Choice of approach for hepatectomy for hepatocellular carcinoma located in the caudate lobe: Isolated or combined lobectomy?

Table 1 Patient characteristics

	Isolated caudate lobectomy group (n = 16)	Combined caudate lobectomy group (n = 20)	P value
Age (yr)	51 ± 14	48 ± 17	NS
Gender			NS
Male	12	15
Female	4	5
Liver cirrhosis			NS
Present	10	14
Absent	6	6
Child-Pugh class			NS
A	14	17
B	2	3
Liver function
Albumin (g/dL)1	2.9	3.5	0.03
ALT (IU/L)1	54	32	0.04
Total bilirubin (mg/dL)1	1.2	0.8	0.04
Prothrombin time (%)1	75	79	NS
Location of the tumor			NS
Spiegel	2	3
Paracaval portion	2	3
Caudate process	1	2
Spiegel + paracaval portion	3	4
Paracaval portion + caudate process	3	2
Complete caudate lobe	5	6
Surgical margin (mm)			0.04
< 5 mm	5	1
≥ 5 mm	11	19
α-Fetoprotein (ng/mL)1	23	25
Cancer spread2			NS
Positive	3	5
Negative	13	15
Differentiation of tumor			NS
Edmondson I	1	1
Edmondson II	5	4
Edmondson III	10	14
Edmondson IV	0	1
Tumor size, median (range), cm	6.1 (2.1-13.4)	7.5 (2.3-15.8)	NS

¹Median;

²Cancer spread was defined by presence of microscopic vascular invasion and/or intrahepatic metastasis. ALT: Alanine aminotransferase; NS: Not significant.

Table 2 Operative procedures

Operations	n (%)
Isolated caudate lobectomy	16 (44.4)
Complete caudate lobectomy	8
Partial caudate lobectomy	8
Concomitant procedures
Partial IVC resection + repair	2
Approaches
Left-side	2
Right-side	2
Bilateral	12
Combined caudate lobectomy	20 (55.6)
Complete caudate lobectomy + left hepatectomy	2
Complete caudate lobectomy + left lateral sectionectomy	2
Complete caudate lobectomy + right hepatectomy	1
Complete caudate lobectomy + right posterior hepatectomy	1
Partial caudate lobectomy + left hepatectomy	7
Partial caudate lobectomy + left lateral sectionectomy	3
Partial caudate lobectomy + right hepatectomy	2
Partial caudate lobectomy + right posterior hepatectomy	2
Concomitant procedures
Partial IVC resection + repair	4
Approaches
Left-side	4
Right-side	2
Bilateral	14

IVC: Inferior vena cava.

Table 3 Surgical outcomes

	Isolated caudate lobectomy group (n = 16)	Combined caudate lobectomy group (n = 20)	P value
Time of vascular control, median (range), min	52 (32-68)	33 (25-39)	0.04
Blood loss, median (range), mL	780 (250-1470)	460 (150-980)	0.03
No. of patients with blood transfusion	14	11	0.02
Operative time, median (range), min	240 (170-310)	170 (150-225)	0.04
Hospital stay, median (range), d	18 (11-22)	13 (9-17)	0.04
Mortality	0	0	-
Complications			0.03
Liver failure	0	0
Post-operative hemorrhage	2	0
Bile leak	2	0
Intra-abdominal collection	2	1
Pleural effusion	1	1

Table 4 Multivariate analysis

Variables	Hazard ratio	95% CI	P value
Overall survival
Absence of cancer spread1	0.44	0.24-0.69	0.007
Child-Pugh class A	0.86	0.66-1.33	0.17
Combined resection	0.57	0.32-0.92	0.04
Tumor size < 30 mm	0.61	0.32-1.05	0.08
Total bilirubin < 1 mg/dL	0.52	0.28-1.06	0.07
α-Fetoprotein < 100 ng/mL	0.61	0.33-1.19	0.07
Disease-free survival
Absence of cancer spread1	0.61	0.37-0.82	0.001
Combined resection	0.66	0.42-0.94	0.03
Negative tumor exposure	0.39	0.20-0.77	0.04
Total bilirubin < 1 mg/dL	0.56	0.37-0.89	0.02

¹Cancer spread was defined by presence of microscopic vascular invasion and/or intrahepatic metastasis.