C liver cirrhosis died due to septic shock 26 days after SRFA and one postinterventional complication required minimal invasive interventional treatment. CONCLUSION Multiprobe SRFA for HCC in the caudate lobe appears to be safe and feasible. The overall outcome is at least comparable to that of surgical resection, with low perioperative mortality and only minimal morbidity.
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Affiliation(s)
- Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck Austria
| | - Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck Austria
| | - Daniel Putzer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck Austria
| | - Maria Effenberger
- University Hospital for Internal Medicine I, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck Austria.
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17
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Neural Networks for Deep Radiotherapy Dose Analysis and Prediction of Liver SBRT Outcomes. IEEE J Biomed Health Inform 2019; 23:1821-1833. [DOI: 10.1109/jbhi.2019.2904078] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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18
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Prognoses and Clinicopathological Characteristics for Hepatocellular Carcinoma Originating from the Caudate Lobe After Surgery. World J Surg 2019; 43:1085-1093. [PMID: 30478681 DOI: 10.1007/s00268-018-4869-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim was to evaluate the prognoses and clinicopathological characteristics of solitary hepatocellular carcinoma (HCC) originating from the caudate lobe (HCC-CL). METHODS We analyzed 584 patients with a solitary tumor <10 cm from January 1990 to November 2014. Patients were classified into a caudate lobe group (CL; n = 39) and a non-caudate lobe group (NCL; n = 545). We investigated the prognoses and clinicopathological characteristics of solitary HCC-CL. We compared the surgical procedures performed in these cases. RESULTS HCC-CL had a similar rate of portal venous invasion (PVI) as HCC-NCL (21% vs. 19%); however, the frequency of tumor thrombus at the first branch of the portal vein (PV) or extension to the trunk or the opposite side of the PV was significantly higher in HCC-CL (8% vs. 2%). HCC-CL had similar OS rates compared to HCC-NCL; however, HCC-CL showed significantly poorer RFS. Although there were no significant differences among the three surgical procedures, blood loss and complication rates tended to be higher in cases who underwent an isolated caudate lobectomy. Tumor size ≥5 cm, PVI, and liver fibrosis or cirrhosis (LF or LC) were independent unfavorable factors for both OS and RFS. PIVKA-II ≥120 mAU/ml was an independent unfavorable factor for RFS. CONCLUSION HCC-CL presented a poorer RFS rate. Patients with a tumor size ≥5 cm, PIVKA-II ≥120 mAU/ml, portal venous invasion, and LF or LC should be diligently followed up as these cases have a high risk of recurrence.
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19
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Deng HX, Huang JH, Lau WY, Ai F, Chen MS, Huang ZM, Zhang TQ, Zuo MX. Hydrochloric acid enhanced radiofrequency ablation for treatment of large hepatocellular carcinoma in the caudate lobe: Report of three cases. World J Clin Cases 2019; 7:508-515. [PMID: 30842963 PMCID: PMC6397810 DOI: 10.12998/wjcc.v7.i4.508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/23/2018] [Accepted: 01/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To report on the use of percutaneous hydrochloric acid (HCl) enhanced radiofrequency ablation (HRFA) for the treatment of large (maximum diameter ≥ 5 cm) hepatocellular carcinoma (HCC) in the caudate lobe.
CASE SUMMARY Between August 2013 and June 2016, three patients with a large HCC (maximum diameter: 5.0, 5.7, and 8.1 cm) in the caudate lobe were treated by transarterial chemoembolization followed by computer tomography (CT) guided RFA using a monopolar perfusion RF electrode, which was enhanced by local infusion of 10% HCl at 0.2 mL/min (total volume, 3 to 12 mL). The output power of HRFA reached 100 W, and the average ablation time was 39 min (range, 15 to 60 min). Two patients each underwent one session of HRFA and one patient two sessions. After treatment, CT/magnetic resonance imaging showed that all the three lesions were completely ablated. There was no major complication. Two patients had asymptomatic bile duct dilatation. One patient died of tongue cancer 24 mo after ablation. The remaining two patients were alive and no area of enhancement is detected in the caudate lobe at 28 and 60 mo after ablation, respectively.
CONCLUSION Percutaneous CT-guided HRFA is safe and efficacious in treating large HCC in the caudate lobe.
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Affiliation(s)
- Han-Xia Deng
- Department of Minimally Invasive Interventional Therapy, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, Guangdong Province, China
| | - Jin-Hua Huang
- Department of Minimally Invasive Interventional Therapy, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, Guangdong Province, China
| | - Wan Yee Lau
- Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Fei Ai
- Department of Minimally Invasive Interventional Therapy, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, Guangdong Province, China
| | - Min-Shan Chen
- Department of Hepatobiliary Surgery, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, Guangdong Province, China
| | - Zhi-Mei Huang
- Department of Minimally Invasive Interventional Therapy, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, Guangdong Province, China
| | - Tian-Qi Zhang
- Department of Minimally Invasive Interventional Therapy, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, Guangdong Province, China
| | - Meng-Xuan Zuo
- Department of Minimally Invasive Interventional Therapy, Cancer Centre of Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in Southern China, Guangzhou 510060, Guangdong Province, China
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Fernandes EDSM, Pacilio CA, de Mello FPT, de Oliveira Andrade R, Pimentel LMS, Girão CL. Anterior transhepatic approach for total caudate lobectomy including spigelian lobe, paracaval portion and caudate process: A Brazilian experience. Hepatobiliary Pancreat Dis Int 2018; 17:371-373. [PMID: 30049478 DOI: 10.1016/j.hbpd.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/05/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Eduardo de Souza Martins Fernandes
- Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Adventista Silvestre, Rio de Janeiro, Brazil; Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio De Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Carlo Alberto Pacilio
- Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Adventista Silvestre, Rio de Janeiro, Brazil.
