Multicenter study on right Glissonean pedicle management in laparoscopic right hepatectomy: main trunk vs. sectoral...

During laparoscopic right hemihepatectomy (LRH), two principal techniques for right Glissonean pedicle management are employed: sectoral pedicle transection of the right anterior and posterior sectional pedicles, or main trunk transection of the entire pedicle. It remains controversial whether these approaches differ in safety and efficacy. This study was therefore designed to compare the perioperative outcomes of these two techniques to determine if significant differences exist.

This was a multicenter retrospective analysis of 246 patients with hepatocellular carcinoma (HCC) undergoing LRH, with data collected from 8 centers. Outcome measurements were intraoperative blood loss, operative time and postoperative complications, etc. We conducted propensity score matching (PSM) analysis to evaluate perioperative outcomes.

In this study, 90 HCC patients used the sectoral pedicle transection approach, while 156 HCC patients used the main trunk transection approach. 90 patients with well-matched baseline levels were enrolled in each group after 1:1 PSM. The sectoral pedicle transection group had less surgical margin (mean, 11.32 vs. 15.02 mm, P = 0.0024). However, the intraoperative blood loss, operative time, postoperative hospital stays, and overall postoperative complications were comparable between the two groups. Additionally, there was no significant difference in the incidence of biliary strictures or bile leakage between the two groups.

The main trunk and sectoral pedicle transection approach for LRH in HCC patients were both safe and effective when performed by experienced surgeons. In our study, the main trunk transection technique provided the technical advantage of a wider surgical margin. Furthermore, it was not associated with an increased incidence of biliary complications.