An isolated resection of the entire caudate lobe, including the paracaval portion, was performed in a 68-year-old man with hepatocellular carcinoma complicated by chronic hepatitis. Precise resection of the paracaval portion, which surrounds the right side of the inferior vena cava, is difficult because of its deep location and the lack of superficial landmarks indicating its margins. Using a counterstaining technique 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 sacrificing the other part of the liver. The whole procedure was performed without blood transfusion, and the postoperative course of the patient was uneventful. This procedure would add a new option for surgical management of hepatic malignancies originating in the caudate lobe of the compromised liver.
(Arch Surg. 1994;129:280-284)