| | | | | | | | - Camila Liberato Girão
- Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Adventista Silvestre, Rio de Janeiro, Brazil
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21
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Lee BC, Liu KL, Wu CH, Huang KW, Ho CM, Hu RH, Ho MC, Wu YM, Lee PH, Liang PC. Comparison of Radiofrequency Ablation and Transarterial Chemoembolization for Hepatocellular Carcinoma in the Caudate Lobe. Cardiovasc Intervent Radiol 2018; 41:1699-1707. [DOI: 10.1007/s00270-018-1978-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/30/2018] [Indexed: 12/17/2022]
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22
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Liu B, Long J, Wang W, Huang G, Jiang C, Zhang X, Liu M, Liang P, Yu J, Xie X, Kuang M. Treatment of hepatocellular carcinoma in the caudate lobe: US-guided percutaneous radiofrequency ablation combined with ethanol ablation. Clin Radiol 2018; 73:647-656. [PMID: 29627066 DOI: 10.1016/j.crad.2018.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/23/2018] [Indexed: 12/18/2022]
Abstract
AIM To evaluate the technical feasibility and treatment results of ultrasound (US)-guided percutaneous radiofrequency ablation (RFA) combined with ethanol ablation (EA) for hepatocellular carcinoma (HCC) in the caudate lobe. MATERIALS AND METHODS The institutional review board approved this retrospective study and the requirement for informed consent was waived. From October 2009 to June 2016, there were 49 patients with HCC in the caudate lobe underwent ablation. Among them, 14 patients (12 men and two women, mean age: 49.9±14.9 years) with 16 caudate lobe HCCs (mean size: 3±1.1 cm) who underwent US-guided RFA-EA were identified. These patients were compared with patients who underwent RFA alone (n=17) and EA alone (n=18). RESULTS HCCs in the RFA-EA group were larger than those in the EA-alone group (3±1.1 versus 2.1±0.7 cm, p=0.028). In the RFA-EA group, all the patients achieved treatment success (14/14) and entered follow-up. After a follow-up period of 17.1±10.6 months (range, 5-36 months), local tumour progression (LTP) was detected in four tumours. The 1- and 2-year LTP rates after RFA-EA were 18.8% and 27.8%, respectively. The 1- and 2-year disease-free survival (DFS) rates were 35.7% and 13.4%. Six patients died, with the 1-, 2-, and 3-year overall survival (OS) rates of 85.1%, 63.1%, and 21%, respectively. There were no significant differences in the LTP, DFS, and OS rates between the RFA-EA group and RFA-alone or EA groups (p=0.363-0.733). CONCLUSION US-guided percutaneous RFA-EA appears to be a feasible and effective treatment for HCC in the caudate lobe.
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Affiliation(s)
- B Liu
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - J Long
- Department of Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - W Wang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - G Huang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - C Jiang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - X Zhang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - M Liu
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - P Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853, China
| | - J Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853, China
| | - X Xie
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - M Kuang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Department of Liver Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
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Hirooka M, Ochi H, Hiraoka A, Koizumi Y, Tokumoto Y, Abe M, Michitaka K, Joko K, Hiasa Y. Multipolar versus monopolar radiofrequency ablation for hepatocellular carcinoma in the caudate lobe: Results of a propensity score analysis. Hepatol Res 2017; 47:658-667. [PMID: 27509446 DOI: 10.1111/hepr.12791] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 02/08/2023]
Abstract
AIM This study aimed to compare multipolar radiofrequency ablation (RFA) with monopolar RFA as the major treatment for nodules of hepatocellular carcinoma in the caudate lobe. METHODS This retrospective study was approved by the institutional review board. Data were reviewed from 101 patients who met the Milan criteria and were treated by multipolar RFA (n = 22) or monopolar RFA (n = 79). After propensity score matching, complications and local tumor progression were compared between the two groups. RESULTS Before propensity score matching (n = 101), the 2-year relapse-free survival rates for multipolar and monopolar RFA (65.1% vs. 38.8%, respectively; P = 0.064) and the local tumor progression rate (12.5% vs. 14.9%, respectively; P = 0.313) were not significantly different. There were no significant differences between the two RFA techniques by treatment efficacy of transcatheter hepatic arterial embolization, location of tumor, and puncture route. After matching (n = 44), the 2-year relapse-free survival rate for the multipolar and monopolar groups (65.1% vs. 22.7%, respectively; P = 0.004) was significantly different, and the local tumor progression rate (12.5% vs. 22.9%, respectively; P = 0.004) was significantly different. No severe complications occurred in the patients treated by multipolar RFA. CONCLUSION Multipolar RFA appears to be a safe and effective method for hepatocellular carcinoma nodules in the caudate lobe.
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Affiliation(s)
- Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hironori Ochi
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Atsushi Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Yohei Koizumi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yoshio Tokumoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Masanori Abe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kojiro Michitaka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Kouji Joko
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
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Sotiropoulos GC, Charalampoudis P, Stamopoulos P, Machairas N, Spartalis ED, Kykalos S, Kouraklis G. Caudate resection for primary and metastatic liver tumors. Eur Surg 2017. [DOI: 10.1007/s10353-017-0466-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nakaji S, Hirata N, Mikata R, Kobayashi M, Shiratori T, Ogasawara S, Ooka Y, Tsuyuguchi T, Yamaguchi T, Yokosuka O. Clinical outcomes of endoscopic ultrasound-guided ethanol injection for hepatocellular carcinoma in the caudate lobe. Endosc Int Open 2016; 4:E1111-E1115. [PMID: 27747288 PMCID: PMC5063731 DOI: 10.1055/s-0042-116146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/19/2016] [Indexed: 02/07/2023] Open
Abstract
Background and study aims: Accurately puncturing hepatocellular carcinomas (HCC) that arise from the caudate lobe is generally considered to be technically difficult. We conducted a retrospective study to evaluate the feasibility and safety (the therapeutic outcomes and adverse events) of endoscopic ultrasound (EUS)-guided ethanol injection as a novel treatment for HCC in the caudate lobe. Patients and methods: Twelve patients with early-stage HCC of the caudate lobe that were treated with EUS-guided ethanol injection at two tertiary referral centers were reviewed retrospectively. To evaluate the therapeutic effect of the treatment, a local control curve and an overall survival curve were constructed using the Kaplan-Meier method. Results: The mean follow-up duration was 31.0 months. The 1-year local control rate was 80.2 %, and recurrent lesions developed in 2 cases (after 3 and 9 months, respectively). The overall survival rate was 91.7 %, 75.0 %, and 53.3 % at 1, 2, and 3 years, respectively. Concerning procedure-related adverse events (AEs), 2 patients suffered episodes of fever lasting a few days; however, no serious AEs occurred. Conclusions: EUS-guided ethanol injection could be a useful treatment for early-stage HCC in the caudate lobe because of its simplicity and reduced invasiveness.
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Affiliation(s)
- So Nakaji
- Department of Gastroenterology, Kameda Medical Center,Corresponding author So Nakaji 929, Higashi-cho, Kamogawa CityChiba, 296-8602Japan+81-4-7099-1131
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center
| | - Rintaro Mikata
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University
| | | | | | - Sadahisa Ogasawara
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University
| | - Yoshihiko Ooka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University
| | - Toshio Tsuyuguchi
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University
| | | | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University
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Dou JP, Yu J, Cheng ZG, Han ZY, Liu FY, Yu XL, Liang P. Ultrasound-Guided Percutaneous Microwave Ablation for Hepatocellular Carcinoma in the Caudate Lobe. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1825-1833. [PMID: 27126238 DOI: 10.1016/j.ultrasmedbio.2016.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
Treatment for liver tumors in the caudate lobe is challenging because of their location and complex anatomy. This study was intended to evaluate the feasibility, efficacy and tolerability of ultrasound-guided percutaneous microwave (MW) ablation for treating hepatocellular carcinoma (HCC) in the caudate lobe. From December 2011 to May 2015, a total of 20 patients (mean age: 62 ± 11 y) with HCC in the caudate lobe were enrolled in this study. Patient characteristics and tumor features were analyzed. The epigastric approach, intercostal approach and the combination were used in 4, 14 and 2 patients, respectively. Contrast-enhanced ultrasound (CEUS) guidance and temperature monitoring were applied as ancillary techniques. Ethanol injection was performed for tumors adjacent to the inferior vena cava or hepatic hilum. Contrast images were performed to evaluate treatment response after ablation. Technical success, technique efficacy, local tumor progression and complications were documented. Technique efficacy was achieved in 18 patients (18/20, 90%). Two patients received (125)I brachytherapy as palliative therapy for residual tumors that could not be ablated technically after the first ablation. Technical success was achieved in 16 patients (16/20, 80%). In 2 patients, ablation was completed after two sessions. CEUS was applied in 5 patients and temperature monitoring in 2 patients. Eight patients received an ethanol injection during ablation. Eleven patients achieved a minimum 5-mm safety margins. Local tumor progression was detected in 3 patients (16.7%, 3/18) during a median follow-up of 18.4 mo (range: 3-45 mo). Tumors in these 3 patients were all larger than 2.0 cm. No major or minor complications were observed. In conclusion, ultrasound-guided percutaneous microwave ablation combined with CEUS, temperature monitoring, and ethanol injection is a tolerable and relatively effective treatment for HCC in the caudate lobe.
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Affiliation(s)
- Jian-Ping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
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Treatment of Small Hepatocellular Carcinoma (≤2 cm) in the Caudate Lobe with Sequential Transcatheter Arterial Chemoembolization and Radiofrequency Ablation. Cardiovasc Intervent Radiol 2016; 39:1015-22. [PMID: 26975761 DOI: 10.1007/s00270-016-1314-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 02/06/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate technical feasibility and treatment results of sequential transcatheter arterial chemoembolization (TACE) and cone-beam computed tomography-guided percutaneous radiofrequency ablation (CBCT-RFA) for small hepatocellular carcinoma (HCC) in the caudate lobe. MATERIALS AND METHODS Institutional review board approved this retrospective study. Radiologic database was searched for the patients referred to perform TACE and CBCT-RFA for small caudate HCCs (≤2 cm) between February 2009 and February 2014. A total of 14 patients (12 men and 2 women, mean age; 61.3 years) were included. Percutaneous ultrasonography-guided RFA (pUS-RFA) and surgery were infeasible due to poor conspicuity, inconspicuity or no safe electrode pathway, and poor hepatic reserve. Procedural success (completion of both TACE and CBCT-RFA), technique efficacy (absence of tumor enhancement at 1 month after treatment), and complication were evaluated. Treatment results including local tumor progression (LTP), intrahepatic distant recurrence (IDR), overall survival (OS), and progression-free survival (PFS) were analyzed. RESULTS Procedural success and technique efficacy rates were 78.6 % (11/14) and 90.9 % (10/11), respectively. Average follow-up period was 45.3 months (range, 13.4-64.6 months). The 1-, 3-, and 5-year LTP probabilities were 0, 12.5, and 12.5 %, respectively. IDR occurred in seven patients (63.6 %, 7/11). The 1-, 3-, and 5-year PFS probabilities were 81.8, 51.9, and 26 %, respectively. The 1-, 3-, and 5-year OS probabilities were 100, 80.8, and 80.8 %, respectively. CONCLUSION Combination of TACE and CBCT-RFA seems feasible for small HCC in the caudate lobe not amenable to pUS-RFA and effective in local tumor control.
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Dong J, Li W, Zeng Q, Li S, Gong X, Shen L, Mao S, Dong A, Wu P. CT-Guided Percutaneous Step-by-Step Radiofrequency Ablation for the Treatment of Carcinoma in the Caudate Lobe. Medicine (Baltimore) 2015; 94:e1594. [PMID: 26426638 PMCID: PMC4616865 DOI: 10.1097/md.0000000000001594] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The location of the caudate lobe and its complex anatomy make caudate lobectomy and radiofrequency ablation (RFA) under ultrasound guidance technically challenging. The objective of the exploratory study was to introduce a novel modality of treatment of lesions in caudate lobe and discuss all details with our experiences to make this novel treatment modality repeatable and educational. The study enrolled 39 patients with liver caudate lobe tumor first diagnosed by computerized tomography (CT) or magnetic resonance imaging (MRI). After consultation of multi-disciplinary team, 7 patients with hepatic caudate lobe lesions were enrolled and accepted CT-guided percutaneous step-by-step RFA treatment. A total of 8 caudate lobe lesions of the 7 patients were treated by RFA in 6 cases and RFA combined with percutaneous ethanol injection (PEI) in 1 case. Median tumor diameter was 29 mm (range, 18-69 mm). A right approach was selected for 6 patients and a dorsal approach for 1 patient. Median operative time was 64 min (range, 59-102 min). Median blood loss was 10 mL (range, 8-16 mL) and mainly due to puncture injury. Median hospitalization time was 4 days (range, 2-5 days). All lesions were completely ablated (8/8; 100%) and no recurrence at the site of previous RFA was observed during median 8 months follow-up (range 3-11 months). No major or life-threatening complications or deaths occurred. In conclusion, percutaneous step-by-step RFA under CT guidance is a novel and effective minimally invasive therapy for hepatic caudate lobe lesions with well repeatability.
