title: Outcomes of central bisectionectomy for hepatocellular carcinoma.
abstract: BACKGROUND
  Central bisectionectomy (resection of Couinaud segments IV, V and VIII) for malignant or benign disease poses a technical challenge to the surgeon but if feasible, has significant benefits in terms of conserving liver volume and options for future intervention. This study reviews a cohort of patients who underwent this procedure; outlines the indications, optimal operative technique as well as both short- and long-term outcomes.
  
  
  METHODS
  A retrospective review of a prospectively maintained database was performed. Pre-operative clinicopathological data, operative details and post-operative outcomes including overall and disease-free survival were analysed.
  
  
  RESULTS
  Between 1989 and 2009, 21 patients underwent a central bisectionectomy. All procedures were performed for hepatocellular carcinoma (HCC). All patients underwent a R0 resection with a median resection margin of 5 mm (1-15 mm). The 1-, 3- and 5-year disease-free survivals were 65%, 34.8% and 34.8%, and the corresponding overall survival rates were 90.5%, 66.8% and 66.8%, respectively.
  
  
  CONCLUSIONS
  These data support the use of a central bisectionectomy in selected cases in the management of HCC. With the use of a meticulous operative technique and adherence to surgical oncological principles, satisfactory long-term outcomes were achievable.
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Gallagher
authors.forename: Albert C Y
authors.initials: AC
authors.lastname: Chan
authors.forename: Ronnie T P
authors.initials: RT
authors.lastname: Poon
authors.forename: Tan To
authors.initials: TT
authors.lastname: Cheung
authors.forename: Kenneth S H
authors.initials: KS
authors.lastname: Chok
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome