title: Unroofing hepatectomy: a facilitating approach for resection of deep-seated hepatocellular carcinoma adjacent to major intrahepatic vessels in cirrhotic patients.
abstract: OBJECTIVE
  Unroofing hepatectomy, an alternative approach to remove a deep-seated hepatocellular carcinoma (HCC) adjacent to major intrahepatic vessels by peel-off technique after sacrificing the overlying noncancerous liver, may result in tumor exposure without resection margin. The aim of the study was to examine the value of this approach in cirrhotic patients.
  
  
  METHODS
  Between 1998 and 2012, 51 cirrhotic patients underwent unroofing hepatectomy for deep-seated newly-diagnosed HCC adjacent to major intrahepatic vessels (group A). Another 274 cirrhotic patients with similar tumor size and without gross major vessel involvement in the same period were selected as the control cohort (group B). The patients' clinicopathological characteristics, the early and long-term outcomes of the two groups were compared.
  
  
  RESULTS
  The HCCs in group A had a significantly higher rate of tumor encapsulation, smaller number of associated satellite nodules, and smaller amount of resected liver weight. Postoperative complication and 90-day mortality rates were similar, but group A patients had a significant better 5-year disease-free (56% vs. 32%, P = 0.011) and overall survival rates (82% vs. 53%, P = 0.008).
  
  
  CONCLUSIONS
  In selected cirrhotic patients, unroofing hepatectomy facilitates resection of deep-seated HCC adjacent to major intrahepatic vessels with acceptable early and long-term results.
authors.affiliation: Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Surgery, Chung-Shan Medical University, Taichung, Taiwan; Department of Surgery, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Surgery, Taipei Medical University, Taipei, Taiwan.
authors.forename: Cheng-Chung
authors.initials: CC
authors.lastname: Wu
authors.forename: Ching-Hui
authors.initials: CH
authors.lastname: Shen
authors.forename: Hsiao-Tien
authors.initials: HT
authors.lastname: Liu
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Lai
authors.forename: Shao-Bin
authors.initials: SB
authors.lastname: Cheng
authors.forename: Cheng-Chan
authors.initials: CC
authors.lastname: Yu
authors.forename: John
authors.initials: J
authors.lastname: Wang
authors.forename: Dah-Cherng
authors.initials: DC
authors.lastname: Yeh
authors.forename: Fang-Ku
authors.initials: FK
authors.lastname: P'eng
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D015331:Cohort Studies; D018572:Disease-Free Survival; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000098:blood supply; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D013624:Taiwan / Q000453:epidemiology
keywords: deep-seated hepatocellular carcinoma; liver cirrhosis; unroofing hepatectomy