Two Cases Performed Curative Resection by Isolated Entire Caudate Lobectomy for Recurrent Hepatocellular Carcinoma in the Paracaval Portion of the Caudate Lobe after Hepatectomy

Kenji Mizukami, Tsutomu Ko, Ikkou Higaki, Katsuhiko Horii, Sinnya Tanimura, Mitsuharu Matsuyama, Osamu Yamazaki, Yasuhisa Fujimoto, Masayuki Higashino, Masahiro Okuno

Department of Surgery, Osaka City General Hospital

This report is about clinical experience of two surgical cases of recurrent hepatocellular carcinoma (HCC) in the paracaval portion (PCP) of the caudate lobe. These two patients received isolatd entire caudate lobectomy (IECL) and are fine without any recurrence more than 2 years. We performed IECL by upper abdominal "reverse T shaped" skin incision. We identified the right margin of the PCP from the demarcation line appearing on the liver surface by clamping the portal triad of the posterior segment. After the liver was isolated from the inferior vena cava by dividing all short hepatic veins, we started dissection on the demarcation line. As the cranial margin of the caudate lobe, we dissected along the caudal surface of the right hepatic vein and the middle hepatic vein. As the caudal margin of the caudate lobe, we divided the portal triads of the caudate lobe along the hilar plate. After we divided the root of Arantius duct at the dorsal end of the umbilical portion from right side approach, we divided Arantius duct at the confluence of the middle hepatic vein from left side approach. Thereafter we continued to dissect hepatic parenchyma along the middle hepatic vein from left side approach and combined both dissection planes together. Therefore we accomplished IECL. Even if HCC recurs after hepatectomy in the PCP, which is the most difficult part for liver surgery, being in the early stage, it is possible for us to perform curative resection by IECL safely.

Key words
repeat hepatectomy for recurrent HCC, isolated entire caudate lobectomy, extent of the caudate lobe

Reprint requests
Kenji Mizukami Institute of Gastoroenterology, Osaka City General Hospital
2-13-22 Miyakojima-hondouri, Miyakojima-ku, Osaka 534-0021 JAPAN

Accepted
May 19, 1998

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