Assiut university researches
ANTERIOR VERSUS CONVENTIONAL
SURGICAL APPROACH FOR HEPATIC
RESECTION OF LARGE
HEPATOCELLULAR CARCINOMA
Murad A. Jabir , Hisham M Hamza, Gamal Amira .Department of
Surgical oncology, Assiut University, Egypt. Etsuro Hatano , Shinji
Uemoto .Department of Surgery, KYOTO UNIVERSITY, Japan.
Abstract:
Abstract Background Data: Hepatic resection of a large HCC
represents a surgical challenge. In patients with large HCC in
the right liver, the conventional technique for hepatectomy,
i.e., mobilization of the right liver from the retro peritoneum
and anterior surface of the inferior vena cava may be difficult
because of the tumor volume and local adhesions. Likewise,
even if the mobilization can be accomplished, the forceful
manipulation of the liver can result in tumor rupture and
dissemination of malignant disease. Objective: To report the
efficacy of using the anterior approach versus the
conventional approach, in surgical resection for large
hepatocellular carcinoma (HCC) in terms of surgical and longterm outcomes. Methods: Between 2000 and 2006, 126
consecutive patients who underwent hepatic resection with
curative intent for large right HCC ≥7 cm were identified from
a prospective database. The 36 patients who had anterior
approach were compared with the remaining 90 patients who
had conventional approach .Clinicopathological features and
surgical results were analyzed and prognostic factors were
evaluated by multivariate analysis. Results: There was no
significant difference between the 2 groups as regard clinical,
laboratory and pathological parameters. The operative results
had shown a comparable proportion of patients experienced
massive operative blood loss and postoperative
complications in the 2 groups. The AA group had a lower
recurrence rate (P = 0•015), better disease-free survival
(DFS) (P = 0•001) and overall survival than the CA group.
Our study identified that AA is prognostic factor of both
overall survival and disease-free survival for large HCC ≥7cm.
Conclusion: The anterior approach is a safe and effective
technique for right hepatic resection for large HCC and
achieves more advantageous long survival outcome over the
conventional approach.
Published in:
ASSIUT MEDICAL JOURNAL.VOL.(37),No.(2),MAY
2013,VOL.(37),No.(2),75-81