title: Null-margin mesohepatectomy for centrally located hepatocellular carcinoma in cirrhotic patients.
abstract: OBJECTIVE
  Anatomic mesohepatectomy is often anatomically restricted by the hilar structure and, therefore, difficult to perform with an adequate resection margin. Especially, in the case of a tumor which is in contact without infiltration with the critical intrahepatic vessels, mesohepatectomy has to be performed without a surgical margin.
  
  
  METHODS
  From January 2005 to December 2009, thirty-seven patients with centrally located HCC underwent anatomic mesohepatectomy without resection margin in our hospital. The surgical techniques, clinicopathological characteristics and outcomes were reviewed.
  
  
  RESULTS
  Mean operative time was 210 minutes (range 130 to 310 minutes) and mean intraoperative blood loss was 950 mL (range 150 to 4,500 mL). Mean postoperative hospitalization was 12.6 days (range 10 to 32 days). Postoperative complications were encountered in 37.8% of patients. The 1-, 3-, and 5-year recurrence-free survival rate was 75.1%, 39.3%, 22.5%, respectively, and the 1-, 3- and 5-year overall survival rate was 91.9%, 60.4%, 28.5%, respectively.
  
  
  CONCLUSIONS
  Null-margin mesohepatectomy is an oncologically radical but parenchyma-sparing hepatic resection. In patients with impaired functional liver reserve and with centrally located tumors in contact without infiltration with major vessels, expected zero resection margins should not be considered as a contraindication for surgery, and null-margin mesohepatectomy should be recommended as a reasonable surgical option.
authors.affiliation: Department of General Surgery, Xiang-Ya 2nd Hospital, Central South University, Chang-Sha, Hunan Province, China.
authors.forename: Xiong-Ying
authors.initials: XY
authors.lastname: Miao
authors.forename: Ji-Xiong
authors.initials: JX
authors.lastname: Hu
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Dai
authors.forename: De-Wu
authors.initials: DW
authors.lastname: Zhong
authors.forename: Shou-Zhi
authors.initials: SZ
authors.lastname: Xiong
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology