Laparoscopic extrahepatic Glissonian versus hilar dissection approach for major hepatectomy in patients with HCC: a...

During laparoscopic major hepatectomy (LMH) for patients with hepatocellular carcinoma (HCC), an appropriate approach for hepatic hilum treatment is crucial. However, to date, there is still controversy about whether the Glissonian approach or hilar dissection approach is more advantageous for hepatic hilum treatment. Thus, we performed this randomized controlled trial to compare the short- and long-term outcomes between the Glissonian and hilar dissection approaches for LMH.

Between November 2017 and July 2021, 256 HCC patients who initially met the criteria via preoperative evaluation were randomly assigned to this trial. After surgical exploration, 119 patients in the Glissonian group and 121 patients in the hilar dissection group were eventually enrolled in the modified intention-to treat (ITT) principled analysis. Perioperative data and survival outcomes between both groups were recorded and compared, and subgroup analysis was further performed.

The 5-year OS rates and 5-year DFS rates were comparable between the two groups. In addition, postoperative overall complications, including bile duct injury, leakage, and stricture, did not differ between the groups. However, the operative time (P = 0.044) and the hilar dissection time (P < 0.001) were significantly shorter in the Glissonian group than the hilar dissection group. Additionally, for patients with liver cirrhosis, the Glissonian group had shorter operative time (P = 0.002) and less intraoperative blood loss (P = 0.004) than the hilar dissection group.

The Glissonian approach for LMH in selected HCC patients is superior to the hilar dissection approach in short-term outcomes, but the survival outcomes were comparable between both groups.

ChiCTR-IOR-17013077.