Routine anterior approach during right hepatectomy: results of a prospective randomised controlled trial

A prospective randomised controlled trial was designed to evaluate the advantages of routine application of the anterior approach during right hepatectomy.

The study was conducted between March 2005 and April 2009 in a tertiary hepatobiliary-pancreatic centre. Patients scheduled for right hepatectomy for primary or metastatic tumours, without infiltration of segment 1, inferior vena cava or main bile duct, were randomly assigned to right hepatectomy using either an anterior or a classic approach. The primary study endpoint was overall blood loss.

Sixty-six patients were randomly allocated to undergo right hepatectomy with an anterior (AA group n=33) or a classic approach (CA group n=33). Sixty-five patients were included in the analysis (33 in AA group and 32 in CA group). There was no significant difference in patient age, diagnosis, preoperative hepatic biochemistry and tumour size between the two groups. Overall blood loss (437 ml ± 664 in AA group vs.500 ml ± 532.3 in CA group; p=0.960) and bleeding during transection (p=0.973) were similar between two groups. Perioperative blood transfusion rates were 18% in the AA group and 9.3 % in the CA group (p=0.253). Time of parenchymal transsection was significantly longer in AA group (75.1 ± 26.6 min vs. 56.7 ± 17.5 min, p=0.01). There was no difference between both groups for postoperative prothrombin time, serum transaminase and total bilirubin levels. One patient died in each group (p=0.746). The two groups had similar morbidity rates.

Routine application of the anterior approach during right hepatectomy does not decrease intraoperative blood loss and morbidity rate.