title: The anterior hanging-approach improves postoperative course after right hepatectomy in patients with colorectal liver metastases. Results of a prospective study with propensity-score matching comparison.
abstract: OBJECTIVE
  To establish the role of the anterior approach with liver hanging maneuver for right hepatectomy in patients with colorectal liver metastases (CRLM).
  
  
  BACKGROUND
  The indications for hepatectomy in patients with CRLM are expanding. The liver remnant must be protected to avoid morbidity.
  
  
  METHODS
  We prospectively enrolled all patients with the diagnosis of CRLM requiring right hepatectomy from 2009 to 2012. In all cases right hepatectomy with an anterior-hanging maneuver approach was attempted. We compared the group of patients who underwent this procedure with a group of patients who had previously undergone a conventional right hepatectomy. To minimize selection bias, propensity score matching was performed, based on baseline patient characteristics.
  
  
  RESULTS
  A right hepatectomy was planned in 57 cases. The anterior-hanging approach was feasible in 85% of cases. Overall morbidity was similar. In-hospital mortality due to hepatic insufficiency was 2.3% in anterior-hanging group compared to 9% in the conventional group (p = 0.30). The incidence of ascites was significantly greater in the conventional group (AH: 18% vs Conv: 54%; p = 0.002), and hospital stay was longer (AH: 10.9 ± 5.7 vs Conv: 14.4 ± 8.1 days; p = 0.05). Bilirubin levels were significantly lower in anterior-hanging group in day 1 and 3. There were no differences on recurrence nor survival.
  
  
  CONCLUSIONS
  The anterior-hanging approach for right hepatectomy in patients with CRLM can be used safely with a high feasibility rate. Its use contributes to improve postoperative course.
authors.affiliation: Department of Surgery, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain. Electronic address: 31513llg@comb.cat.
authors.forename: L
authors.initials: L
authors.lastname: Llado
authors.affiliation: Department of Surgery, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Muñoz
authors.affiliation: Department of Surgery, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Ramos
authors.affiliation: Department of Surgery, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Torras
authors.affiliation: Department of Surgery, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Fabregat
authors.affiliation: Department of Surgery, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rafecas
mesh_terms: D000368:Aged; D001201:Ascites / Q000209:etiology; D001663:Bilirubin / Q000097:blood; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods*; D048550:Hepatic Insufficiency / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000097:blood / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D001663:Bilirubin
keywords: Ascites; Liver surgery; Postoperative complications; Technique