title: The role of median sternotomy in resections for large hepatocellular carcinomas.
abstract: BACKGROUND
  The aim of this study was to identify the role of median sternotomy in the hepatic resection of large hepatocellular carcinomas (HCCs).
  
  
  METHODS
  From 1992 to 2002, 26 patients who underwent hepatectomy for large HCCs greater than 10 cm in diameter were divided into 2 groups according to the type of incision performed: with median sternotomy (10 patients) or without median sternotomy (16 patients).
  
  
  RESULTS
  Median sternotomy was performed for 3 patients with tumor thrombus extending into the right atrium and for 7 patients with inadequate exposure of the hepatic veins and suprahepatic vena cava. In these 7 cases, the tumors were located mainly at the upper part of the right lobe in 4 patients and the upper part of the left lobe in 3 patients. Median sternotomy was performed in 6 of 7 patients whose tumor was located in segments 2, 4, 7, and 8, and was greater than 16 cm. No significant differences were found in the intraoperative parameters of blood transfusion, ischemic time, area of the cut surface, and operation time.
  
  
  CONCLUSIONS
  Median sternotomy may be suitable for use as an approach for large HCCs greater than 16 cm, which are located at the upper part of the liver.
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City Graduate University, School of Medicine, 3-9 Fukuura Kanazawaku, 236-0004 Yokohama City, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Nagano
authors.forename: Shinji
authors.initials: S
authors.lastname: Togo
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Sugita
authors.forename: Daisuke
authors.initials: D
authors.lastname: Morioka
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sekido
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D016896:Treatment Outcome