Introduction Tumours located in the caudate lobe can be challenging due to the anatomical relation of segment I with the inferior vena cava (IVC), the presence of multiple small caudate veins, variable bile ducts anatomy and difficult exposure during surgery. Some groups reported increased morbidity, smaller resection margins and inferior outcomes. Aim of the study was to compare the group of patients who underwent caudate lobe resection (CLR) with a group of patients without caudate lobe excision (NCLR).
Methods Over a 16-year period, from November 1994 to November 2010, 1295 consecutive liver resections for colorectal liver metastases were performed at our Institution. The cohort of caudate resection patients were age (±1 year), sex and number of resected segments matched with an exact number of other hepatic resection patients that did not include the caudate lobe. Seventy-five patients had CLR. Six patients who had isolated CLR were excluded leaving 69 cases from analysis.
Results ASA score, comorbidity, number of bilateral resections, steatosis and fibrosis did not differ among the cohorts (p=NS). Similarly the number of tumours, size of the largest tumour and resection margins (R0 vs R1) did not differ among the two groups (p=NS). Post-operative stay (13.5 vs 10.9 days), ICU admissions (16 vs 7), morbidity (sepsis, bile leak, cardio-vascular, respiratory; 26 vs 27), number of patients transfused (7 vs 5), hepatic failure (7 vs 6) and 60-days mortality (1 vs 2) were not significant (CLR vs NCLR, p=NS). Overall survival at 1, 3 and 5 years were 85%, 57% and 48% for CLR and 95%, 61% and 50% for NCLR respectively. Disease-free survival at 1, 3, and 5 years were 75%, 47% and 47% for CLR and 85%, 63% and 53% respectively.
Conclusion Although caudate lobe involvement adds to the technical complexity of hepatic resection, it does not appear to carry increased morbidity and mortality when associated to major liver surgery. The rate of R0 resection and overall and disease-free survival does not differ between CLR and NCLR.
Competing interests None declared.
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