Skip to main content

Advertisement

SpringerLink
Log in

A multicenter cohort analysis of laparoscopic hepatic caudate lobe resection

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Introduction

Laparoscopic resection of the hepatic caudate lobe (LRCL) requires a high level of expertise due to its challenging anatomical area. Only case reports, case series, and single-center cohort studies have been published. The aim of this study was to assess the safety and feasibility of this laparoscopic procedure.

Methods

A multicenter retrospective cohort study including all patients who underwent LRCL in 4 high-volume hepatobiliary units between January 2000 and May 2018 was performed. Perioperative, postoperative, and survival outcomes were assessed. Postoperative morbidity was stratified according to the Clavien-Dindo classification with severe complications defined by grade III or more. The Kaplan-Meier method was used for survival analysis.

Results

A total of 32 patients were included, including 22 (68.8%) with colorectal liver metastasis (CRLM), one (3.1%) with cholangiocarcinoma, four (12.5%) with other malignancies, and five (15.6%) with symptomatic benign lesions. Simultaneous colorectal and/or additional liver resection was performed in 20 (62.5%) patients. The median (IQR) operative time was 155 (121–280) minutes, blood loss was 100 (50–275) ml, conversion rate was 9.4% (n = 3), severe complications were observed in 2 patients (6.3%), and median (range) length of hospital stay was 3 [1–39] days. No 90-day postoperative mortality was noticed. The median (IQR) follow-up for the CRLM group was 14 [10–23] months. Five-year overall survival rate was 82% in this subgroup. Small interinstitutional differences were observed without major impact on surgical outcomes.

Conclusion

LRCL is safe and feasible when performed in high-volume centers. Profound anatomical knowledge, advanced laparoscopic skills, and mastering intraoperative ultrasound are essential. No major interinstitutional differences were ascertained.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

LLR:

Laparoscopic liver resection

IVC:

Inferior vena cava

LRCL:

Laparoscopic resection of the caudate lobe

LHV:

Left hepatic vein

RHV:

Right hepatic vein

CRLM:

Colorectal liver metastasis

IOUS:

Intraoperative ultrasound

HCC:

Hepatocellular carcinoma

CVP:

Central venous pressure

References

  1. Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, et al. The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg. 2009 [cited 2018 Aug 11];250(5):825–830. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19916210

    Article  Google Scholar 

  2. Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2,804 patients. Ann Surg. 2009 [cited 2018 Aug 11];250(5):831–841. Available from: https://insights.ovid.com/crossref?an=00000658-200911000-00023

    Article  Google Scholar 

  3. Wabitsch S, Kästner A, Haber PK, Feldbrügge L, Winklmann T, Werner S, et al. Laparoscopic versus open hemihepatectomy—a cost analysis after propensity score matching. Langenbeck's Arch Surg. 2019 [cited 2020 Feb 18];404(4):469–475. Available from: http://link.springer.com/10.1007/s00423-019-01790-1

    Article  CAS  Google Scholar 

  4. Lassen K, Nymo LS, Olsen F, Brudvik KW, Fretland ÅA, Søreide K. Contemporary practice and short-term outcomes after liver resections in a complete national cohort. Langenbeck's Arch Surg. 2019 [cited 2020 Feb 18];404(1):11–19. Available from: http://link.springer.com/10.1007/s00423-018-1737-3

    Article  Google Scholar 

  5. Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, et al. A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci. 2014 [cited 2018 Aug 11];21(10):745–753. Available from: http://doi.wiley.com/10.1002/jhbp.166

    Article  Google Scholar 

  6. Wakabayashi G. What has changed after the Morioka consensus conference 2014 on laparoscopic liver resection? Hepatobiliary Surg Nutr. 2016 [cited 2018 Aug 11];5(4):281–289. Available from: http://hbsn.amegroups.com/article/view/9617/11350

  7. D’Hondt M, Ovaere S, Knol J, Vandeputte M, Parmentier I, De Meyere C, et al. Laparoscopic right posterior sectionectomy: single-center experience and technical aspects. Langenbeck's Arch Surg. 2019 [cited 2020 Feb 18];404(1):21–29. Available from: http://link.springer.com/10.1007/s00423-018-1731-9

    Article  Google Scholar 

  8. Kumon M. Anatomical study of the caudate lobe with special reference to portal venous and biliary branches using corrosion liver casts and clinical application. Liver Cancer. 2017 [cited 2018 Aug 11];6(2):161–170. Available from: https://www.karger.com/Article/FullText/454682

    Article  Google Scholar 

  9. Dulucq J-L, Wintringer P, Stabilini C, Mahajna A. Isolated laparoscopic resection of the hepatic caudate lobe: surgical technique and a report of 2 cases. Surg Laparosc Endosc Percutan Tech. 2006 [cited 2018 Aug 11];16(1):32–35. Available from: https://insights.ovid.com/crossref?an=00129689-200602000-00008

    Article  Google Scholar 

  10. Chen K-H, Jeng K-S, Huang S-H, Chu S-H. Laparoscopic caudate hepatectomy for cancer--an innovative approach to the no-man’s land. J Gastrointest Surg. 2013 [cited 2018 Aug 11];17(3):522–526. Available from: http://link.springer.com/10.1007/s11605-012-2115-z

    Article  Google Scholar 

  11. Salloum C, Lahat E, Lim C, Doussot A, Osseis M, Compagnon P, et al. Laparoscopic isolated resection of caudate lobe (segment 1): a safe and versatile technique. J Am Coll Surg. 2016 [cited 2018 Aug 11];222(5):e61–e66. Available from: http://linkinghub.elsevier.com/retrieve/pii/S107275151600123X

    Article  Google Scholar 

  12. Oh D, Kwon CHD, Na BG, Lee KW, Cho WT, Lee SH, et al. Surgical techniques for totally laparoscopic caudate lobectomy. J Laparoendosc Adv Surg Tech A. 2016 [cited 2018 Aug 11];26(9):689–692. Available from: http://www.liebertpub.com/doi/10.1089/lap.2016.0161

    Article  Google Scholar 

  13. Araki K, Fuks D, Nomi T, Ogiso S, Lozano RR, Kuwano H, et al. Feasibility of laparoscopic liver resection for caudate lobe: technical strategy and comparative analysis with anteroinferior and posterosuperior segments. Surg Endosc. 2016 [cited 2018 Aug 11];30(10):4300–4306. Available from: http://link.springer.com/10.1007/s00464-016-4747-7

    Article  Google Scholar 

  14. Jin B, Jiang Z, Hu S, Du G, Shi B, Kong D, et al. Surgical technique and clinical analysis of twelve cases of isolated laparoscopic resection of the hepatic caudate lobe. Biomed Res Int. 2018 [cited 2018 Aug 12];2018:5848309 Available from: https://www.hindawi.com/journals/bmri/2018/5848309/

  15. Cai X, Zhao J, Wang Y, Yu H, Liang X, Jin R, et al. A left-sided, purely laparoscopic approach for anatomic caudate hepatectomy: a single-center experience. J Laparoendosc Adv Surg Tech A. 2016 [cited 2018 Aug 11];26(2):103–108. Available from: http://www.liebertpub.com/doi/10.1089/lap.2015.0223

    Article  Google Scholar 

  16. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Vol. 240, Ann Surg. 2004 [cited 2018 Aug 11]. p. 205–213. Available from: https://insights.ovid.com/crossref?an=00000658-200408000-00003

  17. Kauffmann R, Fong Y. Post-hepatectomy liver failure. Hepatobiliary Surg Nutr. 2014 [cited 2018 Aug 11];3(5):238–46. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25392835

  18. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg. 2015 [cited 2018 Aug 11];261(4):619–629. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25742461

  19. Honda G, Kurata M, Okuda Y, Kobayashi S, Tadano S, Yamaguchi T, et al. Totally laparoscopic hepatectomy exposing the major vessels. J Hepatobiliary Pancreat Sci. 2013 [cited 2018 Aug 11];20(4):435–440. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23269462

    Article  Google Scholar 

  20. Dagher I, Caillard C, Proske J-M, Carloni A, Lainas P, Franco D. Laparoscopic right hepatectomy: original technique and results. J Am Coll Surg. 2008 [cited 2018 Aug 11];206(4):756–760. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1072751507015943

    Article  Google Scholar 

  21. Wakabayashi G, Cherqui D, Geller DA, Han H-S, Kaneko H, Buell JF. Laparoscopic hepatectomy is theoretically better than open hepatectomy: preparing for the 2nd International Consensus Conference on Laparoscopic Liver Resection. J Hepatobiliary Pancreat Sci. 2014 [cited 2018 Aug 11];21(10):723–731. Available from: http://doi.wiley.com/10.1002/jhbp.139

    Article  Google Scholar 

  22. Aoki T, Murakami M, Koizumi T, Matsuda K, Fujimori A, Kusano T, Enami Y, Goto S, Watanabe M, Otsuka K (2018) Determination of the surgical margin in laparoscopic liver resections using infrared indocyanine green fluorescence. Langenbeck's Arch Surg 403(5):671–680

    Article  Google Scholar 

  23. Chai S, Zhao J, Zhang Y, Xiang S, Zhang W. Arantius ligament suspension: a novel technique for retraction of the left lateral lobe liver during laparoscopic isolated caudate lobectomy. J Laparoendosc Adv Surg Tech A. 2018 [cited 2018 Aug 11];28(6):740–744. Available from: http://www.liebertpub.com/doi/10.1089/lap.2017.0572

    Article  Google Scholar 

  24. Tian G, Chen Q, Guo Y, Teng M, Li J. Surgical strategy for isolated caudate lobectomy: experience with 16 cases. HPB Surg 2014 [cited 2018 Aug 12];2014:983684 Available from: http://www.hindawi.com/journals/hpb/2014/983684/

  25. Chaib E, Ribeiro MAF, Silva F de SC, Saad WA, Cecconello I. Caudate lobectomy: tumor location, topographic classification, and technique using right- and left-sided approaches to the liver. Am J Surg. 2008 [cited 2018 Aug 11];196(2):245–251. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0002961008003097

    Article  Google Scholar 

  26. Araki K, Conrad C, Ogiso S, Kuwano H, Gayet B. Intraoperative ultrasonography of laparoscopic hepatectomy: key technique for safe liver transection. J Am Coll Surg. 2014 [cited 2018 Aug 11];218(2):e37–e41. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1072751513011824

    Article  Google Scholar 

  27. Torzilli G, Montorsi M, Donadon M, Palmisano A, Del Fabbro D, Gambetti A, et al. “Radical but conservative” is the main goal for ultrasonography-guided liver resection: prospective validation of this approach. J Am Coll Surg. 2005 [cited 2018 Aug 12];201(4):517–528. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1072751505004813

    Article  Google Scholar 

  28. Hasegawa H, de Cervens T, Yamasaki S, Kosuge T, Takayama T, Shimada K. Surgical strategy for hepatocellular carcinoma of the caudate lobe. J Chir (Paris). 1991 [cited 2018 Aug 11];128(12):533–540. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1667187

  29. Peng SY (2010) Hepatic caudate lobe resection, p 307

    Book  Google Scholar 

  30. Maki H, Sakamoto Y, Kawaguchi Y, Akamatsu N, Kaneko J, Arita J, et al. Anatomical boundary between the caudate lobe of the liver and adjacent segments based on three-dimensional analysis for precise resections. J Gastrointest Surg. 2018 [cited 2018 Aug 11]; Available from: http://link.springer.com/10.1007/s11605-018-3819-5

  31. Viganò L, Capussotti L, Majno P, Toso C, Ferrero A, De Rosa G, et al. Liver resection in patients with eight or more colorectal liver metastases. Br J Surg. 2015 [cited 2018 Aug 11];102(1):92–101. Available from: http://doi.wiley.com/10.1002/bjs.9680

    Article  Google Scholar 

  32. Kornprat P, Jarnagin WR, Gonen M, DeMatteo RP, Fong Y, Blumgart LH, et al. Outcome after hepatectomy for multiple (four or more) colorectal metastases in the era of effective chemotherapy. Ann Surg Oncol. 2007 [cited 2018 Aug 11];14(3):1151–1160. Available from: http://www.springerlink.com/index/10.1245/s10434-006-9068-y

    Article  Google Scholar 

  33. Malik HZ, Hamady ZZR, Adair R, Finch R, Al-Mukhtar A, Toogood GJ, et al. Prognostic influence of multiple hepatic metastases from colorectal cancer. Eur J Surg Oncol. 2007 [cited 2018 Aug 11];33(4):468–473. Available from: http://linkinghub.elsevier.com/retrieve/pii/S074879830600360X

  34. van Dam RM, Lodewick TM, van den Broek MAJ, de Jong MC, Greve JW, Jansen RLH, et al. Outcomes of extended versus limited indications for patients undergoing a liver resection for colorectal cancer liver metastases. HPB (Oxford). 2014 [cited 2018 Aug 11];16(6):550–559. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1365182X15315975

    Article  Google Scholar 

  35. Castaing D, Vibert E, Ricca L, Azoulay D, Adam R, Gayet B. Oncologic results of laparoscopic versus open hepatectomy for colorectal liver metastases in two specialized centers. Ann Surg. 2009 [cited 2018 Aug 12];250(5):849–855. Available from: https://insights.ovid.com/crossref?an=00000658-200911000-00025

    Article  Google Scholar 

  36. de Haas RJ, Wicherts DA, Flores E, Azoulay D, Castaing D, Adam R. R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery? Ann Surg. 2008 [cited 2018 Aug 12];248(4):626–637. Available from: https://insights.ovid.com/crossref?an=00153307-200801260-00031

  37. Viganò L, Procopio F, Cimino MM, Donadon M, Gatti A, Costa G, et al. Is tumor detachment from vascular structures equivalent to R0 resection in surgery for colorectal liver metastases? An observational cohort. Ann Surg Oncol. 2016 [cited 2018 Aug 11];23(4):1352–1360. Available from: http://link.springer.com/10.1245/s10434-015-5009-y

    Article  Google Scholar 

  38. Guro H, Kim JW, Choi YR, Cho JY, Yoon YS, Han HS. Multidisciplinary management of intrahepatic cholangiocarcinoma: current approaches. Surg Oncol 2017;26(2):146–152. Available from: https://doi.org/10.1016/j.suronc.2017.03.001

    Article  Google Scholar 

  39. Uchida H, Iwashita Y, Tada K, Saga K, Takayama H, Hirashita T, et al. Laparoscopic liver resection in cirrhotic patients with specific reference to a difficulty scoring system. Langenbeck's Arch Surg. 2018 [cited 2020 Feb 18];403(3):371–377. Available from: http://link.springer.com/10.1007/s00423-018-1671-4

    Article  Google Scholar 

  40. Ryckx A, Christiaens C, Clarysse M, Vansteenkiste F, Jan Steelant P, Sergeant G, et al. Central venous pressure drop after hypovolemic phlebotomy is a strong independent predictor of intraoperative blood loss during liver resection. Oncol. 2017 [cited 2018 Aug 24];24:1367–1375 Available from: https://link-springer-com.kuleuven.ezproxy.kuleuven.be/content/pdf/10.1245%2Fs10434-016-5737-7.pdf

    Article  Google Scholar 

  41. Marino MV, Glagolieva A, Guarrasi D. Robotic resection of the liver caudate lobe: technical description and initial consideration. Cirugía Española. 2018;96(3):162–168. Available from: https://doi.org/10.1016/j.cireng.2018.02.003

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium

    M. Cappelle, I. Parmentier, C. De Meyere, F. Vansteenkiste & M. D’Hondt

  2. The Intervention Centre, Oslo University Hospital, Oslo, Norway

    D. L. Aghayan & B. Edwin

  3. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    D. L. Aghayan & B. Edwin

  4. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands

    M. J. van der Poel & M. G. Besselink

  5. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Jessa Hospital, Hasselt, Belgium

    G. Sergeant

  6. Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway

    B. Edwin

Authors
  1. M. Cappelle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. L. Aghayan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. J. van der Poel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. G. Besselink
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Sergeant
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. Edwin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. I. Parmentier
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. De Meyere
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. F. Vansteenkiste
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. D’Hondt
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: M. Cappelle, F. Vansteenkiste, M. D’Hondt

Acquisition of data: M. Cappelle, D. Aghayan, M.J. van der Poel, G. Sergeant, I. Parmentier

Analysis and interpretation of data: M. Cappelle, D. Aghayan, I. Parmentier, F. Vansteenkiste, M. D’Hondt

Drafting of the manuscript: M. Cappelle, D. Aghayan, M. D’Hondt

Critical review: D. Aghayan, M.J. van der Poel, M.G. Besselink, G. Sergeant, B. Edwin, F. Vansteenkiste, M. D’Hondt

Corresponding author

Correspondence to M. D’Hondt.

Ethics declarations

This article was written in accordance with the ethical standards of the institutional review board and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest.

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cappelle, M., Aghayan, D.L., van der Poel, M.J. et al. A multicenter cohort analysis of laparoscopic hepatic caudate lobe resection. Langenbecks Arch Surg 405, 181–189 (2020). https://doi.org/10.1007/s00423-020-01867-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-020-01867-2

Keywords

Search

Navigation