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World Journal of Surgery

, Volume 34, Issue 8, pp 1874–1878 | Cite as

Resection of Large Hepatocellular Carcinoma Using the Combination of Liver Hanging Maneuver and Anterior Approach

  • Chih-Chi Wang
  • Kailash Jawade
  • Anthony Q. Yap
  • Allan M. Concejero
  • Chi-Yin Lin
  • Chao-Long Chen
Article

Abstract

Background

Resection of a large hepatocellular carcinoma (HCC) is difficult and is associated with a poor outcome. Herein we describe our experience with the use of a liver hanging maneuver (LHM) in conjunction with the anterior approach (AA) in patients with large HCC (>10 cm) and compare the perioperative outcome with the conventional method (CM) for hepatic resection.

Methods

Patients who underwent major hepatic resections for large HCC (>10 cm) were categorized as group 1 (n = 14), treated with LHM and AA, versus group 2 (n = 11), treated with CM. Variables including patient age, tumor size, operative time and transection time, blood loss, blood transfusion requirements, and postoperative ICU and hospital stay were used to compare the two groups.

Results

There were 14 and 11 patients in groups 1 and 2, respectively. The variables in group 1 and 2 of median tumor size, median operative time, median transection time, median ICU stay, and median hospital stay were comparable. In contrast, the intraoperative blood loss and the blood transfusion requirements were significantly higher in group 2. Patients under LHM and AA and CM had a median blood loss of 375 ml (237.5–850) and 1,000 ml (500–1,200), requirement of blood transfusion of 3 (21.42%) and 8 (72.7%), respectively. Postoperative complications were comparable in the two groups. There were no deaths in the series.

Conclusions

The liver hanging maneuver in conjunction with AA is a safe and highly feasible procedure, particularly in patients with sizable (>10 cm) tumors and tumors found to be adherent to the diaphragm and retroperitoneum. The use of the procedure eventuated in lower blood loss as well as fewer blood transfusion requirements when compared to the conventional method.

Keywords

Inferior Vena Cava Hepatic Resection Anterior Approach Blood Transfusion Requirement Middle Hepatic Vein 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Lai EC, Fan ST, Lo CM et al (1996) Anterior approach for difficult major hepatectomy. World J Surg 20:314–317CrossRefPubMedGoogle Scholar
  2. 2.
    Belghiti J, Guevara OA, Noun R et al (2001) Liver hanging maneuver: a safe approach to right hepatectomy without live rmobilization. J Am Coll Surg 193:109–111CrossRefPubMedGoogle Scholar
  3. 3.
    Donadon M, Abdalla EK, Vauthey JN (2007) Liver hanging maneuver for large or recurrent right upper quadrant tumors. J Am Coll Surg 204:329–333CrossRefPubMedGoogle Scholar
  4. 4.
    Liu CL, Fan ST, Cheung ST et al (2006) Anterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma: a prospective randomised controlled study. Ann Surg 244:194–203CrossRefPubMedGoogle Scholar
  5. 5.
    Gaujoux S, Douard R, Ettorre GM et al (2007) Liver hanging maneuver: an anatomic and clinical review. Ann Surg 193:488–492CrossRefGoogle Scholar
  6. 6.
    Kokudo N, Sugawara Y, Imamura H et al (2003) Sling suspension of the liver in donor operation: a gradual tape-repositioning technique. Transplantation 76:803–807CrossRefPubMedGoogle Scholar
  7. 7.
    Ogata S, Belghiti J, Varma D et al (2007) Two hundred liver hanging maneuvers for major hepatectomy: a single-center experience. Ann Surg 245:31–35CrossRefPubMedGoogle Scholar
  8. 8.
    Unal A, Pinar Y, Murat Z et al (2007) A new approach to the surgical treatment of parasitic cysts of liver: hepatectomy using the liver hanging maneuver. World J Gastroenterol 13:3864–3867PubMedGoogle Scholar
  9. 9.
    Nanashima A, Simida Y, Abo T et al (2008) Usefulness and application of liver hanging maneuver for anatomical liver resections. World J Surg 32:2070–2076CrossRefPubMedGoogle Scholar
  10. 10.
    Hwang S, Lee SG, Lee YJ et al (2008) Modified liver hanging maneuver to facilitate left hepatectomy and caudate lobe resection for hilar bile duct cancer. J Gastrointest Surg 12:1288–1292CrossRefPubMedGoogle Scholar
  11. 11.
    Ettorre GM, Douard R, Corazza V et al (2007) Anatomical basis of liver hanging maneuver: a clinical and anatomical in vivo study. Am Surg 73:1193–1196PubMedGoogle Scholar
  12. 12.
    Cho YB, Lee KU, Lee HW et al (2007) Outcome of hepatic resection for single large hepatocellular carcinoma. World J Surg 31:795–805CrossRefPubMedGoogle Scholar
  13. 13.
    Kokudo N, Imamura H, Sano K et al (2005) Ultrasonically assisted retrohepatic dissection for a liver hanging maneuver. Ann Surg 242:651–654CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Chih-Chi Wang
    • 1
  • Kailash Jawade
    • 1
  • Anthony Q. Yap
    • 1
  • Allan M. Concejero
    • 1
  • Chi-Yin Lin
    • 2
  • Chao-Long Chen
    • 1
  1. 1.Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical CenterChang Gung University College of MedicineKaohsiungTaiwan
  2. 2.Division of General Surgery, Department of SurgeryPingTung Christian HospitalPing TungTaiwan

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