Isolated resection of the caudate lobe harboring hepatocellular carcinoma in the paracaval portion of the cirrhotic liver without complete interruption of hepatic outflow - An alternative surgical approach

Background/Aims: Isolated resection of the caudate lobe harboring hepatocellular carcinoma (HCC) in the paracaval portion is a challenge. To obtain a bloodless surgical field and to minimize the intraoperative blood loss, various vascular procedures of the outflow occlusion have been introduced. However, in those with liver cirrhosis and portal hypertension total outflow occlusion, may increase the hemodynamic instability and postoperative morbidity. Methodology: Of 21 patients receiving curative resection of HCC in caudate lobe, 3 had tumors in the paracaval portion (a largest diameter of 2.5cm, 9.5cm and 7.3cm, respectively). A Satinsky vascular clamp was applied obliquely on one side of inferior vena cava (IVC) to preserve the hepatic outflow. Pringle's maneuver was used for inflow control. Results: Using such measures, curative resection was performed smoothly in these 3 patients. Repair of an IVC defect by simple continuous suture with prolene 4-0 was undertaken in the second one. All patients had an uneventful postoperative course. Conclusion: During resection of HCC in the paracaval portion of caudate lobe, using side clamping of IVC without complete interruption of hepatic outflow is safe and feasible. We suggest it as an alternative approach. It would reduce the hemodynamic instability and perioperative morbidity in a cirrhotic liver.