Validation of biological and clinical outcome between with and without thoracotomy in liver resection: a matched cohort study.
BACKGROUND
The transthoracic approach in liver resection is a useful option for improving the clearance of and access to the operation field. However, this approach remains controversial due to the threat of increased respiratory complications. The aim of this study was to evaluate the clinical outcomes and biological responses of patients who underwent the transthoracic versus the transabdominal approach in liver resection.


METHODS
This case-matched cohort study included a total of 127 patients who underwent treatment for hepatocellular carcinoma from June 2006 to December 2007 at the Nihon University Itabashi Hospital. Forty-four (34.6%) patients had the transthoracic approach of liver resection, and the patients were matched on three variables: (1) scale of liver resection, (2) perioperative steroid administration, and (3) pathologically proven liver cirrhosis. The patients were divided into two groups according to the transthoracic (n = 36) or transabdominal (n = 36) approaches. Clinical outcomes (including respiratory and overall complications) and biological responses (including acute-phase cytokine production and oxygenation) were compared between the two different approaches.


RESULTS
The preoperative variables were well matched. However, for the transthoracic group relative to the transabdominal group, the median operative time was significantly longer (median = 402 min [range = 236-661] vs. 330 min [range = 178-697], P ≤ 0.001), the ischemia time was shorter (65 min [range = 12-223] vs. 76 min [range = 28-247], P = 0.04), the level of AaDO(2) on POD 1 was higher (66.1 vs. 33.5 Torr, P = 0.04), and the IL-6 level in pleural effusions on POD 2 was higher (21,900 pg/ml [range = 6,020-123,000] vs. 866 pg/ml [range = 389-2,210], P < 0.001). There was no postoperative mortality and no significant difference between groups in overall morbidity (P = 0.81), overall respiratory complications (P = 0.11), atelectasis (P = 0.10), pleural effusion (P = 0.06), pneumonia (P = 1.00), and length of postoperative hospital stay (P = 0.23).


CONCLUSIONS
Because of there was no significant difference between transthoracic and transabdominal approaches. We recommend using the transthoracic approach in liver resection.
Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ohyaguchikami-machi, Itabashi-ku, Tokyo 173-8610, Japan. yamazaki-nmed@umin.ac.jp
Shintaro
S
Yamazaki
Tadatoshi
T
Takayama
Masamichi
M
Moriguchi
Shunji
S
Okada
Yuki
Y
Hayashi
Hisashi
H
Nakayama
Tokio
T
Higaki
Masahiko
M
Sugitani
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000378:metabolism / Q000601:surgery*; D015331:Cohort Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000378:metabolism; D007902:Length of Stay; D008113:Liver Neoplasms / Q000378:metabolism / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000378:metabolism; D013908:Thoracotomy; D016896:Treatment Outcome
D015415:Biomarkers