title: Prognostic influence of the liver hanging maneuver for patients with hepatobiliary malignancies who underwent hepatic resections.
abstract: BACKGROUND
  Prognostic influences of hepatic transection by an anterior approach using the liver hanging maneuver (LHM) has not been fully clarified.
  
  
  METHODS
  We examined 233 patients who underwent major hepatectomy with the LHM (n = 75; hepatocellular carcinoma (HCC) in 35, colorectal liver metastasis (CLM) in 10, intrahepatic cholangiocarcinoma (ICC) in 14 and perihilar bile duct carcinoma (BDC) in 16) or without it (n = 158; HCC in 78, CLM in 21, ICC in 31 and BDC in 28).
  
  
  RESULTS
  In HCC patients, cancer-positive margin rate, blood loss, transection time and prevalence of posthepatectomy ascites in the LHM group were significantly lower than those in the non-LHM group (p < 0.05). In CLM, transection time in the LHM group was significantly lower than that in the non-LHM group (p < 0.05). In BDC patients, amount of blood loss, transection time and prevalence of ascites in the LHM group were significantly lower than those in the non-LHM group (p < 0.05). In CLM patients, tumor recurrence rate in the non-LHM group was significantly higher than that in the LHM group and disease-free survival in the LHM group was significantly better than that in the non-LHM group in CLM patients and, however, this difference was not observed in a large CLM exceeding 5 cm. However, significant differences of posthepatectomy disease-free and overall survivals were not observed in HCC, ICC and BDC patients.
  
  
  CONCLUSIONS
  Although advantages of LHM improving surgical records in major anatomical liver resections were clarified, oncological advantages in the long-term survival of LHM was still uncertain in the hepatobiliary malignancies.
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Electronic address: a-nanasm@nagasaki-u.ac.jp.
authors.forename: A
authors.initials: A
authors.lastname: Nanashima
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Abo
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Arai
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: K
authors.initials: K
authors.lastname: To
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kunizaki
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Hidaka
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Takeshita
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Sawai
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nagayasu
mesh_terms: D000368:Aged; D001201:Ascites / Q000150:complications; D001650:Bile Duct Neoplasms / Q000150:complications / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000150:complications / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D061646:Operative Time; D011379:Prognosis; D016896:Treatment Outcome
keywords: Hepatectomy; Hepatobiliary malignancies; Liver hanging maneuver; Major anatomic resection; Patient prognosis