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Affiliation(s)
- Jun Dong
- From the Department of Medical Imaging & Image Guided Therapy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, East Dong Feng Road 651, Guangzhou, Guangdong 510060, PR China (JD, WL, QZ, SL, LS, SM, AD, PW); and Department of Medical Statistics and Epidemiology School of Public Health, Sun Yat-sen University, Zhongshan 2nd Road, 74, Guangzhou, Guangdong 510080, PR China (XG)
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Robot-assisted laparoscopic partial caudate lobe resection for hepatocellular carcinoma in cirrhotic liver. Surg Laparosc Endosc Percutan Tech 2015; 24:e88-91. [PMID: 24887545 DOI: 10.1097/sle.0b013e31829ce820] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the technical feasibility and safety of robot-assisted laparoscopic partial caudate lobe resection using the robotic surgical system. MATERIALS AND METHODS This is a report of the use of robot-assisted laparoscopic partial caudate lobe resection on 2 patients with hepatocellular carcinoma. RESULTS Robot-assisted laparoscopic partial caudate lobe resection was completed successfully in these 2 patients. The operating time was 137 and 150 minutes, respectively. The blood loss was 137 and 150 mL, respectively. They were able to tolerate liquids on the second postoperative day. Both patients recovered from the operation. They were discharged 4 and 5 days after the operation, respectively. The resected margins of both specimens were tumor free (R0 resections). CONCLUSIONS Robot-assisted laparoscopic partial caudate lobe resection is a feasible and safe procedure. Our results demonstrate the advantages of robotic system on short-term outcomes and suggest the extended indication of minimally invasive hepatectomy even in the technically challenging anatomic area.
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Woo S, Kim HC, Chung JW, Jung HS, Hur S, Lee M, Jae HJ. Chemoembolization of extrahepatic collateral arteries for treatment of hepatocellular carcinoma in the caudate lobe of the liver. Cardiovasc Intervent Radiol 2014; 38:389-96. [PMID: 24934735 DOI: 10.1007/s00270-014-0929-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/21/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE This study was designed to evaluate the efficacy and safety in performing chemoembolization of extrahepatic collateral arteries (EHC) for hepatocellular carcinoma (HCC) located in the caudate lobe. METHODS Between January 2006 and November 2013, chemoembolization via EHC was performed in 35 patients with 35 caudate HCCs. Preprocedural and follow-up CT or MR scans, angiographic images, and medical records were reviewed retrospectively in consensus. Chi-square analysis was used to evaluate the relationship between tumor characteristics and type of EHC and that between tumor response and the characteristics of the tumor and chemoembolization. RESULTS In 31 (88.6 %) patients, EHCs supplying the caudate HCC originated from the right inferior phrenic artery (RIPA). The remaining four HCCs were supplied by the gastroduodenal artery, dorsal pancreatic artery, and right and left gastric arteries. Superselective catheterization of tumor-feeding vessels from the EHC was achieved in 27 patients (77.1 %). There were no major complications. Individual tumor response supplied by the EHC at follow-up contrast-enhanced CT were as follows: complete response (n = 18), partial response (n = 9), stable disease (n = 3), and progressive disease (n = 3). Non-RIPA EHCs were significantly more common in patients who had previously received chemoembolization via the RIPA (50 %) than those who had not (6.5 %; P = 0.01). There was no significant predictive factor associated with tumor response. CONCLUSIONS HCC in the caudate lobe can be supplied by several EHCs. Chemoembolization via these arteries can be performed safely and effectively.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, # 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Korea
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Dai WD, Huang JS, Hu JX. Isolated Caudate Lobe Resection for Huge Hepatocellular Carcinoma (10 cm or greater in diameter). Am Surg 2014. [DOI: 10.1177/000313481408000224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Isolated caudate lobectomy for huge hepatocellular carcinoma (HCC) (10 cm or greater in diameter) is a technically demanding surgical procedure that entails the surgeon's experience and precise anatomical knowledge of the liver. We describe our clinical experiences and evaluate the results of partial or total isolated caudate lobectomy for HCC larger than 10 cm in the caudate lobe. En bloc excisions combined with adjacent hepatic parenchyma (as part of extended hepatectomies) were excluded. Twenty-seven patients were included in the study (24 male, three3 female). Median age was 43 years (range, 18 to 81 years). All primary diagnoses were HCC. Twenty-one patients had surgical margins lesser than 1 cm. Tumor embolus within the main trunk of the portal vein was found in five patients by intraoperative ultrasound. Median operative time was 288 minutes (range, 160 to 310 minutes), and estimated intraoperative blood loss was 2260 mL (range, 200 to 7000 mL). Median blood transfusion was 1460 mL (range, 0 to 7200 mL). Postoperative morbidity rate was 44.4 per cent. There were no postoperative deaths. Overall survival rates at 1, 3, and 5 years were 80.2, 52.1, and 27.1 per cent, respectively. Nineteen patients (70.4%) had tumor recurrence as of the last follow-up. The recurrence lesion was treated in most of these patients. Isolated caudate lobectomy for huge HCC is a technically demanding but safe procedure, although the procedure is sometimes extremely difficult.
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Affiliation(s)
- Wei-Dong Dai
- Department of General Surgery, XiangYa 2nd Hospital, Central South University, Hangsha, China
| | - Jiang-Sheng Huang
- Department of General Surgery, XiangYa 2nd Hospital, Central South University, Hangsha, China
| | - Ji-Xiong Hu
- Department of General Surgery, XiangYa 2nd Hospital, Central South University, Hangsha, China
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Jiang K, Zhang W, Su M, Liu Y, Zhao X, Wang J, Yao M, Ogbonna J, Dong J, Huang Z. Laparoscopic radiofrequency ablation of solitary small hepatocellular carcinoma in the caudate lobe. Eur J Surg Oncol 2013; 39:1236-42. [DOI: 10.1016/j.ejso.2013.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 08/01/2013] [Accepted: 08/05/2013] [Indexed: 01/25/2023] Open
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Fujimori M, Takaki H, Nakatsuka A, Uraki J, Yamanaka T, Hasegawa T, Shiraki K, Takei Y, Yamakado K. Combination therapy of chemoembolization and radiofrequency ablation for the treatment of hepatocellular carcinoma in the caudate lobe. J Vasc Interv Radiol 2013. [PMID: 23177108 DOI: 10.1016/j.jvir.2012.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the clinical utility of radiofrequency (RF) ablation combined with chemoembolization in treatment of hepatocellular carcinoma (HCC) located in the caudate lobe. MATERIALS AND METHODS Between September 2000 and October 2011, 20 consecutive patients with single HCC measuring≤5 cm were treated with combination therapy of chemoembolization and RF ablation. Technical success was defined as completion of a planned electrode placement and ablation protocol. The effectiveness of the technique was defined as disappearance of tumor enhancement with an ablative margin of≥5 mm. Technical success, technique effectiveness, local tumor progression, overall and recurrence-free survival, and complications were evaluated. RESULTS RF electrodes were placed in planned sites of each tumor, and ablation was complete in all patients (technical success rate 100%). Tumor enhancement disappeared with sufficient ablative margins after 20 RF sessions in all patients (technique effectiveness rate 100%). Major and minor complication rates were 10.0% and 15.0%. Local tumor progression was found in 2 of 20 patients (10.0%) with local tumor progression rates of 6.3% at 1 year and 13.5% at 3 years and 5 years. Six patients died during the follow-up period (mean, 40.0 months; range, 2.0-110.5 months). Overall and recurrence-free survival rates were 94.4% and 70.8% at 1 year, 86.6% and 36.9% at 3 years, and 67.5% and 45.5% at 5 years. CONCLUSIONS RF ablation combined with chemoembolization is a safe and useful therapeutic option to treat HCCs located in the caudate lobe.
