Impact of Glissonean Pedicle Approach for Centrally Located Hepatocellular Carcinoma in Mongolia

Abstract

Approaches to surgical resection of centrally located HCC remain controversial. Traditionally, hemi- or extended hepatectomy is suggested. However, it carries a high risk of postoperative complications in patients with cirrhosis. An alternative approach is Glissonean pedicle transection method. This study was conducted to assess the surgical and survival outcomes associated with central liver resection using the Glissonean pedicle transection. Sixty-nine patients with centrally located HCC were studied retrospectively. They were divided into conventional approach group with hemi- or extended hepatectomy, and Glissonean approach group with multisegmental central liver resection using the Glissonean pedicle transection. Glissonean pedicle transection method has comparable or superior surgical and survival outcomes to conventional hemi- or extended hepatectomy with regard to intraoperative bleeding, complications, hospital stay, and postoperative mortality and survival outcomes in patients with centrally located HCC. The 1-, 3-, and 5-year overall survival rates of the conventional approach group were 74%, 64%, and 55% respectively. For the Glissonean approach group, the 1 and 3-year overall survival rates were 86% and 61%, respectively. Glissonean pedicle transection method is a safe and effective surgical procedure in patients with centrally located HCC.

Updates and Critical Insights on Glissonian Approach in Liver Surgery

“…16 Mongolia et al reported that the Glissonian pedicle approach had comparable surgical and long-term survival outcomes versus conventional liver resection. 27 Similarly, in a prospective randomized trial, Figueras et al compared hilar dissection versus the Glissonian approach among patients undergoing a major hepatectomy. 15 Although en bloc transection of the Glisson's pedicle was faster than isolated ligation of each element in the hilar pedicle, the duration of pedicle clamping was shorter with hilar dissection, probably due to an initial period of Pringle maneuver applied for introduction of the stapler with the Glissonian approach.…”

The outcomes of central hepatectomy versus extended hepatectomy: a systematic review and meta-analysis

“…8,14,15,[17][18][19][27][28][29] The remaining nine were comparative studies comparing CH to either EH and/or hemihepatectomy. 6,[11][12][13]16,22,25,30,31 Of these, one compared CH with hemihepatectomies, four compared CH to combined EH and hemihepatectomies and five evaluated CH versus EH. The five comparative studies comparing CH with EH included 432 patients who underwent CH and 598 who underwent EH (left/ right).…”

“…Eight papers studied HCC patients only, all of which were from East Asia. 6,15,17,18,22,25,30,31 One study only specified the number of patients with primary or secondary liver tumours with no description of malignancy type. 27 The overall main indication was HCC comprising 85% (n = 1147) of patients, followed by CLM (n = 118 (8.8%)).…”

“…6,8,11,13,[15][16][17][18][19]22,25,27,28,30 The median intraoperative blood loss ranged from 400 to 2263 mL. 15 studies 6,8,[12][13][14][15][16][17]22,25,[27][28][29][30][31] reported intraoperative blood transfusion requirements and the median amount transfused ranged from 2 to 2.2 units and 345-820 mL 318/1009 (32%) patients who underwent CH required intraoperative transfusion. Pringle manoeuvre was commonly used amongst publications followed by hemihepatic inflow occlusion.…”

“…right anterior and left medial sections) with or without resection of segment 1 (caudate lobe). It is also known in the literature as mesohepatectomy, 5,6,8,9,[13][14][15][16] central bisectionectomy, 17,18 central bisegmentectomy 19,20 and central hepatic resection, 21,22 however there is currently no definition of this procedure in the Brisbane 2000 Nomenclature of Hepatic Anatomy and Liver Resections by the International Hepatopancreaticobiliary Association (IHPBA). 23,24 CH has been performed for CLLT including hepatocellular carcinoma (HCC), colorectal liver metastases (CLM) and cholangiocarcinoma (CCA).…”