title: Right hepatectomy by the anterior method with liver hanging versus conventional approach for large hepatocellular carcinomas.
abstract: BACKGROUND
  The aim was to compare short-term results of right hepatectomy using the anterior approach (AA) and liver hanging manoeuvre with the conventional approach (CA) for large hepatocellular carcinoma (HCC).
  
  
  METHODS
  This was a retrospective review of 71 consecutive patients with HCC at least 5 cm in diameter who underwent curative right hepatectomy using either the AA with the liver hanging manoeuvre (33) or the CA (38) between January 2004 and December 2008. Clinical data, operative results and survival outcomes were analysed.
  
  
  RESULTS
  The groups had similar clinical, laboratory and pathological parameters. The AA group had larger tumours than the CA group (P = 0.039), but comparable grade and stage distribution. The operative results were similar except for an increased blood transfusion requirement with the conventional procedure (P = 0.001). The AA group had a lower recurrence rate (P = 0.003) and better disease-free survival (DFS) (P = 0.001) than the CA group, but overall survival rates were not significantly different (P = 0.091). Presence of tumour encapsulation, absence of tumour microvascular invasion and AA were predictive of DFS, whereas tumour stage was the only independent predictor of overall survival.
  
  
  CONCLUSIONS
  The AA right hepatectomy with liver hanging manoeuvre for large HCC is associated with reduced blood transfusion requirement and lower recurrence rates in the short term.
authors.affiliation: Division of Transplantation and Liver Surgery, Department of General Surgery, Chang Gung Memorial Hospital Linkou Medical Centre, Chang Gung University Medical School, Taoyuan, Taiwan.
authors.forename: T-J
authors.initials: TJ
authors.lastname: Wu
authors.forename: F
authors.initials: F
authors.lastname: Wang
authors.forename: Y-S
authors.initials: YS
authors.lastname: Lin
authors.forename: K-M
authors.initials: KM
authors.lastname: Chan
authors.forename: M-C
authors.initials: MC
authors.lastname: Yu
authors.forename: W-C
authors.initials: WC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor