Prospective comparative study between anterior approach and conventional approach right formal hepatic resection for large hepatocellular carcinom

Abstract

Background: A study is carried out to assess the possible advantages of operative and postoperative outcomes ofthe anterior approach (AA) over the conventional approach (CA) in major right hepatectomy for large hepatocellularcarcinoma (HCC).Patients and Methods: A prospective randomized controlled study was performed on 50 patients who had a large (≥5cm) right lobe of the liver HCC and underwent curative right formal hepatectomy during a 28-month period. The patientswere randomized to undergo resection of the tumor using the anterior approach technique (AA group, n=25) or theconventional approach technique (CA group, n=25). The CA involves initial complete mobilization of the right liverfollowed by extrahepatic vascular control then hepatic parenchymatous dissection is performed. AA consists of initialvascular inflow control and parenchymal transection before mobilization of the right lobe.Results: There was no significant difference between the two groups as regards clinical, laboratory, and pathologicalparameters. The operative results showed a significant blood loss in the CA group in comparison to the AA group. TheAA group had better disease-free survival and overall survival than the CA group.Conclusion: The anterior approach is the recommended technique for right formal hepatectomy for large HCC as itresults in improved operative and survival outcomes of the patients.