Background and Aims: Resection of the caudate lobe is difficult and risky, because of its deep location and complex anatomical structure. Surgical resection of the caudate lobe for hepatocellular carcinoma (HCC) has long been a challenging problem in liver surgery. Therefore, this study was conducted to assess the feasibility and safety of surgical treatment of HCC in the caudate lobe. 
Methods: The clinical data of 51 patients with HCC in the caudate lobe who underwent surgical resection from 2008 to 2018 in Xiangya Hospital of Central South University were retrospectively analyzed.
Results: Operations were all uneventfully completed in the 51 patients. Surgical approaches included the left approach in 8 cases, the right approach in 5 cases, the anterior approach in 10 cases, and the left-right combined approach in 28 cases. The average operative time was (198.4±101.6) min, the time of liver parenchymal transection was 30 (10–118) min, the intraoperative blood loss was 700.8 (240–7 700) mL, and the amount of intraoperative blood transfusion was 602.9 (0–6 500) mL. The incidence rate of postoperative complications was 15.7%, including bile leakage occurred in 4 cases, abdominal fluid collection occurred in 2 cases, hepatic failure occurred in one case, and postoperative bleeding occurred in one case, which were all recovered by symptomatic treatment. No death occurred during perioperative period. The 51 patients were followed up for 2.5 to 68.6 months, the overall recurrence rate was 55.4%, and the 1-, 3-, and 5-year overall survival rates after surgery were 90.5%, 71.2%, and 52.8%, respectively.
Conclusion: By strictly following the indications for surgery, familiarizing with the anatomical characteristics of the caudate lobe, and selecting the best surgical approach, resection of the caudate lobe liver cancer is safe and feasible.