ISOLATED CAUDATE LOBECTOMY FOR SPIEGEL LOBE NEOPLASMS

Introduction: Caudate lobe, or segment 1 of the liver, is the segment of the liver that occupies the space between the hilar plate and the retrohepatic vena cava. Its peculiar embryology accounts for the unique vascular and biliary anatomy. The location among three major vascular structures (the hepato-duodenal ligament, the vena cava and the hepatic veins cranially), together with its characteristic hypertrophy in case of increased portal system pressure, makes the caudate lobe as one of the most challenging liver segments. Caudate lobe resections for tumor may be performed as isolated segmental resections or associated to major hepatic resections, when other liver segments are involved. We describe here our 14-years experience of 7 cases of isolated caudate lobe resection for tumor.Patients and Methods: From October 2000 to December 2014 826 patients underwent liver resection at our institution, of which 286 (34.6%) minor resection (wedge resection, sub-segmental resection and segmental resection), 200 (24.2%) right hepatectomy, 260 (31.4%) left hepatectomy, 20 (2.4%) left trisegmentectomy and 60 (7.2%) patient right trisegmentectomy. Of those, 45 (8.3%) had a concomitant caudate lobe resection. In seven patients (0.8%), the tumor was confined to the caudate lobe and an isolated caudate lobe resection was performed. The indication was as follow: 2 patients had Hepatocellular carcinoma (HCC), 3 patients had metastasis (colorectal in two cases and from adrenal gland in one case), 1 adenoma, and one presented with a non-Hodgkin lymphoma. For these patients we analyzed intraoperative data, post operative course and survival.Results: Five (71.4%) out of 7 patients are still alive after a mean follow up of 8.4+/-5 years. Two patients died of disease recurrence after 7 months and 8 years, respectively. The mean operating time was 304.8+/-109.7 minutes and the mean estimated blood loss was 266.6+/-123.8 ml. There were no intra-operative or post-operative complication. The mean Intensive Care Unit stay was 1.2+/-0.7 days. Each lesion was localized into the Spiegel lobe, and each patient had at the pathology specimen only one nodule. In all cases the margins were free of tumor.Conclusions: Isolated caudate lobectomy is a difficult surgical procedure that may be associated with significant intra-operative bleeding and dangerous vascular and biliary injuries. In spite of these difficulties, this procedure can be considered the gold standard treatment for any lesions, benign or malignant, involving and confined to the Spiegel Lobe, especially when is crucial to preserve the remnant parenchyma.