Management of hepatocellular carcinoma rupture in the caudate lobe  

作　　者：De-Fei Hong Ying-Bin Liu Shu-You Peng Jin-Zhong Pang Zhi-Fei Wang Jian Cheng Guo-Liang Shen Yuan-Biao Zhang 

机构地区：[1]Department of Hepatobiliary,Pancreatic Surgery and Minimally Invasive Surgery,Zhejiang Provincial People’s Hospital [2]Department of General Surgery,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine [3]Department of General Surgery,the First People’s Hospital of Qingdao Economic and Technical Department Zone

出　　处：《World Journal of Gastroenterology》2015年第26期8163-8169,共7页世界胃肠病学杂志（英文版）

摘　　要：AIM: To demonstrate that caudate lobectomy is a valid treatment in cases of hepatocellular carcinoma(HCC) rupture in the caudate lobe based on our experience with the largest case series reported to date.METHODS: A retrospective study of eight patients presenting with spontaneous rupture and hemorrhage of HCC in the caudate lobe was conducted.Two patients underwent ineffective transarterial embolization preoperatively.Caudate lobectomy was performed in all eight patients.Bilateral approach was taken in seven cases for isolated complete caudate lobectomy.Left-sided approach was employed in one case for isolated partial caudate lobectomy.Transarterial chemoembolization was performed postoperatively in all patients.RESULTS: Caudate lobectomy was successfully completed in all eight cases.The median time delay from the diagnosis to operation was 5 d(range: 0.25-9).Median operating time was 200 min(range: 120-310) with a median blood loss of 900 m L(range: 300-1500).Five patient remained in long-term follow-up,with one patient becoming lost to followup at 3 years and two patients currently alive at 7 and 19 mo.One patient required reoperation due to recurrence.Gamma knife intervention was performed for brain metastasis in another case.Two patients survived for 10 and 84 mo postoperatively,ultimately succumbing to multiple organ metastases.CONCLUSION: Caudate lobectomy is the salvage choice for HCC rupture in the caudate lobe.Local anatomy and physiologic features of the disease render caudate lobectomy a technically difficult operation.Postponement of surgical intervention is thus recommended while the rupture remains hemodynamically stable until an experienced surgeon becomes available.Prognosis is confounded by numerous factors,but long-term survival can be expected in the majority of cases.AIM: To demonstrate that caudate lobectomy is a valid treatment in cases of hepatocellular carcinoma(HCC) rupture in the caudate lobe based on our experience with the largest case series reported to date.METHODS: A retrospective study of eight patients presenting with spontaneous rupture and hemorrhage of HCC in the caudate lobe was conducted.Two patients underwent ineffective transarterial embolization preoperatively.Caudate lobectomy was performed in all eight patients.Bilateral approach was taken in seven cases for isolated complete caudate lobectomy.Left-sided approach was employed in one case for isolated partial caudate lobectomy.Transarterial chemoembolization was performed postoperatively in all patients.RESULTS: Caudate lobectomy was successfully completed in all eight cases.The median time delay from the diagnosis to operation was 5 d(range: 0.25-9).Median operating time was 200 min(range: 120-310) with a median blood loss of 900 m L(range: 300-1500).Five patient remained in long-term follow-up,with one patient becoming lost to followup at 3 years and two patients currently alive at 7 and 19 mo.One patient required reoperation due to recurrence.Gamma knife intervention was performed for brain metastasis in another case.Two patients survived for 10 and 84 mo postoperatively,ultimately succumbing to multiple organ metastases.CONCLUSION: Caudate lobectomy is the salvage choice for HCC rupture in the caudate lobe.Local anatomy and physiologic features of the disease render caudate lobectomy a technically difficult operation.Postponement of surgical intervention is thus recommended while the rupture remains hemodynamically stable until an experienced surgeon becomes available.Prognosis is confounded by numerous factors,but long-term survival can be expected in the majority of cases.

关 键 词：CAUDATE LOBECTOMY HEPATOCELLULAR carcinoma EMERGENCY RUPTURE transarterial EMBOLIZATION 

分 类 号：R735.7[医药卫生—肿瘤]