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Parenchymal-sparing approaches for resection of tumors located in the paracaval portion of the caudate lobe of the liver—utility of limited resection and central hepatectomy

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Abstract

Purpose

Resection of liver cancer involving the paracaval portion (PC) of the caudate lobe is challenging because the PC is located deepest in the liver. This study aimed to elucidate the utility of two parenchymal-sparing approaches of limited resection and central hepatectomy for resecting tumors located in the PC.

Methods

In 2018 and 2020, 12 out of 143 patients underwent hepatectomy for tumors located in the PC of the liver. In six patients, limited resection (LR) of the PC after full mobilization of the liver off the inferior vena cava (IVC) was performed for tumors excluding the hilar plate or large hepatic veins (large HVs), including major hepatic veins or thick short hepatic veins. In six patients, central hepatectomy (CH) using liver tunnel was performed for tumors involving or close to the hilar plate and/or large HVs.

Results

During CH, the surgical view of the cranial side of the hilar plate was wide enough to perform combined resection of the large HVs in front of the IVC. Five of the six CHs were performed with resection of the LHVs. No LRs were accompanied with resection of the LHVs. The CH was associated with longer Pringle’s time (76 min vs. 29.5 min, p = 0.015) and blood loss (1104 ml vs. 370 ml, p = 0.041). The preserved liver parenchyma volumes were 82% and 95% of the total liver volume after CH and LR, respectively.

Conclusion

Our parenchymal-sparing approach for resection of liver cancer located in the PC is feasible for curative resection.

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Funding

This work was supported by Grants-in-Aid for Scientific Research (Number: 20K09019), Japan.

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan

    Masaharu Kogure, Yutaka Suzuki, Hirokazu Momose, Ryota Matsuki, Toshiyuki Mori & Yoshihiro Sakamoto

  2. Gunma University School of Medicine, Maebashi, Japan

    Kimitaka Kogure

Authors
  1. Masaharu Kogure
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  2. Yutaka Suzuki
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  3. Hirokazu Momose
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  4. Ryota Matsuki
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  5. Toshiyuki Mori
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  6. Kimitaka Kogure
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  7. Yoshihiro Sakamoto
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Contributions

Study conception and design: Yoshihiro Sakamoto. Acquisition of data: Masaharu Kogure, Yutaka Suzuki, Ryota Matsuki, Hirokazu Momose. Analysis and interpretation of data: Masaharu Kogure. Drafting of manuscript: Masaharu Kogure. Critical revision of manuscript: Toshiyuki Mori, Kimitaka Kogure.

Corresponding author

Correspondence to Yoshihiro Sakamoto.

Ethics declarations

Ethics approval

The protocol for this research project has been approved by a suitably constituted Ethics Committee of the institution and it conforms to the provisions of the Declaration of Helsinki. All analyses in this study were performed in accordance with the ethical guidelines for clinical studies at Committee of Kyorin University (approval no. 1608.). The need for consent in this study is waived by our review board; however, information about this study was made available to the patients to ensure that they could refuse to participate in this study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

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Kogure, M., Suzuki, Y., Momose, H. et al. Parenchymal-sparing approaches for resection of tumors located in the paracaval portion of the caudate lobe of the liver—utility of limited resection and central hepatectomy. Langenbecks Arch Surg 406, 2099–2106 (2021). https://doi.org/10.1007/s00423-021-02220-x

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  • DOI: https://doi.org/10.1007/s00423-021-02220-x

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