Right Hemihepatectomy Using an Anterior Approach Technique for a Hepatocellular Carcinoma >10 cm in Size

Kim, Tae Hwan; Lee, Sung Gyu; Song, Gi Won; Hwang, Shin; Kim, Ki Hun; Ahn, Chul Soo; Moon, Deok Bog; Ha, Tae Yong; Jung, Dong Hwan

Abstract

PURPOSE: This study was conducted to evaluate the technical feasibility and the impact on survival of the anterior approach technique for resecting a huge hepatocelluar carcinoma (HCC) as compared with the conventional approach technique.
METHODS
We performed a retrospective observational study on 57 patients who underwent right hemihepatectomy for a huge HCC over than 10cm in diameter. A total of 57 patients were divided into two groups; the anterior approach technique group (AA group, n=23) and the conventional approach group (CA group, n=34). The overall perioperative data was collected and analyzed. The post-hepatectomy liver function, the operative mortality and morbidity and the survival outcome were compared between the two groups.
RESULTS
The post-hepatectomy liver function profile was not significantly different between the two groups. The operative mortality and morbidity were comparable in both groups. The transfusion requirement was not significantly different in both groups (p=0.470), but the cases without transfusion were more common in the AA group (p=0.046). The tumor with an advanced stage (UICC stage III/IV) was significantly more frequent in the AA group (p=0.014). The overall patient survival and disease-free survival was not significantly different between the two groups despite of the difference of the disease stage between the 2 groups (p=0.050, p=0.822). Pulmonary metastasis was more common in the CA group (p=0.035).
CONCLUSIONS
Despite of the advanced disease state, the anterior approach technique resulted in comparable operative and survival outcomes as compared with the outcomes of the conventional approach technique. In terms of the technical feasibility, the anterior approach technique may reduce the required amount of transfusion when performing hepatectomy for a huge HCC.