Anterior approach for difficult major right hepatectomy

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Liver Transplantation

Background:

• Conventional right hepatectomy for large tumors carries risks of bleeding and cancer cell spillage.
• Injudicious liver mobilization can lead to complications like excessive hemorrhage and prolonged ischemia.

Purpose of the Study:

• To evaluate the safety and efficacy of the "anterior" approach for major right hepatectomy in patients with difficult liver tumors.
• To compare outcomes of the anterior approach with the conventional method for major right hepatectomy.

Main Methods:

• Prospective data from 25 patients undergoing major right hepatectomy via the anterior approach were analyzed.
• The anterior approach involves completing parenchymal transection before mobilizing the right hepatic lobe, with initial hilar control.
• Comparison was made with 34 patients who underwent conventional hepatectomy.

Main Results:

• The anterior approach group had comparable perioperative transfusion and fluid replacement needs despite resecting larger tumors and more extrahepatic structures.
• The anterior approach demonstrated comparable patient outcomes to the conventional method.
• One intraoperative catastrophe occurred in the conventional approach group, contributing to three hospital deaths.

Conclusions:

• The "anterior" approach is a safe and effective alternative for selected patients with complicated major right hepatectomy.
• This technique offers a viable solution for managing large, infiltrating right hepatic tumors.
• The anterior approach may reduce risks associated with conventional hepatectomy for challenging cases.