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Affiliation(s)
- Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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Nishigaki Y, Tomita E, Hayashi H, Suzuki Y, Iritani S, Kato T, Yamada T. Efficacy and safety of radiofrequency ablation for hepatocellular carcinoma in the caudate lobe of the liver. Hepatol Res 2013; 43:467-74. [PMID: 23072582 DOI: 10.1111/j.1872-034x.2012.01095.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 08/23/2012] [Accepted: 08/27/2012] [Indexed: 12/12/2022]
Abstract
AIM Radiofrequency ablation (RFA) is a promising alternative to hepatic resection for the treatment of hepatocellular carcinoma (HCC) located in the caudate lobe. We evaluated the therapeutic efficacy and safety of RFA for HCC located in the caudate lobe compared with HCC located elsewhere in the liver. METHODS Overall, 555 consecutive patients treated by RFA for a single HCC tumor of less than 3 cm diameter, were enrolled in this study, including 20 patients with HCC located in the caudate lobe. Among these 20 patients, HCC was located in the Spiegel lobe in eight patients, in the paracaval portion in another 10 and in the caudate process in two. We evaluated differences in the local recurrence rate and the incidence of complications associated with RFA between the caudate and the non-caudate groups. RESULTS The 4-year cumulative local recurrence rate after RFA in the caudate group and the non-caudate group was 22.3% and 4.5%, respectively (P < 0.001). Multivariate analysis of factors affecting local recurrence demonstrated that tumor size and tumor location (caudate or non-caudate) were independent significant factors. No postoperative complications were observed in the caudate group, whereas 15 patients (2.8%) in the non-caudate group experienced complications related to RFA. CONCLUSION We were able to safely treat HCC located in the caudate lobe by RFA. However, there was a high incidence of local recurrence, presumably because of the heat sink effect of the inferior vena cava and the restricted puncture approach. We should pursue a revised method to reduce local recurrence.
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Affiliation(s)
- Youichi Nishigaki
- Department of Gastroenterology and Hepatology, Gifu Municipal Hospital, Gifu, Japan
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Isolated caudate lobe resection for hepatocellular carcinoma. FORMOSAN JOURNAL OF SURGERY 2012. [DOI: 10.1016/j.fjs.2012.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zhou Y, Zhang X, Wu L, Xu D, Li B. Surgical outcomes of hepatocellular carcinoma originating from caudate lobe. ANZ J Surg 2012; 83:275-9. [PMID: 22931453 DOI: 10.1111/j.1445-2197.2012.06232.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2012] [Indexed: 01/08/2023]
Affiliation(s)
- Yanming Zhou
- Department of Hepato-Biliary-Pancreato-Vascular Surgery; First Affiliated Hospital of Xiamen University; Xiamen; China
| | - Xiaofeng Zhang
- Department IV of Hepatic Surgery; Eastern Hepatobiliary Surgery Hospital, Second Military Medical University; Shanghai; China
| | - Lupeng Wu
- Department of Hepato-Biliary-Pancreato-Vascular Surgery; First Affiliated Hospital of Xiamen University; Xiamen; China
| | - Donghui Xu
- Department of Hepato-Biliary-Pancreato-Vascular Surgery; First Affiliated Hospital of Xiamen University; Xiamen; China
| | - Bin Li
- Department of Hepato-Biliary-Pancreato-Vascular Surgery; First Affiliated Hospital of Xiamen University; Xiamen; China
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Liu P, Qiu BA, Bai G, Bai HW, Xia NX, Yang YX, Zhu JY, An Y, Hu B. Choice of approach for hepatectomy for hepatocellular carcinoma located in the caudate lobe: Isolated or combined lobectomy? World J Gastroenterol 2012; 18:3904-9. [PMID: 22876044 PMCID: PMC3413064 DOI: 10.3748/wjg.v18.i29.3904] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 04/05/2012] [Accepted: 04/12/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the significance of the surgical approaches in the prognosis of hepatocellular carcinoma (HCC) located in the caudate lobe with a multivariate regression analysis using a Cox proportional hazard model.
METHODS: Thirty-six patients with HCC underwent caudate lobectomy at a single tertiary referral center between January 1995 and June 2010. In this series, left-sided, right-sided and bilateral approaches were used. The outcomes of patients who underwent isolated caudate lobectomy or caudate lobectomy combined with an additional partial hepatectomy were compared. The survival curves of the isolated and combined resection groups were generated by the Kaplan-Meier method and compared by a log-rank test.
RESULTS: Sixteen (44.4%) of 36 patients underwent isolated total or partial caudate lobectomy whereas 20 (55.6%) received a total or partial caudate lobectomy combined with an additional partial hepatectomy. The median diameter of the tumor was 6.7 cm (range, 2.1-15.8 cm). Patients who underwent an isolated caudate lobectomy had significantly longer operative time (240 min vs 170 min), longer length of hospital stay (18 d vs 13 d) and more blood loss (780 mL vs 270 mL) than patients who underwent a combined caudate lobectomy (P < 0.05). There were no perioperative deaths in both groups of patients. The complication rate was higher in the patients who underwent an isolated caudate lobectomy than in those who underwent combined caudate lobectomy (31.3% vs 10.0%, P < 0.05). The 1-, 3- and 5-year disease-free survival rates for the isolated caudate lobectomy and the combined caudate lobectomy groups were 54.5%, 6.5% and 0% and 85.8%, 37.6% and 0%, respectively (P < 0.05). The corresponding overall survival rates were 73.8%, 18.5% and 0% and 93.1%, 43.6% and 6.7% (P < 0.05).
