AN ISOLATED, COMPLETE RESECTION OF THE CAUDATE LOBE, INCLUDING THE PARACAVAL PORTION, FOR HEPATOCELLULAR-CARCINOMA

An isolated resection of the entire caudate lobe, including the paraca val portion, was performed in a 68-year-old man with hepatocellular ca rcinoma complicated by chronic hepatitis. Precise resection of the par acaval portion, which surrounds the right side of the inferior vena ca va, is difficult because of its deep location and the lack of superfic ial landmarks indicating its margins. Using a counterstaining techniqu e to define the right margin and the transhepatic anterior approach to access the ventral border, the paracaval portion, with the spigelian lobe and the caudate process, was completely resected without sacrific ing the other part of the liver. The whole procedure was performed wit hout blood transfusion, and the postoperative course of the patient wa s uneventful. This procedure would add a new option for surgical manag ement of hepatic malignancies originating in the caudate lobe of the c ompromised liver.