Anterior approach for right hepatectomy with hanging maneuver for hepatocellular carcinoma: a multi-institutional propensity score-matching study.
BACKGROUND
This multi-institutional study aimed to assess the benefits of anterior approach for right hepatectomy with hanging maneuver (ARH-HM) for hepatocellular carcinoma (HCC) compared with conventional right hepatectomy (CRH).


METHODS
From January 2000 to December 2012, 306 patients with HCC ≥5 cm were divided into two groups: ARH-HM (n = 104) and CRH (n = 202).


RESULTS
After one-to-one propensity score-matched analysis, 72 ARH-HM and 72 CRH patients presented comparable background factors. Patients in the ARH-HM group demonstrated significantly less intraoperative blood loss (480 vs. 1,242 g, P < 0.001) and a lower frequency of red cell concentrate transfusion (21.1% vs. 50.7%, P < 0.001) compared with patients in the CRH group. The 5-year overall survival rate was significantly better in the ARH-HM group compared with the CRH group (50.2% vs. 31.4%, P = 0.021). Limited to patients with HCC ≥10 cm, recurrence-free and overall survival of the ARH-HM group was significantly greater than those of the CRH group.


CONCLUSIONS
In comparison with CRH, ARH-HM for large HCC can provide better overall survival rates with a decrease in intraoperative blood loss and transfusion rates. Survival impact was evident especially in patients with HCC ≥10 cm.
Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
Toru
T
Beppu
Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
Katsunori
K
Imai
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Kurume University, Kurume, Japan.
Koji
K
Okuda
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Susumu
S
Eguchi
Department of Surgery, Saga University Faculty of Medicine, Saga, Japan.
Kenji
K
Kitahara
Department of Surgery, Nippon Medical School, Tokyo, Japan.
Nobuhiko
N
Taniai
Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan.
Shinichi
S
Ueno
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Ken
K
Shirabe
Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
Masayuki
M
Ohta
Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Miyazaki, Japan.
Kazuhiro
K
Kondo
Division of Surgical Oncology and Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Atsushi
A
Nanashima
Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan.
Tomoaki
T
Noritomi
First Department of Surgery, Faculty of Medicine, University of the Ryukyu, Okinawa, Japan.
Masayuki
M
Shiraishi
Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Yuko
Y
Takami
Department of Surgery, Gastroenterology and Hepatology Center, Kitakyushu City Yahata Hospital, Kitakyushu, Japan.
Kohji
K
Okamoto
Medical Quality Management Center, Kumamoto University, Kumamoto, Japan.
Ken
K
Kikuchi
Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
Hideo
H
Baba
Clinical Research Center and Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan.
Hikaru
H
Fujioka
D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007564:Japan; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D057216:Propensity Score; D015996:Survival Rate; D016896:Treatment Outcome
Anterior approach; Hepatectomy; Hepatocellular carcinoma; Liver hanging maneuver; Propensity score