Purpose: Most liver surgeons perform a right hepatic resection
for a hepatocellular carcinoma (HCC) for the complete
mobilization of the right lobe of liver, via the conventional
approach, prior to a parenchymal transection. However, in
selected p...
Purpose: Most liver surgeons perform a right hepatic resection
for a hepatocellular carcinoma (HCC) for the complete
mobilization of the right lobe of liver, via the conventional
approach, prior to a parenchymal transection. However, in
selected patients, with a massive hepatoma that has invaded
to the diaphragm, the conventional mobilization of the liver
prior to a parenchymal transection may be very difficult and
result in excessive bleeding. The feasibility of an ‘anterior
approach’ was evaluated by analyzing of the clinical result
of the surgical treatment for a massive hepatoma with diaphragmatic
invasion.
Methods: Between November, 2001 and November, 2002,
six patients underwent a major right hepatic resection, using
an anterior approach, for a HCC that had invaded or was
adhered to the diaphragm, preventing the easy mobilization
of the right lobe of the liver.
Results: There was no hospital mortality among six patients.
A massive transfusion, followed by massive bleeding, was
performed in four patients, but no post-operative liver failure
occurred.
Conclusion: These cases, performed via an anterior approach,
had massive bleeding, but no hospital mortality or postoperative
liver failure was observed. If the patients had
undergone the procedure via the conventional approach,much more bleeding would have been expected. An ‘anterior
approach' is a safe and effective option in selected patients
with a massive hepatoma and diaphragmatic invasion.