Anterior Approach for Liver Resection in the Treatment of Large Liver Tumors

Abstract

Background: We compared retrospectively the results of the patients who underwent hemihepatectomy through anterior approach (AHH) with those undergoing conventional hemihepatectomy (HH). Patients and Methods: In 119 patients hemihepatectomy was done, 52 of them were anterior approaches. We used this technique if the tumor size was large or if the tumor seemed to be fragile, and thus a liver mobilization would be very dangerous. We started the operation with dissecting parenchyma from the anterior surface toward hilus without preparation of the hilus. Resection of the liver was performed with the help of CUSA dissector. Results: No patient died following AHH. Two re-operations were performed in the HH group, and 2 patients died. The operation time was not significantly different in both groups. The need for blood transfusion was much less during AHH. The average nursing days were also similar in both groups. However, in those cases in which the operations were performed because of liver malignancies, there were no differences in the survival rate after 32-month follow-up between both groups. Conclusions: AHH can be performed safely. The blood consumption during AHH is significantly lower than during HH. The median survival rate was similar in both groups. Our team suggest the anterior approach for liver resection in those cases when the hilar structures and the hepatic veins cannot be isolated easily.

Anterior vs conventional approach right hepatic resection for large hepatocellular carcinoma: A systematic review and meta-analysis

“…The characteristics of the included studies are shown in Table 1 . Among them, there were three RCTs[ 5 , 6 , 17 ] and thirteen CCTs[ 3 , 5 , 17 - 29 ] including a total of 2297 patients (AA = 1076; CA = 1221). All of the patients in the studies underwent right hepatectomy or extended right hepatectomy.…”

“…All of the patients in the studies underwent right hepatectomy or extended right hepatectomy. Eight studies described simple right hepatectomy[ 5 , 6 , 20 , 23 - 26 , 28 ], while another eight studies detailed a mixture of right hepatectomy for large liver right-lobe tumors[ 3 , 17 - 19 , 21 , 22 , 27 , 29 ].…”

“…Methods for managing missing data and intention to treat right-lobe hepatectomy analyses were generally adequate among the majority of studies. Eleven studies[ 3 , 5 , 18 , 19 , 22 , 23 , 25 - 29 ] mentioned the length of follow-up, and most provided accurate data.…”

“…Intraoperative blood transfusion: Data concerning intraoperative blood transfusion were available in three RCTs[ 5 , 6 , 17 ] and nine CCTs[ 3 , 18 , 20 , 21 , 23 , 26 - 29 ] including 1400 patients who underwent large right-lobe hepatic cancer resection (AA = 659; CA = 741). Meta-analysis using a random-effects model revealed a significant decrease in blood transfusions in the AA group than in the CA group (OR = 0.42; 95%CI: 0.29-0.61; P < 0.00001) (Figure 2C ).…”

Modified hanging manoeuvre facilitates inferior vena cava resection and reconstruction during extended right hepatectomy: A technical case report

“…Due to the conflicting data, Li et al (16) performed a meta-analysis of 807 patients across 2 prospective randomized trials (13,20), plus an additional 6 non-randomized controlled trials (11,12,(21)(22)(23)(24) comparing 444 patients undergoing conventional right hepatectomy to 363 undergoing right hepatectomy via anterior transection. The authors reported that the anterior approach resulted in significant reductions in transfusion rate (35 vs. 57.3%; P<0.01), mortality (1.9 vs. 7.4%; P<0.01) and local recurrence (48.9 vs. 62.9%; P<0.01; odds ratio=0.57; 95% confidence interval: 0.37-0.87).…”