Anterior approach for right hepatectomy with hanging maneuver for hepatocellular carcinoma: a multi-institutional propensity score-matching study

作者：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

来源：Journal of Hepato-Biliary-Pancreatic Sciences, 2017, 24(3): 127-136.

DOI：10.1002/jhbp.431

• Anterior approach
• Hepatectomy
• Hepatocellular carcinoma
• Liver hanging maneuver
• Propensity score

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.

• 出版日期2017-3