Impact of selective Glisson transection on survival of hepatocellular carcinoma.
OBJECTIVE
The aim of this study is to assess whether selective transection of tumor-bearing portal pedicle before dissection of the liver parenchyma in hepatectomy for hepatocellular carcinoma can prevent intraoperative spread of the tumor and can lead to the prolongation of postoperative survival.


METHODS
Survival for 159 patients who underwent hepatectomies with selective portal transection by Glissonean pedicle transection method was retrospectively compared with that of 100 patients who underwent hepatectomies with Pringle maneuver. According to the number of recurrent tumors, intrahepatic recurrence was divided into two types: nodular type of 3 or less, diffuse type of 4 or more.


RESULTS
The 5-year survival for the patients who underwent hepatectomies with Glissonean pedicle transection method was significantly higher than that with Pringle maneuver (64.7% vs. 36.4%, p < 0.0001, log-rank test). The diffuse type recurrence, which occurred early and resulted in the unfavorable prognosis compared with the nodular type, was significantly reduced in patients treated with Glissonean pedicle transection method compared with those with Pringle maneuver (p = 0.0013). Multivariate analyses demonstrated that Glissonean pedicle transection method was a potent independent prognostic indicator for survival.


CONCLUSIONS
Glissonean pedicle transection method prevented intraoperative metastasis and significantly improved the postoperative survival in patients with hepatocellular carcinoma.
Tsuruta
Koji
K
Department of Surgery, Tokyo Metropolitan Komagome Hospital, First Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan. aq4k-trt@asahi-net.or.jp
Okamoto
Atsutake
A
Toi
Masakazu
M
Saji
Hisashi
H
Takahashi
Toshio
T
D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome