Laparoscopic Caudate Lobectomy for Cholangiocarcinoma of Caudate Lobe Invading Middle Hepatic Vein

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 × 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.

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.

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Funding

Funding was provided by National Key Technologies R&D Program (Grant No. 2018YFC1106800), the Natural Science Foundation of China (Grant Nos. 81672882, 81700555, 81770615, 81800564, 81872004 and 81972747), the Science and Technology Program of Tibet Autonomous Region (Grant No. XZ201801-GB-02), the Science and Technology Support Program of Sichuan Province (Grant Nos. 2017SZ0003, 2018SZ0115, 2019YFQ0001) and the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (Grant No. ZYJC18008).

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Correspondence to Hong Wu MD or Ji-Wei Huang MD.

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Wan, H., Xie, K., Li, J. et al. Laparoscopic Caudate Lobectomy for Cholangiocarcinoma of Caudate Lobe Invading Middle Hepatic Vein. Ann Surg Oncol 27, 4181–4185 (2020). https://doi.org/10.1245/s10434-020-08577-5

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