Anterior approach for right hepatectomy with hanging maneuver for hepatocellular carcinoma: a multi‐institutional propensity score‐matching study. (10th March 2017)

• Record Type: Journal Article
• Authors: Beppu, Toru; Imai, Katsunori; Okuda, Koji; Eguchi, Susumu; Kitahara, Kenji; Taniai, Nobuhiko; Ueno, Shinichi; Shirabe, Ken; Ohta, Masayuki; Kondo, Kazuhiro; Nanashima, Atsushi; Noritomi, Tomoaki; Shiraishi, Masayuki; Takami, Yuko; Okamoto, Kohji; Kikuchi, Ken; Baba, Hideo; Fujioka, Hikaru
• Is Part Of: Journal of hepato-biliary-pancreatic sciences. Volume 24:Number 3(2017)
• Page Start: 127
• Page End: 136
• Publication Date: 2017-03-10
• Subjects: Anterior approach -- Hepatectomy -- Hepatocellular carcinoma -- Liver hanging maneuver -- Propensity score; Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 617.556
• DOI: 10.1002/jhbp.431
• Languages: English
• ISSNs: 1868-6974

Abstract

Abstract: Background: This multi‐institutional study aimed to assess the benefits of anterior approach for right hepatectomy with hanging maneuver (ARH‐HM) for hepatocellular carcinoma (HCC) compared with conventional right hepatectomy (CRH). Methods: From January 2000 to December 2012, 306 patients with HCC ≥5 cm were divided into two groups: ARH‐HM ( n = 104) and CRH ( n = 202). Results: After one‐to‐one propensity score‐matched analysis, 72 ARH‐HM and 72 CRH patients presented comparable background factors. Patients in the ARH‐HM group demonstrated significantly less intraoperative blood loss (480 vs. 1, 242 g, P < 0.001) and a lower frequency of red cell concentrate transfusion (21.1% vs. 50.7%, P < 0.001) compared with patients in the CRH group. The 5‐year overall survival rate was significantly better in the ARH‐HM group compared with the CRH group (50.2% vs. 31.4%, P = 0.021). Limited to patients with HCC ≥10 cm, recurrence‐free and overall survival of the ARH‐HM group was significantly greater than those of the CRH group. Conclusion: In comparison with CRH, ARH‐HM for large HCC can provide better overall survival rates with a decrease in intraoperative blood loss and transfusion rates. Survival impact was evident especially in patients with HCC ≥10 cm. Abstract : Highlight Beppu and colleagues assessed the benefits of the anterior approach with hanging maneuver compared with the conventional approach for right hepatectomy using precise propensity‐score matching. In large hepatocellular carcinoma, in particular, the anterior approach with hanging maneuver provided excellent overall survival rates with lower intraoperative blood loss and transfusion rates.