CONCLUSION: The caudate lobectomy combined with an additional partial hepatectomy is preferred because this approach is technically less demanding and offers an adequate surgical margin.
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Chae S, Kim YB, Lee JS, Cho H. Resistance to paclitaxel in hepatoma cells is related to static JNK activation and prohibition into entry of mitosis. Am J Physiol Gastrointest Liver Physiol 2012; 302:G1016-24. [PMID: 22323130 DOI: 10.1152/ajpgi.00449.2011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hepatocellular carcinoma (HCC) generally shows chemoresistant features to anticancer agents. Paclitaxel has been clinically used in the treatment of various cancers. However, effect of paclitaxel on HCC has not been adequately addressed. Here, we found two categories of hepatoma cells in response to paclitaxel. Paclitaxel effectively decreased the cell viability of SNU475, Hep3B, and SNU387 HCC cells and Chang liver cells (death prone). In contrast, the other five hepatoma cell lines (SNU449, SNU398, SUN368, SNU354, and HepG2 cells) were resistant to paclitaxel (death reluctant). In response to paclitaxel, Bcl-2 was highly phosphorylated in death-prone cells, whereas much less Bcl-2 was phosphorylated in death-reluctant cells. Cotreatment with SP600125, an inhibitor JNK, significantly reduced the phosphorylated Bcl-2 in death-prone cells and caused a significant reduction in cell death. The reduced cell death was due to prohibition into mitotic entry as evidenced by low cyclin B(1)/Cdk1 kinase activity. In death-reluctant cells, inbuild-phospho-JNK levels were high but no longer activated in response to paclitaxel. We found that paclitaxel combined with caffeine or UCN-01, inhibitors of G(2) DNA damage checkpoint, was able to partially overcome resistance to paclitaxel in these cells. Thus our data provide the molecular basis of paclitaxel resistance in hepatoma cells, and appropriate combination therapy may increase treatment efficacy.
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Affiliation(s)
- Sunyoung Chae
- Department of Biochemistry, Ajou University School of Medicine, Suwon, Korea
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Ibrahim SM, Kulik L, Baker T, Ryu RK, Mulcahy MF, Abecassis M, Salem R, Lewandowski RJ. Treating and downstaging hepatocellular carcinoma in the caudate lobe with yttrium-90 radioembolization. Cardiovasc Intervent Radiol 2011; 35:1094-101. [PMID: 22069121 DOI: 10.1007/s00270-011-0292-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 09/25/2011] [Indexed: 12/17/2022]
Abstract
PURPOSE This study was designed to determine the technical feasibility, safety, efficacy, and potential to downstage patients to within transplantation criteria when treating patients with hepatocellular carcinoma (HCC) of the caudate lobe using Y90 radioembolization. METHODS During a 4-year period, 8 of 291 patients treated with radioembolization for unresectable HCC had disease involving the caudate lobe. All patients were followed for treatment-related clinical/biochemical toxicities, serum tumor marker response, and treatment response. Imaging response was assessed with the World Health Organization (WHO) and European Association for the Study of the Liver (EASL) classification schemes. Pathologic response was reported as percent necrosis at explantation. RESULTS Caudate lobe radioembolization was successfully performed in all eight patients. All patients presented with both cirrhosis and portal hypertension. Half were United Network for Organ Sharing (UNOS) stage T3 (n = 4, 50%). Fatigue was reported in half of the patients (n = 4, 50%). One (13%) grade 3/4 bilirubin toxicity was reported. One patient (13%) showed complete tumor response by WHO criteria, and three patients (38%) showed complete response using EASL guidelines. Serum AFP decreased by more than 50% in most patients (n = 6, 75%). Four patients (50%) were UNOS downstaged from T3 to T2, three of who underwent transplantation. One specimen showed histopathologic evidence of 100% complete necrosis, and two specimens demonstrated greater than 50% necrosis. CONCLUSIONS Radioembolization with yttrium-90 appears to be a feasible, safe, and effective treatment option for patients with unresectable caudate lobe HCC. It has the potential to downstage patients to transplantation.
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Affiliation(s)
- Saad M Ibrahim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Joh DH, Kim JD, Kim YN, Song HH, Kim H, Song KH, Lee SJ, Lee JR, Jeon WJ, Cha BH. A case of hepatocellular carcinoma in the caudate lobe successfully treated by transcatheter arterial chemoembolization using drug-eluting beads. THE KOREAN JOURNAL OF HEPATOLOGY 2011; 16:405-9. [PMID: 21415586 PMCID: PMC3304613 DOI: 10.3350/kjhep.2010.16.4.405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hepatocellular carcinoma (HCC) in the caudate lobe remains one of the most intricate locations where various treatments tend to pose problems with regard to the optimal approach. Surgical resection has been regarded as the most effective treatment; however, isolated resection of the caudate lobe is strenuous and associated with a high rate of early recurrence. Percutaneous ablation might be technically difficult or impossible to perform due to the deep location of tumors and adjacent large vessels. Treatment with drug-eluting beads (DEB) can potentially enhance the therapeutic efficacy for patients with unresectable HCC by drawing on the slower, more consistent drug delivery process. We described a case of a 62-year-old man with HCC in the caudate lobe who was successfully treated by DEB.
