To evaluate the safety and clinical efficacy of resection of caudate lobe tumor via devascularization and reconstruction of right hepatic vein.

Clinical data of a patient who underwent resection of caudate lobe tumor in the First Affiliated Hospital of Xi'an Jiaotong University in November 2017 were retrospectively analyzed. The patient was female, 54-year-old, was diagnosed with hepatocellular carcinoma in the liver caudate lobe before operation. The informed consent of the patient was obtained and the local ethical committee approval was received. Resection of caudate lobe tumor was performed via a new approach, devascularization and reconstruction of the right hepatic vein. The short hepatic vein was treated preferentially. Devascularization of the right hepatic vein was performed, followed by resection of caudate lobe tumors and subsequently the right hepatic vein was reconstructed.

The operation was successfully accomplished. Blood flow of the right lobe and the inferior hepatic vena cava was excluded for 20 min. Total hepatic flow was occluded once for 15 min. The intraoperative blood loss was 800 ml, and 4 U of red blood cell transfusion was performed. Postoperative treatments anti-infection, acid suppression, lowering portal vein pressure, liver protection and nutritional support were routinely delivered. CT scan of the upper abdomen at postoperative 7 d indicated patchy low-density shadows in the right lobe near the hepatic porta, no expansion of the portal vein and intrahepatic bile duct, and a slight pneumatosis and hydrops in the gallbladder fossa. Pathological examination showed a bulky moderately-differentiated hepatocellular carcinoma combined with local cystic lesions. The patient recovered well and discharged at postoperative 15 d.

Compared with the conventional caudate lobectomy, devascularization and reconstruction of the right hepatic vein is a novel approach for caudate lobectomy with slighter trauma and less bleeding, which is suitable for the resection of caudate lobe tumor involving the vena cava and caudate process.