Background: Caudate lobe resection is a complex surgical procedure that requires a high level of technical skills and a deep knowledge of liver surgical anatomy.
Materials and methods: From 1998 to 2008, 16 patients (8 females, 8 males), median age 60 years (44-77) underwent caudate lobe resection for 10 colorectal metastases; 4 hepatocarcinomas (HCC); 2 cholangiocarcinomas. Surgical procedures: 4 left hepatectomies with caudate lobectomy; 8 right hepatectomies with caudate lobectomy; 4 isolated caudate lobectomy. Pringle maneuver and a combined approach from right to left have been always used. In the 4 isolated caudate lobectomy, the control of supra and infrahepatic vena cava was accomplished by tourniquet occlusion.
Results: Surgical procedure were R0 in 15 cases and R1 in one case. The median operative time was 320 min (± 20 min); estimated intraoperative bleeding was 900 ml (± 150 ml); morbility rate was 18,7% (1 anastomotic biliary fistula, 1 biliopleuric fistula; one acute kidney failure). Mortality rate was 6,25% (1 emoperitoneum). The median postoperative stay was 17,8 days (range 5-42). Median survival was 20,5, 36,1 and 7,3 months for colorectal metastases, HCC and cholangiocarcinomas, respectively. Discussion: Isolated or associated caudectomy is a feasible surgical technique. However, isolated resection of caudate lobe is more complex and technical demanding due to its deep location and close relationships with hepatic hilar structures and the inferior vena cava. Therefore, a deep knowledge of caudate lobe surgical anatomy and a combined from right to left approach are strongly required.