Can we delineate preoperatively the right and ventral margins of caudate lobe of the liver?

Xue-Yin Shen,Hee-Jung Wang,Bong-Wan Kim,Sung-Yeon Hong,Mi-Na Kim,Xu-Guang Hu 대한외과학회 2019 Annals of Surgical Treatment and Research(ASRT) Vol.97 No.3

Purpose: Complete removal of the caudate lobe, which is sometimes necessary, is accomplished via isolated caudate lobectomy or hepatectomy that includes the caudate lobe. It is impossible, however, to confirm the right and ventral margins of the caudate lobe by preoperative imaging. This study was undertaken to determine whether we could identify the right and ventral margins of the caudate lobe preoperatively using Synapse 3D visualization software. Methods: Ninety-four preoperative 3-dimensional (3D) computed tomographic images (1-mm slices) of the liver from candidate donors were examined. The images of the caudate lobe were subjected to a counter-staining method according to Synapse 3D to delineate their dimensions. We first examined whether the right margin of the caudate lobe exceeded the plane formed by the root of the right hepatic vein (RHV) and the right side of the inferior vena cava (IVC). Second, we determined whether the ventral margin of the caudate lobe exceeded the plane formed by the root of the middle hepatic vein (MHV) and the root of the RHV. Results: For the right margin, 17 cases (18%) exceeded the RHV-IVC plane by a mean of 10.2 mm (range, 2.4–27.2 mm). For the ventral margin, 28 cases (30%) exceeded the MHV-RHV plane by a mean of 17.4 mm (range, 1.2–49.1 mm). Conclusion: Evaluating the anatomy of caudate lobe using Synapse 3D preoperatively could be helpful for more precise anatomical resection of the caudate lobe.

미상엽에 발생한 간종양에 대한 수술적 접근: 다양한 수술 전략?

한영석 ( Young Seok Han ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Caudate lobectomy remains a surgical challenge because hepatic tumors in the caudate lobe is deeply located in the center of the liver and close to the vena cava and hepatic hilum. Hence, precise anatomic knowledge of the caudate lobe and improvement in the surgical techniques are necessary for more performance of caudate lobectomies. Caudate lobectomy is technically classified as an isolated or combined resection. Isolated caudate lobectomy is a procedure that required knowledge of liver anatomy, experience in liver resection and safe management of vascular structures. Although it has been considered a technically difficult and dangerous procedure, an isolated caudate lobectomy is the viable surgical option in patients with a marginal liver functional reserve. For huge tumors in the caudate lobe, anterior trans-hepatic approach seems to be recommended. However, this approach requires splitting the liver parenchyma and long operation time. For patients with sufficient liver functional reserve, caudate lobectomy combined with an additional partial hepatectomy is preferred because such an approach is technically less demanding and offers an adequate surgical margin. Recent reports suggest that minimally invasive liver resection provides better quality of care and improvements of patient outcome by minimizing blood loss and postoperative pain or morbidity, and shortens hospital stay than open surgery. With today’s high definition display unit, the intrinsic illumination and magnified view of the video image system, the laparoscopic approach for caudate lobectomy can provide excellent visualization for dissection and vascular control in addition to the known benefits of a minimally invasive procedure. Therefore, pure laparoscopic caudate lobectomy can be suggested as a feasible and safe treatment option for well-selected caudate lesions and bring about the post-operative benefits. However, laparoscopic caudate lobectomy is one of the most difficult procedures in laparoscopic liver resection and have only been reported rarely. It can be still performed to patients in center by surgeons with experience in both hepatobiliary surgery and laparoscopic skills. In this session, I will present my experiences and reviews for caudate lobectomy.

HCC : PE-062 ; The Radiotherapy on HCC in caudate lobe

( Hyun Jung Kim ),( Ji Hye Cha ),( Hae Ok Pyun ),( Jin Sil Seong ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Background: Hepatocelluar carcinoma (HCC) in caudate lobe has poor prognosis and is challenging to treat with surgery, radiofreqeuncy ablation (RFA), transcatheter arterial embolization (TACE) because of its unique anatomic location. This study was designed to assess the efficacy and safety of radiotherapy (RT) for HCC in the caudate lobe. Methods: Between January 1996 and August 2011, 58 patients with HCC in caudate lobe were treated with RT. Fifty cases were treated after the failure of previous RFA or TACE. Eight patients were treated as definitive aim. Most of the patients were treated with RT alone (44%) while the others were treated with RT with intra-arterial (34%) or systemic chemotherapy (15%), RT after TACE (7%) within 1 month. Median radiation dose was 45Gy (range, 30.6 - 80 Gy) in 25 fractions. The tumor response was determined by CT scans at post-RT 3 months. Results: The median follow-up period after RT was 10.6 months (range, 1 - 93 months). The 1 year- and 2 year-local control rates were 73.5% and 47.7%, respectively, and 1 yearand 2 year-overall survival rates were 53.8% and 40.4%, respectively. Complete response was achieved in two patients. In-field local control was achieved in 70% of patients. During the follow-up, 14 patients (24%) developed intra-hepatic metastases and eight patients (13%) developed extra-hepatic metastases: lung, distant lymph nodes, bone, and brain. Seven patients developed grade 1 nausea or anorexia during RT. There were no grade 3 or greater treatment-related toxicities. Conclusions: Radiotherapy appears to be an effective and feasible treatment modality for HCC in caudate lobe.

HCC : PE-062 ; The Radiotherapy on HCC in caudate lobe

( Hyun Jung Kim ),( Jih Ye Cha ),( Hae Ok Pyun ),( Jin Sil Seong ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Background: Hepatocelluar carcinoma (HCC) in caudate lobe has poor prognosis and is challenging to treat with surgery, radiofreqeuncy ablation (RFA), transcatheter arterial embolization (TACE) because of its unique anatomic location. This study was designed to assess the efficacy and safety of radiotherapy (RT) for HCC in the caudate lobe. Methods: Between January 1996 and August 2011, 58 patients with HCC in caudate lobe were treated with RT. Fifty cases were treated after the failure of previous RFA or TACE. Eight patients were treated as definitive aim. Most of the patients were treated with RT alone (44%) while the others were treated with RT with intra-arterial (34%) or systemic chemotherapy (15%), RT after TACE (7%) within 1 month. Median radiation dose was 45Gy (range, 30.6 - 80 Gy) in 25 fractions. The tumor response was determined by CT scans at post-RT 3 months. Results: The median follow-up period after RT was 10.6 months (range, 1 ? 93 months). The 1 year- and 2 year-local control rates were 73.5% and 47.7%, respectively, and 1 yearand 2 year-overall survival rates were 53.8% and 40.4%, respectively. Complete response was achieved in two patients. In-field local control was achieved in 70% of patients. During the follow-up, 14 patients (24%) developed intra-hepatic metastases and eight patients (13%) developed extra-hepatic metastases: lung, distant lymph nodes, bone, and brain. Seven patients developed grade 1 nausea or anorexia during RT. There were no grade 3 or greater treatment-related toxicities. Conclusions: Radiotherapy appears to be an effective and feasible treatment modality for HCC in caudate lobe.

HCC : PE-063 ; The therapeutic efficacy of radiotherapy for HCC in caudate lobe

( Hyun Jung Kim ),( Jih Ye Cha ),( Hae Ok Pyun ),( Jin Sil Seong ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Background: Hepatocellular carcinoma (HCC) in caudate lobe has poor prognosis due to unsatisfactory effect with currenttreatment including surgery, radiofrequency ablation (RFA), transcatheter arterial embolization (TACE) because of its unique anatomic location. This study was designed to assess the efficacy and safety of radiotherapy (RT) for HCC in the caudate lobe. Methods: Between January 1996 and August 2011, 58 patients with HCC in caudate lobe were treated with RT. Fifty patients were treated after the failure of previous RFA or TACE and 8 patients, as definitive aim. Most of the patients were treated with RT alone (44%) while the others were treated with RT with intra-arterial (34%) or systemic chemotherapy (15%), RT after TACE (7%) within 1 month. Median radiation dose was 45Gy (range, 30.6 - 80 Gy) in 25 fractions. The tumor response was determined by CT scans at post-RT 3 months. Results: The median follow-up period after RT was 10.6 months (range, 1?93 months). The 1- and 2- year local control rates were 73.5% and 47.7%, respectively, and 1- and 2- year overall survival rates were 53.8% and 40.4%, respectively. Complete response was achieved in two patients. In-field local control was achieved in 70% of patients. During the follow-up, 14 patients (24%) developed intra-hepatic metastases and eight patients (13%) developed extra-hepatic metastases: lung, distant lymph nodes, bone, and brain. Seven patients developed grade 1 nausea or anorexia during RT. There were no grade 3 or above treatment-related toxicities. Conclusions: Radiotherapy appears to be an effective and feasible treatment modality for HCC in caudate lobe.

Case Report : Giant Hyperplasia of the Caudate Lobe in a Patient with Liver Cirrhosis: Case Report and Literature Review

( Jeong Ho Choi ),( Dae Won Jun ),( Han Hyo Lee ),( Mun Hee Song ),( Seong Hwan Kim ),( Yun Ju Jo ),( Young Sook Park ),( Jun Young Jung ),( Won Mi Lee ) The Editorial Office of Gut and Liver 2008 Gut and Liver Vol.2 No.3

The caudate lobe often exhibits enlargement and nodularity in cases of cirrhosis, which makes differentiation of hepatocellular carcinoma from other mass-like lesions of the caudate lobe difficult in cirrhotic patients. A 12×6 cm mass-like enlargement of the caudate lobe was incidentally found by computed tomography in a 38-year-old man suffering from alcoholic liver cirrhosis. Magnetic resonance imaging, liver colloidal scan, and sonoguided liver biopsy were used for the differential diagnosis. A literature review revealed two case reports, all of which (like ours) presented with an enlarged caudate lobe supplied with blood via a branch of the portal vein. Therefore, in cases of giant hyperplasia of the caudate lobe, confirmation of the caudate lobe blood supply and the enhancement pattern might be important for the differentiation. (Gut and Liver 2008;2:205-208)

Concurrent Torsion of the Caudate Liver Lobe and Spleen in a German Shepherd Dog

권영삼 한국임상수의학회 2024 한국임상수의학회지 Vol.41 No.1

A 3-year-old, 20.6 kg, neutered male German Shepherd dog was referred to Kyungpook National University Veterinary Medicine Teaching Hospital. Clinical examination revealed chronic diarrhea for 6 weeks and a non-tender, distended abdomen without lethargy, anorexia, and vomiting. Diarrhea was watery and had a waxing and waning course despite symptomatic treatment. A complete blood count identified mild leukocytosis and mild anemia. Serum biochemistry analysis showed elevated alanine aminotransferase and aspartate aminotransferase levels, and mild hypoalbuminemia. Abdominal ultrasound examination revealed mixed echogenicity with absent blood flow at the caudate process of the caudate liver lobe and a small amount of ascites. Computed tomography revealed torsion of the caudate process of the caudate liver lobe and spleen and gas dilatation of the intestine. After establishing a diagnosis of organ torsion on imaging, we deemed the condition an emergency and immediately performed surgery. Given that laparotomy confirmed organ torsion, liver lobectomy, total splenectomy, and prophylactic gastropexy were conducted. The patient was discharged 11 days after surgery without complications. In general, liver lobe torsion and splenic torsion are uncommon in dogs and present with nonspecific clinical signs, such as abdominal pain, lethargy, anorexia, and vomiting. In the current case, torsion of the caudate liver lobe and spleen occurred without other clinical signs except for a distended abdomen. Moreover, no reports in dogs have demonstrated the simultaneous occurrence of both diseases.

주의력결핍/과잉운동장애에서 전두엽과 미상핵의 뇌자기공명영상상 연구

공석원,이정섭,류인균,홍강의 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.6

목 적 : 미상핵은 전두엽의 각 부분으로부터 입력신호를 받고 있어서 주의력겹핍/과잉운동장애의 원인을 연구하는 분야에서 주목을 받고 있다. 본 연구에서는 주의력결핍/과잉운동장애에서 전두엽과 미상핵의 정상적 비대칭성이 어떻게 관찰되는지를 뇌자기공명영상을 통하여 알아보려고 하였다. 방법 : DSM-III-R의 진단 기준에 맞는 14명의 주의력결핍/과잉운동장애 남아(평균11.1, 표준편차 3.0)와 16명의 두통 대조군(평균연령 10.6, 표준편차 2.5)에서 뇌자기공명영상상을 후향적으로 모집하였다. 분석을 위해서는 미상핵이 가장 잘보이는 축영상중 한 단면을 선택하였다. 뇌자기공명영상은 평판형 스캐너로 읽어들여서 Brainimage Pascal 2.3.3.1 프로그램을 이용해서 분석하였다. 화소수 및 면적을 측정하였으며, 검사자간 신뢰도는 0.89 이상이었다. 결과 : 환자군과 대조군 모두에게 우측 전두엽과 우측 미상핵의 면적이 컸다. 그리고, 이 차이는 대조군에만 통계적으로 유의하였다. 전두엽과 미상핵이 정상적인 비대칭성이 주의력결핍/과잉운동장애 환아군에서는 관찰되지 않았다. 결론 : 우측전두엽발달과정의 문제가 주의력 결핍/과잉행동장애의 원인이라는 가설을 지지하는 증거라고 할 수 있을 것이다. Objectives Because the caudate nucleus receives inputs from the dorsolateral prefrontal and orbitofrontal cortices, it is the area of the interest with ADHD patients in many researches. To identify the lack of normal asymmetry in the frontal lobe and caudate nucleus of the subjects with ADHD, one slice of brain MR images for each subjects were selected, and planimetric method was applied and analyzed. Methods : The brain MR images of 14 ADHD boys who met the DSM-111-R diagnostic criteria and 16 headache control group were collected. Single best view for the head of the caudate nucleus, one axial slice was selected for analysis. MR images were redigitized with flatbed scanner and data were analyzed with Brainimage Pascal 2.3.3.1 software. Pixel counting and area measurements were done. Interrater reliabilities were 0.89 or greater. Results : In both ADHD and control groups, right caudate area was slightly greater than left side, and this difference were more significant in control group. The results showed that the normal asymmetry of frontal lobe and the caudate nucleus was not observed far the ADHD group. Conclusion : The normal asymmetry of the frontal lobe and the caudate nucleus was not seen in boys with ADHD.

Case Report : A case of hepatocellular carcinoma in the caudate Lobe successfully treated by transcatheter arterial chemoembolization using drug-eluting beads

( Dong Hoo Joh ),( Jin Dong Kim ),( Young Nam Kim ),( Ha Hun Song ),( Hyun Kim ),( Kyung Ho Song ),( Sang Jin Lee ),( Jeong Rok Lee ),( Won Joong Jeon ),( Byung Hyo Cha ) 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.4

Hepatocellular carcinoma (HCC) in the caudate lobe remains one of the most intricate locations where various treatments tend to pose problems with regard to the optimal approach. Surgical resection has been regarded as the most effective treatment; however, isolated resection of the caudate lobe is strenuous and associated with a high rate of early recurrence. Percutaneous ablation might be technically difficult or impossible to perform due to the deep location of tumors and adjacent large vessels. Treatment with drug-eluting beads (DEB) can potentially enhance the therapeutic efficacy for patients with unresectable HCC by drawing on the slower, more consistent drug delivery process. We described a case of a 62-year-old man with HCC in the caudate lobe who was successfully treated by DEB. (Korean J Hepatol 2010;16:405-409)

미상엽에 발생한 간세포암 절제치유

민영일(Young Il Min),이영상(Young Sang Lee),김명환(Myung Hwan Kim),이승규(Sung Gyu Lee),민병철(Pyung Chul Min),유은실(Eun Sil Yu),정영화(Yong Hwa Chung),오용호(Young Ho Oh) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.5

Hepatocellular carcinoma arising in the caudate lobe is rare and its prognosis is generally poor. Most of lesions already show multiple metastases and are inoperable at the time of presentation, because tumor cells may spread readily through its short portal and hepatic vein branches into the main portal vein and the inferior vena cava early in the disease. We report a case of hepatocellular carcinoma arising in the caudate lobe which was successfully resected through the combined upper midline incision and median sternotomy 43 months ago