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Affiliation(s)
- Dong Hoo Joh
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Angiographic evaluation of feeding arteries of hepatocellular carcinoma in the caudate lobe of the liver. Cardiovasc Intervent Radiol 2010; 34:1244-53. [PMID: 21085960 DOI: 10.1007/s00270-010-0036-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 10/24/2010] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate the origins of feeders of hepatocellular carcinoma (HCC) in the caudate lobe (S1). MATERIALS AND METHODS Eighty-eight HCCs (mean diameter 21.4 mm) were treated by chemoembolization. The tumor-feeding caudate artery was confirmed when a tumor stain was demonstrated on angiogram and iodized oil was accumulated into the HCC and S1 on computed tomography (CT). The origins were divided into R(1) (right proximal), R(2) (right distal), L(1) (left proximal), L(2) (left distal), A (anterior segmental), P (posterior segmental), M (middle hepatic or medial segmental), Ph (proper hepatic), Ch (common hepatic), and Ex (extrahepatic). The origins of feeders supplying HCCs in the Spiegel lobe (SP; n = 36), the paracaval portion (PC; n = 38), and the caudate process (CP; n = 14) were also analyzed. RESULTS One hundred sixteen feeders were identified: 11 (9.5%) arose from R(1); 21 (18.1%) arose from R(2); nine arose (0.9%) from L(1); 15 (12.9%) arose from L(2); 24 (20.7%) arose from A; 25 (21.6%) arose from P; seven (6.0%) arose from M; one (0.9%) arose from Ph; and three (2.6%) arose from Ex. HCCs in the SP and the PC were fed by feeders from both hepatic arteries (the ratios of right to left were 3:2 and 3:1, respectively), and HCCs in the CP were dominantly fed by feeders from the right hepatic artery. CONCLUSION The caudate artery most frequently arises from the right hepatic artery, followed with almost equal frequency by the left hepatic, the anterior segmental, and the posterior segmental artery. The origins of the caudate arteries differ according to the subsegmental locations.
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Miyayama S, Yamashiro M, Yoshie Y, Nakashima Y, Ikeno H, Orito N, Yoshida M, Matsui O. Hepatocellular carcinoma in the caudate lobe of the liver: variations of its feeding branches on arteriography. Jpn J Radiol 2010; 28:555-62. [PMID: 20972854 DOI: 10.1007/s11604-010-0471-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 05/27/2010] [Indexed: 02/06/2023]
Abstract
There are usually multiple caudate arteries arising from the right, left, and middle hepatic arteries, and they are frequently connected to each other. Therefore, hepatocellular carcinoma (HCC) in the caudate lobe is frequently fed by multiple branches arising from different origins. HCC located in the Spiegel lobe is usually fed by the caudate arteries derived from the right and/or left hepatic artery. HCC in the paracaval portion is mainly fed by the caudate artery derived from the right hepatic artery; with low frequency, it is fed by the caudate artery derived from the left hepatic artery. HCC in the caudate process is usually fed by the caudate artery derived from the right hepatic artery. Because of the complexity and overlap of vascular territories, the tumor-feeding branch of a recurrent HCC lesion in the caudate lobe frequently changes on follow-up arteriograms. In addition, several extrahepatic collateral vessels supply the recurrent tumor. To perform effective transcatheter arterial chemoembolization (TACE) for HCC in the caudate lobe, radiologists should have sufficient knowledge of vascular anatomy supplying HCC in the caudate lobe.
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Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Wadanaka-cho, Fukui, Japan.
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Kim HC, Chung JW, Jae HJ, Yoon JH, Lee JH, Kim YJ, Lee HS, Yoon CJ, Park JH. Caudate lobe hepatocellular carcinoma treated with selective chemoembolization. Radiology 2010; 257:278-87. [PMID: 20697120 DOI: 10.1148/radiol.10100105] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To analyze the clinical outcomes of chemoembolization for solitary caudate lobe hepatocellular carcinoma (HCC) found at initial presentation. MATERIALS AND METHODS This retrospective study was approved by the institutional review board; the requirement for informed patient consent was waived. From July 1998 to June 2009, 40 patients (28 men, 12 women; mean age, 57 years) found to have a single HCC lesion in the caudate lobe at initial presentation were treated with chemoembolization and evaluated for overall survival and progression-free survival. Multivariate analyses for potential clinical and radiologic factors were performed by using the Cox proportional hazard model. RESULTS Selective chemoembolization via the caudate artery was achieved in 34 (85%) patients. Overall survival rates at 1, 2, 3, 4, and 5 years were 92%, 79%, 65%, 56%, and 56%, respectively. Selective chemoembolization of the caudate artery was a critically important factor in longer overall survival (hazard ratio, 0.091; 95% confidence interval [CI]: 0.021, 0.389; P < .001), and portal vein tumor thrombosis (hazard ratio, 31.25; 95% CI: 4.88, 200.1; P < .001) and multiple tumor-feeding vessels (hazard ratio, 6.87; 95% CI: 1.47, 32.1; P = .014) were significant factors in shorter overall survival. Selective chemoembolization of the caudate artery was also a significant factor in longer progression-free survival (hazard ratio, 0.278; 95% CI: 0.10, 0.76; P = .013). CONCLUSION Selective chemoembolization via the caudate artery is possible in most patients with caudate lobe HCC and a critical factor in longer overall survival and longer progression-free survival.
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Affiliation(s)
- Hyo-Cheol Kim
- Department of Radiology, Seoul National University College of Medicine; Institute of Radiation Medicine; Seoul National University Medical Research Center, Seoul, Korea
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Wang Y, Zhang LY, Yuan L, Sun FY, Wei TG. Isolated caudate lobe resection for hepatic tumor: surgical approaches and perioperative outcomes. Am J Surg 2010; 200:346-51. [PMID: 20409523 DOI: 10.1016/j.amjsurg.2009.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Revised: 10/02/2009] [Accepted: 10/21/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND Caudate lobe of the liver is relatively inaccessible because of its deep location and lying between the major vascular structures. Therefore, isolated caudate lobe resection (ICLR) is a much challengeable operation. METHODS Review of prospectively collected data from patients who underwent ICLR for hepatic tumor. RESULTS Forty-six patients (mean age 46.8 years) underwent ICLR for malignant (39 cases) and benign (7 cases) hepatic tumors. ICLRs were performed by 3 different approaches and in different ways of hepatic vascular control: without any vascular control in 7 patients, under Pringle maneuver in 26 patients, and under sequential inflow and outflow vascular occlusion in 13 patients. There were no perioperative deaths, and the postoperative complication rate was 8.7% (4/46). The mean operative time was 174.5 +/- 44.3 minutes and the mean estimated intraoperative blood loss was 504.4 +/- 356.2 mL. CONCLUSIONS ICLR is a technically demanding but safe procedure. Choice of surgical approaches and ways of hepatic vascular control should be based on tumor location and surgeons'experience.
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Affiliation(s)
- Yi Wang
- Eastern Hepatobiliary Surgery Hospital, Shanghai, People's Republic of China.
