title: Comparison of outcome of hepatectomy with thoraco-abdominal or abdominal approach.
abstract: OBJECTIVE
  Thoraco-abdominal approach is a suitable choice for hepatectomy to secure good view for mobilization. The aim of this study was to assess efficacy of thoraco-abdominal approach (TAA) for hepatectomy.
  
  
  METHODS
  There were compared clinicopathological data, surgical results and postoperative complications of 425 consecutive patients who underwent hepatectomy via abdominal (AA) (n = 147) or TAA (n = 278).
  
  
  RESULTS
  Blood loss and operating time were significantly higher in TAA than AA group (970 vs. 830 ml and 408 vs. 372 min.) (p < 0.05). Prevalence of pleural effusion was significantly higher in TAA than AA group (24 vs. 9%) (p < 0.01). However, proportions of patients who developed hepatic complications such as biloma (14 vs. 23%), and wound infection (8 vs.25%) were significantly less in TAA than AA group (p < 0.05). Hospital stay after hepatectomy and mortality were similar between both groups. Presence of chronic viral hepatitis, lower platelet count, higher level of serum hyaluronic acid, larger blood loss and TAA correlated significantly with thoracic complications (p < 0.05). Multivariate analysis showed that increased blood loss (p = 0.011), but not TAA, was a significant determinant of thoracic complications (p = 0.08).
  
  
  CONCLUSIONS
  TAA can be considered a relatively safe approach for hepatectomy with minimal abdominal complications nevertheless of frequent pleural effusion.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. a-nanasm@net.nagasaki-u.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.forename: Syuuichi
authors.initials: S
authors.lastname: Tobinaga
authors.forename: Takafumi
authors.initials: T
authors.lastname: Abo
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takeshita
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Hidaka
authors.forename: Terumitsu
authors.initials: T
authors.lastname: Sawai
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012372:ROC Curve; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods