Cholangiocellular carcinoma--the role of caudate lobe
resection and mesohepatectomy.
Shape of caudate lobe
is variable as also its anterior and upper margin.
According to Kumon's nomenclature , the caudate lobe
consists of 3 portions: the Spiegel lobe (i.e., Couinaud's segment I), the paracaval portion (i.e., Couinaud's segment IX ), and the caudate process.
Results of the CT scan showed progressive hypertrophy of the caudate lobe
which measures 12cm in diameter.
Three ultrasound parameters which include liver surface nodularity, caudate lobe
hypertrophy and pattern of hepatic venous flow can be evaluated and compared with histological results obtained after liver biopsy for diagnosis of severe liver fibrosis/cirrhosis6.
After establishing the resectability of the colonic lesion, an extended right hepatectomy sparing segment VI was performed (segments V, VII, VIII, IV B & cranial half of caudate lobe
) (Figure 2).
After the portal vein was tied and divided, an enlarged lymph node, measuring 2 x 2 x 1.5 cm, was seen between the retroportal caudate lobe
and the vena cava.
forms the 1st segment according to this classification, but has distinctive features from other 7 segments.
Dissected right gastric artery (12); common hepatic duct (HD); cystic duct (CD); caudate lobe
(CL); pyloric region (RP); duodenal bulb (*).
Before surgery he had inferior vena caval and right atrial pressure checked to rule out any compression by the caudate lobe
Further evaluation with magnetic resonance imaging (MRI) of the abdomen demonstrated a huge tumor of 14.7x11.6x15.3cm in right lobe, multiple intrahepatic calculi located within the left billiary tree, and atrophy of the left lobe with compensatory hyperplasia of caudate lobe
A 3cm x 3cm portion of diaphragm was incised and dissection was carried down around the liver and the adrenal mass was excised from the caudate lobe
. The cancer was noted to be invading the wall of the IVC, and therefore, a vascular surgeon was consulted to assist in completion of the resection.