Anterior transhepatic approach for total caudate lobectomy including spigelian lobe, paracaval portion and caudate process: A Brazilian experience

摘要

To the Editor:Nowadays,because of the infiltration of cholangiocarcinoma to the parenchyma and/or bile ducts of the caudate lobe,the inclusion of caudate lobe combined with a major hepatectomy remains the gold standard approach for a resectable hilar cholangiocarcinoma.Since the last years of the 20th century,some authors have begun to report isolated caudate lobe resection for hepatocellular carcinoma(HCC),in order to achieve a radical surgery by sparing at the same time hepatic parenchyma[1].Moreover,caudate lobe can be an uncommon site of metastatic involvement.Without any doubt,caudate lobectomy is a very demanding procedure,mainly because of the deep and complex location of the caudate lobe between major vessels.Hepatectomies performed for tumors located in this dangerous area may lead to massive hemorrage that can be difficult to control.In this setting,the so called anterior transhepatic approach provides a very good exposure to the surgical field.