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Kim et al. Hepatoma Res 2021;7:31 https://dx.doi.org/10.20517/2394-5079.2021.09 Page 5 of 7

based on the premise that this procedure would be performed by experienced surgeons in laparoscopic liver
resection who have profound anatomical knowledge [18-24,29,39] .

[5]
The oncologic outcomes of HCC of the caudate lobe have been controversial. Takayasu et al. reported that
HCC in the caudate lobe readily develops intrahepatic metastases because of the frequent portal and/or
venous infiltration found due to its anatomical characteristics and according to a study by Tanaka et al. ,
[6]
the patients with caudate lobe HCC showed significantly more intrahepatic recurrence and poorer survival
rate compared to the patients with HCC in other lobes. On the contrary, others reported that the survival
rates of patients with caudate lobe HCC were not different. Other factors such as vascular invasion, satellite
nodules, tumor size, tumor marker and severe fibrosis have been shown to impact survival irrespective of
tumor location [40-42] . Only a few studies with limited case numbers have reported oncologic outcome of
laparoscopic isolated caudate lobectomy for HCC, and thus it is difficult to make any conclusions regarding
the oncologic safety, but negative resection margin rates are acceptable [19,21,29] . Long term oncologic safety
will need to be confirmed with further studies including a large cohorts with longer follow up data.

CONCLUSIONS
Laparoscopic caudate lobectomy is a technically challenging surgery that requires in-depth knowledge of the
anatomy of the caudate and extensive experience in laparoscopic liver surgery to perform it safely. However,
laparoscopic approach for caudate lesions has advantages that are uniquely beneficial compared to open
surgery. The typical caudal view seen in laparoscopic surgery and the magnified view on high-definition
screen provide precision surgery necessary while the small size of resected specimen only requires a small
incision, maximizing the benefit of minimal invasive approach. For these reasons, laparoscopic approach is
an exceptionally favorable method of approach for isolated caudate lobectomy and worth an aggressive
approach, especially for surgeons with relatively large experience in laparoscopic liver surgery.

DECLARATIONS
Authors’ contributions
Researched public database and wrote manuscript: Kim TS, Kwon CHD
Designed, edited and approved manuscript: Kwon CHD

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2021.