A new approach for liver surgery. Transdiaphragmatic hepatectomy for cirrhotic patients with hepatocellular carcinoma.

OBJECTIVE

To clarify the efficacy of transdiaphragmatic hepatectomy.

DESIGN

Transdiaphragmatic hepatectomy and transabdominal hepatectomy were retrospectively compared.

SETTING

This technique is used in cirrhotic patients with hepatocellular carcinoma located near the diaphragm.

PATIENTS

Thirty-six cirrhotic patients with hepatocellular carcinoma who underwent transdiaphragmatic (group 1 [n = 8]) or transabdominal (group 2 [n = 28]) hepatectomies between April 1985 and March 1993 were investigated. All patients underwent a partial hepatectomy for hepatocellular carcinoma less than 3 cm in diameter located in segment VII or VIII or near the confluence of the hepatic veins.

MAIN OUTCOME MEASURE

Intraoperative and postoperative clinical parameters, including operative time, blood loss, and length of hospital stay.

RESULTS

The mean +/- SD operative time was significantly shorter in group 1 (184 +/- 25 minutes) than in group 2 (270 +/- 79 minutes). The intraoperative blood loss was significantly smaller in group 1 (857 +/- 622 mL) than in group 2 (1318 +/- 926 mL). The rate of postoperative complications was lower in group 1 (13% [n = 1]) than in group 2 (43% [n = 12]). The postoperative hospital stay was significantly shorter in group 1 (16 +/- 5 days) than in group 2 (23 +/- 16 days).

CONCLUSIONS

Transdiaphragmatic hepatectomy is a useful technique for cirrhotic patients with hepatocellular carcinoma located near the diaphragm.