title: Anterior approach to improve the long-term outcome in patients with large-size hepatocellular carcinoma having liver resection.
abstract: OBJECTIVE
  A prospective study was conducted to investigate the effect of anterior approach for hepatectomy on long-term outcome of HCC patients with different tumor size.
  
  
  METHODS
  Long-term outcomes were investigated between patients with different tumor size underwent liver resection by either anterior or conventional approach (i.e., AA or CA group).
  
  
  RESULTS
  The recurrence rate in AA group was much lower than that in CA group (52.4% vs.73.1%, P = 0.001). The survival rate in AA group was much higher than that in CA group (60.0% vs. 38.0%, P < 0.001). Furthermore, the differences in recurrence and survival rates in patients with large-size tumor (>5 cm) between AA and CA groups were significant (80.0% vs. 54.7%, P = 0.002; 25.0% vs. 54.2%, P = 0.001, respectively), whereas the differences in tumor recurrence and survival rates in patients with small-size tumor between the two groups (≤5 cm) were not significant (64.6% vs. 50.0%, P = 0.141; 56.3% vs. 65.4%, P = 0.349, respectively). Multivariate analysis found that convention approach for hepatectomy was one of the independent risk factors for HCC recurrence and poor survival.
  
  
  CONCLUSIONS
  Prognosis of patients with large-size HCC tumor with the anterior approach was superior to that with the conventional approach. Large-size tumor (>5 cm) could be the clinical indicator for anterior approach for hepatectomy. J. Surg. Oncol. 2016;114:872-878. © 2016 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. haoshenghua@126.com.
authors.forename: Shenghua
authors.initials: S
authors.lastname: Hao
authors.affiliation: Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Fan
authors.affiliation: Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Shaofei
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Caixue
authors.initials: C
authors.lastname: Tu
authors.affiliation: Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Chidan
authors.initials: C
authors.lastname: Wan
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: anterior approach; conventional approach; hepatectomy; hepatocellular carcinoma; recurrence; survival