Surgical Strategy And Approaches Of Caudate Lobectomy

Objective To explore surgical strategy and approaches for caudate lobectomy. Methods From April 1994 to May 2006,125 cases of caudate lobectomy were performed with many new surgical techniques,such as transecting the liver parenchyma with"curettage and aspiration"dissection technique,control of blood flow,liver-splitting anterior approach,liver hanging maneuver,retrograde caudate lobectomy and two step liver resection. Including 19 cases of isolated lobectomy,and the factors that might influence postoperative liver function were compared between these groups. Results All cases were resected successfully,no patient died in the operation. The mean duration of operation was 256±42 minutes,mean blood loss was 1480±580ml,mean length of stay after operation was 16d. There were 2 patients died of postoperative liver failure, 1 died of intra-abdominal bleeding 50h after operation, 1 died of pulmonary infraction 2 weeks after operation, 1 died of renal failure 30 days after operation. Complications including Wound infection in 8 cases,bile leakage in 7 cases,ascites in 6 cases,hydrothorax in 4 cases, upper gastrointestinal bleeding in 3 cases,intra-abdominal infection in 3 cases,liver failure in 2 cases and renal dysfunction in 1 case were recovered fully with conservative treatment. Conclusions Caudate lobectomy is effective and feasible in the treatment of diseases originating from caudate lobe .Control of blood flow is essential. Liver hanging maneuver is helpful to ligated the short hepatic vein in some cases. Anterior approach is indicated when the tumor is very large or closely attached to hepatic veins or mainly located in paracaval portion. Retrograde resection is useful for tumor closely attached to IVC. Caudate lobectomy may be performed when the big tumor originating from caudate lobe decreased through transarterial chemoembolization(TACE). Peng's multifunctionl operative dissector (PMOD) and "curettage and aspiration" dissection technique can be of great help in the dissection of vessels clearly, enabling caudate lobe resection to become safer, easier and faster.