Significance of liver hanging maneuver for anatomical hepatectomy in patients with a large hepatocellular carcinoma compressing intrahepatic vasculatures.

BACKGROUNDS/AIMS: To achieve complete anatomic hepatectomy in a large hepatocellular carcinoma (HCC), hepatic transection through an anterior approach is required. Liver hanging maneuver (LHM) is a useful procedure for transection of an adequately cut plane in anatomical liver resection. It may reduce intraoperative bleeding and transection time.

METHODS

We examined records of 27 patients with large HCC (over 10 cm in size) who underwent anatomic hepatic resection with LHM (n=11, between 2001 and 2007) or without LHM (n=16, between 2000 and 2003). The two groups were retrospectively compared in terms of patient demographics, preoperative hepatic function, surgical records, and post-hepatectomy outcome.

RESULTS

Although transection time was not significantly different between the two groups, the amount of intraoperative blood loss was significantly lower in the LHM group than that in the non-LHM group (1,269±1,407 ml vs. 2,197±1,281 ml, =0.039). Related blood transfusion or total operation time in the LHM group tended to be lower than those in the non-LHM group, although differences between the two groups were not statistically significant (<1.0). Prevalence of total complications in the LHM group tended to be lower than that in the LHM group (36% vs. 88%, =0.011). However, prevalence of hepatectomy-related complications or length of hospital stay was not significantly different between the two groups.

CONCLUSIONS

LHM can reduce intraoperative blood loss. It is useful for transecting adequately cut plane in a hepatectomy for a large HCC. However, postoperative outcomes are not improved by LHM compared to those by non-LHM.