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Liu P, Yang JM, Niu WY, Kan T, Xie F, Li DQ, Wang Y, Zhou YM. Prognostic factors in the surgical treatment of caudate lobe hepatocellular carcinoma. World J Gastroenterol 2010; 16:1123-8. [PMID: 20205285 PMCID: PMC2835791 DOI: 10.3748/wjg.v16.i9.1123] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the short- and long-term outcomes of liver resection for caudate lobe hepatocellular carcinoma (HCC).
METHODS: We retrospectively analyzed 114 consecutive patients with HCC, originating from the caudate lobe, who underwent resection between January 2001 and January 2007. Univariate and multivariate analyses were performed on several clinicopathologic variables to determine the factors affecting long-term outcome and intrahepatic recurrence.
RESULTS: Overall mortality and morbidity were 0% and 18%, respectively. After a median follow-up of 31 mo (interquartile range, 11-66 mo), tumor recurrence had occurred in 76 patients (66.7%). The 1-, 3-, and 5-year disease-free survival rates were 65.7%, 38.1%, and 18.4%, respectively. The 1-, 3-, and 5-year overall survival rates were 76.1%, 54.7%, and 31.8%, respectively. Univariate analysis showed that subsegmental location of the tumor (45.7% vs 16.2%, P = 0.01), liver cirrhosis (12.3% vs 47.9%, P = 0.03), surgical margin (18.5% vs 54.6%, P = 0.04), vascular invasion (37.9% vs 23.2%, P = 0.04) and extended caudate resection (42.1% vs 15.4%, P = 0.04) were related to poorer long-term survival. Multivariate analysis showed that only subsegmental location of the tumor, liver cirrhosis and surgical margin were significant independent prognostic factors.
CONCLUSION: Hepatectomy was an effective treatment for HCC in the caudate lobe. The subsegmental location of the tumor, liver cirrhosis and surgical margin affected long-term survival.
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Caudate lobe resection: an Egyptian center experience. Langenbecks Arch Surg 2010; 394:1057-63. [PMID: 19763602 DOI: 10.1007/s00423-009-0554-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 08/20/2009] [Indexed: 02/06/2023]
Abstract
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.
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Virtual Puncture Line in Radiofrequency Ablation for Hepatocellular Carcinoma of the Caudate Lobe. AJR Am J Roentgenol 2009; 193:W149-51. [DOI: 10.2214/ajr.08.1817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Yoon CJ, Chung JW, Cho BH, Jae HJ, Kang SG, Kim HC, Choi YH, Jeon UB, Park JH. Hepatocellular carcinoma in the caudate lobe of the liver: angiographic analysis of tumor-feeding arteries according to subsegmental location. J Vasc Interv Radiol 2008; 19:1543-50; quiz 1550. [PMID: 18755606 DOI: 10.1016/j.jvir.2008.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 07/01/2008] [Accepted: 07/05/2008] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To investigate the tumor-feeding arteries in hepatocellular carcinoma (HCC) arising in the caudate lobe of the liver. MATERIALS AND METHODS From January 1998 to March 2004, 140 patients with 146 caudate HCCs underwent chemoembolization. Subsegmental location of the caudate HCC and the origin of the tumor-feeding arteries was determined with computed tomography and hepatic arteriography. On follow-up angiography at 6-96 months (mean, 24 months), changes in the tumor-feeding arteries were recorded. RESULTS A total of 175 tumor-feeding arteries were identified. The tumors in the Spiegel lobe (n = 72) were supplied by tumor-feeding arteries derived from the right hepatic artery (RHA; n = 45), left hepatic artery (LHA; n = 30), and proper hepatic artery (PHA) or common hepatic artery (CHA; n = 6; P = .083, right vs left). In tumors in the paracaval portion (n = 42), the tumor-feeding arteries were derived more frequently from the RHA (n = 46) than the LHA (n = 3) or PHA/CHA (n = 2; P < .001). All the feeding arteries (n = 43) of the caudate process tumors (n = 32) were derived from the RHA (P < .001). During the follow-up period, there were replacements of the tumor-feeding arteries in 16 patients with recurrent tumors. An extrahepatic collateral supply for the recurrent tumors developed in 10 patients. CONCLUSIONS The distribution of the origin of tumor-feeding arteries supplying caudate HCC is different according to tumors' subsegmental locations. When treating recurrent caudate HCC, it is important to identify replacement of tumor-feeding arteries and extrahepatic collateral supply.
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Affiliation(s)
- Chang Jin Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
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Radiofrequency Ablation With Hand-assisted Laparoscopic Surgery for the Treatment of Hepatocellular Carcinoma in the Caudate Lobe. Surg Laparosc Endosc Percutan Tech 2008; 18:272-6. [PMID: 18574414 DOI: 10.1097/sle.0b013e31816a24bf] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
AIM: To find the precautions against the safety in caudate lobe resection.
METHODS: The clinical data obtained from 11 cases of primary liver cancer in caudate lobe who received hepatectomy successfully were retrospectively analyzed. Four safe procedures were used in resection of primary liver cancer in caudate lobe: (1) selection of appropriate skin incision to obtain excellent exposure of operative field; (2) adequate mobilization of the liver to allow the liver to be displaced upwards to the left or to the right; (3) preparatory placement of tapes for total hepatic vascular exclusion, so that this procedure could be used to control the fatal bleeding of the liver when necessary; (4) selection of the ideal route for hepatectomy based on the condition of the tumor and the combined removal of multiple lobes if necessary. Among the 11 cases, simple occlusion of vessels of porta hepatis was used in caudate lobectomy for 6 cases, while in the other cases, the vessels were intermittently occluded several times or total hepatic vascular isolation was used in the caudate lobectomy. Combined partial right hepatectomy was done for 3 cases, combined left lateral lobectomy for 2 cases and caudate lobectomy alone for 6 cases.
RESULTS: Operation was successful for all the 11 cases. Intermittent inflow occlusion was performed for all patients for 15 min at 5-min intervals. Blockade was performed twice in 3 patients and total hepatic vascular exclusion was performed in one of the three patients. Blockade was performed three times in one patient, including a total hepatic vascular exclusion. Total hepatic vascular exclusion was performed only in one patient. The mean blood loss was 300 mL. Ascites and pleural effusion occurred in 4 patients, jaundice in 1 patient. Six patients died of tumor recurrence in 6, 11, 12, 13, 15, 19 mo after operation, respectively. The other 5 patients have survived more than 16 mo since the operation.
CONCLUSION: Caudate lobectomy for liver cancer in candidate lobe can be safely performed with the above procedures.
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