title: Anterior Versus Conventional Approach for Resection of Large Right Lobe Hepatocellular Carcinoma.
abstract: OBJECTIVE
  In this study, we aim to report the efficacy of using the anterior approach (AA) versus the conventional approach (CA), in surgical resection for large hepatocellular carcinoma (HCC) (≥7 cm) of the right hepatic lobe in terms of surgical and long-term outcomes.
  
  
  METHODS
  Between 2000 and 2006, 138 consecutive patients who underwent hepatic resection with curative intent for large right lobe HCC ≥7 cm were identified from a retrospective database. The 40 patients who had AA were compared with the remaining 98 patients who had CA. Clinicopathological features and surgical results were analyzed and prognostic factors were evaluated by multivariate analysis.
  
  
  RESULTS
  There was no significant difference between the two groups as regards clinical, laboratory, and pathological parameters. The operative results had shown a comparable proportion of patients who experienced massive operative blood loss and postoperative complications in the two groups. The AA group had a lower recurrence rate (P = 0·015), better disease-free survival (DFS) (P = 0·001), and overall survival than the CA group. Our study identified that AA is a prognostic factor of both overall survival and disease-free survival for large HCC ≥7 cm.
  
  
  CONCLUSIONS
  The AA is a safe and effective technique for right hepatic resection for large HCC and achieves more advantageous long survival outcome over the CA.
authors: Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, 71111, Egypt.
authors: Murad A
authors: MA
authors: Jabir
authors: Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, 71111, Egypt.
authors: Hesham M
authors: HM
authors: Hamza
authors: Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, 71111, Egypt. hussein_hozayen@yahoo.com.
authors: Hussein
authors: H
authors: Fakhry
authors: Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.
authors: Gamal
authors: G
authors: Amira
authors: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Etsuro
authors: E
authors: Hatano
authors: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Shinji
authors: S
authors: Uemoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies
keywords: Blood loss, surgical; Carcinoma, hepatocellular; Disease-free survival; Multivariate analysis; Postoperative complications; Retrospective studies