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Il Giornale di Chirurgia

Le resezioni del lobo caudato: note di tecnica e risultati chirurgici

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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,
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.

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