Hawkins William G, DeMatteo Ronald P, Cohen Michael S, Jarnagin William R, Fong Yuman, D'Angelica Michael, Gonen Mithat, Blumgart Leslie H
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Am Coll Surg. 2005 Mar;200(3):345-52. doi: 10.1016/j.jamcollsurg.2004.10.036.
Resection of the caudate lobe of the liver is technically demanding, with the disparate goals of preserving major vascular and biliary structures without compromising tumor clearance. Our objective was to assess our results with resection of the caudate lobe of the liver for malignant disease.
From 1992 to 2004, we performed caudate resection for malignancy in 150 patients. Clinicopathologic correlates, surgical methods, patterns of recurrence, and survival were analyzed.
Of the 150 patients identified, 21 (14%) underwent an isolated caudate lobe resection and 129 (86%) underwent caudate lobe resection as part of a more extensive hepatectomy. The most common indication was for metastatic colorectal cancer (48%), followed by cholangiocarcinoma (30%) and hepatocellular cancer (10%). Thirty patients required resection and reconstruction of the portal vein (n = 16), vena cava (n = 15), or both. Pathologic microscopic margins were positive in 30 patients (20%). At least one postoperative complication was reported in the majority of patients (55%), and nine patients (6%) died as a result of these complications. Postoperative mortality was significantly higher in patients who underwent a major vascular reconstruction (20% versus 2.5%, p < 0.002). Median survivals for patients with colorectal metastasis, cholangiocarcinoma, and hepatocellular carcinoma were 37, 28, and 32 months, respectively.
Performing caudate hepatectomy with negative microscopic margins remains a technical challenge because of the proximity of major biliary and vascular structures. Although caudate resection of the liver can be performed safely, concomitant major vascular reconstruction substantially increases the mortality of the procedure.
肝尾状叶切除术在技术上要求较高，目标是在不影响肿瘤清除的前提下保留主要血管和胆管结构。我们的目的是评估肝尾状叶切除术治疗恶性疾病的结果。
1992年至2004年，我们对150例恶性肿瘤患者进行了尾状叶切除术。分析了临床病理相关性、手术方法、复发模式和生存率。
在确定的150例患者中，21例（14%）接受了单纯尾状叶切除术，129例（86%）接受了尾状叶切除术作为更广泛肝切除术的一部分。最常见的适应证是转移性结直肠癌（48%），其次是胆管癌（30%）和肝细胞癌（10%）。30例患者需要切除并重建门静脉（n = 16）、腔静脉（n = 15）或两者。30例患者（20%）病理显微镜切缘阳性。大多数患者（55%）报告至少有1种术后并发症，9例患者（6%）死于这些并发症。接受主要血管重建的患者术后死亡率显著更高（20%对2.5%，p < 0.002）。结直肠癌转移、胆管癌和肝细胞癌患者的中位生存期分别为37个月、28个月和32个月。
由于主要胆管和血管结构位置接近，进行显微镜下切缘阴性的尾状叶肝切除术仍然是一项技术挑战。虽然肝尾状叶切除术可以安全进行，但同时进行主要血管重建会显著增加手术死亡率。
