• Tadatoshi Takayama, Yutaka Midorikawa, Tokio Higaki, Hisashi Nakayama, Masamichi Moriguchi, Osamu Aramaki, Shintaro Yamazaki, Masaru Aoki, Kimitaka Kogure, and Masatoshi Makuuchi.
• Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
• Ann. Surg. 2021 Jun 1; 273 (6): e222-e229.

ObjectiveTo propose an algorithm for resecting hepatocellular carcinoma (HCC) in the caudate lobe.BackgroundOwing to a deep location, resection of HCC originating in the caudate lobe is challenging, but a plausible guideline enabling safe, curable resection remains unknown.MethodsWe developed an algorithm based on sublocation or size of the tumor and liver function to guide the optimal procedure for resecting HCC in the caudate lobe, consisting of 3 portions (Spiegel, process, and caval). Partial resection was prioritized to remove Spiegel or process HCC, while total resection was aimed to remove caval HCC depending on liver function.ResultsAccording to the algorithm, we performed total (n = 43) or partial (n = 158) resections of the caudate lobe for HCC in 174 of 201 patients (compliance rate, 86.6%), with a median blood loss of 400 (10-4530) mL. Postoperative morbidity (Clavien grade ≥III b) and mortality rates were 3.0% and 0%, respectively. After a median follow-up of 2.6 years (range, 0.5-14.3), the 5-year overall and recurrence-free survival rates were 57.3% and 15.3%, respectively. Total and partial resection showed no significant difference in overall survival (71.2% vs 54.0% at 5 yr; P = 0.213), but a significant factor in survival was surgical margin (58.0% vs 45.6%, P = 0.034). The major determinant for survival was vascular invasion (hazard ratio 1.7, 95% CI 1.0-3.1, P = 0.026).ConclusionsOur algorithm-oriented strategy is appropriate for the resection of HCC originating in the caudate lobe because of the acceptable surgical safety and curability.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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