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February 1995

A New Approach for Liver Surgery: Transdiaphragmatic Hepatectomy for Cirrhotic Patients With Hepatocellular Carcinoma

Author Affiliations

From the Second Department of Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.

Arch Surg. 1995;130(2):157-160. doi:10.1001/archsurg.1995.01430020047007

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.(Arch Surg. 1995;130:157-160)