Surgical Treatment For Liver Cancer Of Caudate Lobe:A Matched Case Control Study

Part 1 Surgical treatment for liver cancer of caudate lobe:a matched case control study Background and objectivePrimary liver cancer is one of the ordinary malignant tumors,and most of them are hepatocellular carcinoma(HCC).In our country the incidence and mortality of HCC was high.There are a variety of treatments for this disease,including surgery and other 5 therapies.Surgery is preferred because domestic liver is scarce,cost,postoperative graft rejection and lifelong immunosuppression.Among them,HCC for caudate lobe due to the specificity of its anatomical location,the adjacent large blood vessels and bile ducts,the risk of liver resection is often larger,while the effect of non-operative treatment is limited.However,with the improvement of surgical techniques,accurate medical concepts,especially the application of abdominal 3D-CT imaging,the liver resection is becoming skilled and consummation especially for caudate lobe.This study compares the safety and prognosis of caudate lobe HCC with non-caudate lobe HCC by case-control study in Eastern Hepatobiliary Surgery Hospital for 10 years.Materials and methodsA total of 414 cases of caudate lobe HCC were collected during 2003-2014 in the Eastern Hepatobiliary Surgery Hospital.Matching 1:2 with 5 standards,828 cases as control group were collected during the same period of HCC at non-caudate lobe.The data was analyzed between perioperation.The SPSS19.0 statistical software was used for analysis.ResultsThere was no outstanding difference in general data(P >0.05).Research group was higher for warm ischemia time(29 vs 24 min,P=0.0322),intraoperative blood transfusion(36.96% vs 27.42%,P=0.0006),and intraoperative blood transfusion(5U vs 4U,P=0.0013)than control group.The complication incidence rate of caudate lobe of liver cancer was significantly higher than that of non-caudate lobe of liver cancer(47.58% vs 39.49%,P=0.0065),mainly in the bile leakage(12.08% vs 8.33%,P=0.0346).For the ICU stay time and LOH,the caudate lobe HCC was longer than that of the non-caudate lobe HCC(1.3±0.7 vs 1.2±0.6 days and 10.6±4.4 vs 9.3±5.2 days,P <0.0001),two groups of patients had no perioperative death cases.There was no outstanding distinction in disease free survival(DFS)and overall survival(OS)rate about 1 and 3 years of two groups(DFS rate was P=0.066,OS rate was P=0.053).Further classification,left caudate lobe to left liver tumor(DFS rate was P=0.872,OS rate was P=0.561),paracaval portion caudate and right liver tumor(DFS rate was P=0.347,OS rate was P=0.463),this two DFS and OS rates of 1,3,5 years were no significant differences.While the whole caudate lobe tumor to part IV,V,VIII patients after 1,3 and 5 years DFS and OS rate was lower than control group(both P <0.0001).ConclusionAlthough the complications incidence,the surgical risk is high,the DFS and OS compared with non-caudate lobe HCC had no significant difference.Surgical resection for caudate lobe HCC is feasible and preferred at present.Part 2 Application of 3D-CT imaging in surgical treatment for liver cancer of caudate lobe Background and objective Primary liver cancer is one of the ordinary cancers.The incidence and mortality was the highest in the age of below 60 in male.Although there are many treatment methods for liver tumor,hepatectomy is still the first choice for the treatment.Since the location,surrounded by a large number of large vessels and bile ducts,the risk of operation is very high.Because of the invasion,the caudate lobe resection often needs to be combined with other segments,lobes,or even semi-hepatic.For patients with liver cirrhosis combined with other hepatic segments or lobes also increase the risk of postoperative liver failure.With the development of imaging technology,especially the application of liver 3D-CT imaging technique used in clinical,we can clearly distinguish the tumor and surrounding bile ducts and vessels preoperative and can practise in the preoperative 3D image with the cutting line,accurately calculate the liver volume of resection and retention volume,and the surgery can be more safely.This study is a retrospective analysis of the caudate lobe cancer 75 cases at the Eastern Hepatobiliary Surgery Hospital from Apr2015 to Dec 2016 with CT 3D imaging,further explore the application of 3D-CT imaging.Materials and methods 75 cases in the caudate lobe cases retrospectively collected our department from Apr 2015 to Dec 2016 using the liver 3D-CT imaging,the patient,pathology and tumor characteristics,operative details,and complications were analyzed.Results 75 cases of patients with complete resection of the tumor,the median warm ischemia time was 25min(0-62min),the median blood loss was 300ml(100-3600ml),the median operation time was 198min(116-388min),11 cases of patients with intraoperative blood transfusion,the median blood transfusion is 600ml(200-3000ml).The single caudate lobe tumor resection in 27 cases,with left hemihepatectomy in 6 cases,with partial right liver(VI,VII)resection in 14 cases,with right hemihepatectomy in 20 cases,with IV,V,VIII segment resection in 8 cases.Post-operative complications in 29 cases,including bleeding after operation in 1 case,1 case liver failure,9 cases bileleakage,8 cases ascites,4 pleural effusion,6 incision infection and no perioperative death.Postoperative pathology showed 67 cases of hepatocellular carcinoma,cholangiocarcinoma in 5 cases,hepato-cholangiocarcinoma in 3 cases.Conclusion Preoperative liver 3D-CT imaging can help us to understand the relationship between tumor and adjacent liver vessels and bile duct,accurately calculate the residual liver volume,reduce the risk and the incidence of complications,has a great value.