title: Mesohepatectomy for centrally located hepatocellular carcinoma: an appraisal of a rare procedure.
abstract: BACKGROUND
  For centrally located hepatocellular carcinoma (HCC), extended major hepatectomy is usually recommended, but the risk of postoperative liver failure is high when liver function is not sound. Mesohepatectomy (en bloc resection of Goldsmith and Woodburne's left medial and right anterior segments or Couinaud's segments IV, V, and VIII) is a rare procedure, so its role in treating HCC is unclear.
  
  
  METHODS
  We retrospectively reviewed 364 patients who underwent a curative resection for HCC. Among them, 15 patients were treated by mesohepatectomy. Their nontumorous liver revealed cirrhosis in 11 and chronic hepatitis in 4. The mean tumor diameter was 12.8 cm. In 10 of the 15 patients, HCC also invaded adjacent organs. The operative results of another 25 patients with different disease extent who underwent extended major hepatectomy were compared.
  
  
  RESULTS
  The hepatic inflow occlusion time for mesohepatectomy was longer than for extended hepatectomy (p = 0.01). The mean operative blood loss, amount of blood transfusion, operating time, and postoperative hospital stay in the mesohepatectomy group were 2,450 mL, 1,100 mL, 7.9 hours, and 14.9 days, respectively. In the extended-hepatectomy group, the values were 1,863mL, 768mL, 5.8 hours, and 16.8 days, respectively (all p>0.05 compared with mesohepatectomy). No patient died after mesohepatectomy, but after extended hepatectomy there was one death from liver failure. The Union Internationale contre le cancer (UICC) TNM stages of patients who underwent mesohepatectomy were as follows: stage II in 1, stage III in 4, and stage IVA in 10. All patients who underwent extended hepatectomy presented with stage IVA disease. The 6-year disease-free and actuarial survival rates after mesohepatectomy were 21% and 30%, respectively. The 6-year disease-free survival rate after extended hepatectomy was 9% (p = 0.11 compared with mesohepatectomy).
  
  
  CONCLUSIONS
  Although mesohepatectomy is time-consuming, it is justified for selected patients with centrally located large HCC in a diseased liver.
authors.affiliation: Department of Surgery, Taichung Veterans General Hospital, Chung-Shan Medical College, Taiwan.
authors.forename: C C
authors.initials: CC
authors.lastname: Wu
authors.forename: W L
authors.initials: WL
authors.lastname: Ho
authors.forename: J T
authors.initials: JT
authors.lastname: Chen
authors.forename: C S
authors.initials: CS
authors.lastname: Tang
authors.forename: D C
authors.initials: DC
authors.lastname: Yeh
authors.forename: T J
authors.initials: TJ
authors.lastname: Liu
authors.forename: F K
authors.initials: FK
authors.lastname: P'eng
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate