Laparoscopic Caudate Lobectomy for Cholangiocarcinoma of Caudate Lobe Invading Middle Hepatic Vein
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ORIGINAL ARTICLE – HEPATOBILIARY TUMORS
Laparoscopic Caudate Lobectomy for Cholangiocarcinoma of Caudate Lobe Invading Middle Hepatic Vein Hai-Feng Wan, MD1, Kun-Lin Xie, MD1, Jia-Xin Li, MD1, Kit-Man Ho, MD2, Hong Wu, MD1, and Ji-Wei Huang, MD1 1
Department of Liver Surgery and Liver Transplantation, West China Hospital, Sichuan University, Chengdu, Sichuan, China; 2Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Kwong Wah Hospital, Kowloon, Hong Kong
ABSTRACT Background. Laparoscopic hepatectomy has gained popularity in the management of malignant liver lesions in the past decade. Its safety and feasibility, with faster recovery and comparable long-term outcomes, have been widely published. Nonetheless, laparoscopic isolated caudate lobectomy is still rare and technically demanding. We herein present a video on laparoscopic total caudate lobectomy for caudate cholangiocarcinoma. Methods. The patient is a 61-year-old man who presented with epigastric distending discomfort. A contrast-enhanced magnetic resonance imaging was performed, showing a 4.6 9 3.9 cm tumor in the caudate lobe adjacent to the inferior vena cava, middle hepatic vein, right hepatic vein, as well as the bifurcation of the main trunk of the portal pedicle. The carbohydrate antigen was elevated to 54.58 U/ ml (normal \ 37 U/ml), and his liver function was normal. With the preoperative diagnosis of intrahepatic cholangiocarcinoma, laparoscopic caudate lobectomy was contemplated.
Hai-Feng Wan and Kun-Lin Xie contributed equally to this work.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08577-5) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 9 January 2020 H. Wu, MD e-mail: [email protected] J.-W. Huang, MD e-mail: [email protected]
Results. The operative time was 300 min. The estimated intraoperative blood loss was 180 ml. The patient was discharged on the seventh postoperative day without any complications. Histopathological examination showed a 4.2 cm cholangiocarcinoma (T2N0M0) with a negative margin. He received a course of adjuvant chemotherapy. No recurrence was noted upon follow-up at 6 months after the operation. Conclusions. Laparoscopic resection for caudate lobe is a feasible and safe procedure. An experienced hepatobiliary surgeon could perform the procedure in selected cases, even with hepatic vein invasion.
Laparoscopic hepatectomy has been gaining popularity over the last decade, and its safety and feasibility have been widely published. This was shown to have better short-term outcomes with shorter operative time and shorter hospital stay.1-3 Technical issues aside, the disease-free survival and overall survival were shown to be comparable with open hepatectomy in case-matched studies.4 Laparoscopic hepatectomy is now considered to be the standard for left lateral sectionectomy,5 and different difficulty scores have been published to guide patient and surgeon
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