Caudate lobe tumor resection anatomy and surgical treatment techniques: 22 case reports in one medical center

Background: Caudate surgical resection is considered to be the most effective method and the main indication for treating tumors in the caudate lobe and that is still a challenge for hepatobiliary surgeons. Our objective is to present two new main concepts; one is the fourth porta hepatis, the other is that large caudate lobe tumors could be defined if the size of the tumor is larger than 5cm. Methods: of the 22 patients who underwent caudate lobe tumors resection between January 2013 and December 2016, we performed various surgical approaches for resecting the caudate lobe tumors. Results: There were 12 male, 10 female patients, age ranging between 15 and 74 years. The indications were hepatocellular carcinoma in seven patients, hemangioma in six patients, focal nodular hyperplasia in two patients, cholangiocarcinoma in seven patients. Left-sided approach was performed in one case, right-sided approach in two cases, a combined approach in 17 cases, and anterior approach in one case. There was no death in the postoperative period. Conclusions: Caudate lobe is not only a hepatic segment but can also be defined as an Accessory liver, and it has individual bile duct and blood vessels which we define as a fourth porta hepatis. Caudate lobe Tumor size and location is the main factor that influences the choice of surgical approach.