Surgical Strategy for Resecting Hepatocellular Carcinoma in the Caudate Lobe: Isolated or Combined Lobectomy? A Single-Center Study and Meta-Analysis

Abstract

Background

Resection of hepatocellular carcinoma (HCC) originating in the caudate lobe remains challenging, while the optimal extent of resection is debated. We aimed to evaluate the relative benefits of combined caudate lobectomy (CCL) versus isolated caudate lobectomy (ICL) for caudate HCC.

Methods

Patients who underwent curative-intent resection for caudate HCC between January 2010 and December 2018 were identified from a single-center database. Surgical outcomes of the two strategy groups were analyzed before and after propensity score matching. A systematic review with meta-analysis was also performed to compare outcomes of CCL versus ICL for caudate HCC.

Results

A total of 28 patients were included: 11 in the CCL and 17 in the ICL group. Compared with ICL, the CCL group contained patients with larger tumors and a higher incidence of vascular invasion. After propensity score matching, 6 pairs of patients were selected. In the well-matched cohort, CCL demonstrated significantly improved recurrence-free survival (RFS) (P = 0.047) compared with ICL; no significant differences were noted for overall survival (OS), operation time, blood loss and morbidity rate. A total of 227 patients from nine eligible studies and ours were involved in the systematic review. Meta-analysis revealed that CCL provided better RFS (hazard ratio 0.54, 95% confidence interval 0.31–0.92) than ICL; no significant differences were observed in OS, operation time, blood loss and morbidity rate.

Conclusion

CCL confers superior RFS over ICL without compromise of perioperative outcomes and should be prioritized for patients with caudate HCC when feasible, especially for those with large-sized tumors.

Graphical Abstract

Keywords:

• hepatocellular carcinoma
• caudate lobe
• surgery
• outcomes
• meta-analysis

Abbreviations

HCC, hepatocellular carcinoma, IVC, inferior vena cava; ICL, isolated caudate lobectomy; CCL, combined caudate lobectomy; AFP, alpha-fetoprotein; OS, overall survival; RFS, recurrence-free survival; NOS, Newcastle-Ottawa scale; PSM, propensity score matching; HR, hazard ratio; CI, confidence interval; WMD, weighted mean difference; RD, risk difference.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author, Ke Wang, upon reasonable request.

Ethics Approval and Informed Consent

This study protocol was approved by the Institution Review Board of First Affiliated Hospital of Nanjing Medical University and in accordance with the Declaration of Helsinki. Written informed consent was waived because retrospective anonymous data were analyzed.

Disclosure

The authors declare no potential conflicts of interest in this work.

Additional information

Funding

This study was supported by Key Program of the National Natural Science Foundation of China (31930020), National Natural Science Foundation of China (82102150) and Natural Science Foundation of Jiangsu Province (BK20210968).