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Safe hepatectomy for the paracaval portion of the caudate lobe is technically demanding. We propose central hepatectomy using the hilar approach for resection of the paracaval portion.The right liver with the caudate lobe was totally mobilized from the inferior vena cava. Central hepatectomy with or without middle hepatic vein (MHV) resection was performed by dividing the right anterior and left medial sections vertically toward the inferior vena cava. The bilateral Glissonian pedicles were widely exposed (hilar approach), and the liver parenchyma including the paracaval portion of the liver was removed with a good surgical view.This procedure was performed in four patients with hepatocellular carcinoma, one patient with intrahepatic cholangiocarcinoma, and one patient with colorectal liver metastasis. Combined resection of the MHV was performed in four patients, and removal of the tumor thrombus in the bile duct was performed in one patient. The median operation time was 439 minutes, and the median blood loss was 800 ml. The resected liver parenchyma was12.0% (range, 4.7%–39.5%) of the total liver volume. No patients developed postoperative liver failure. Central hepatectomy using the hilar approach is a safe, parenchyma-preserving surgical procedure for removal of tumors located in the paracaval portion.

Central Hepatectomy Using the Hilar Approach for Removal of Tumors in the Paracaval Portion of the Caudate Lobe