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Article: Anterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma: A prospective randomized controlled study

TitleAnterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma: A prospective randomized controlled study
Authors
Issue Date2006
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com
Citation
Annals Of Surgery, 2006, v. 244 n. 2, p. 194-203 How to Cite?
AbstractOBJECTIVE: To evaluate whether major right hepatectomy using the anterior approach technique for large hepatocellular carcinoma (HCC) results in better operative and long-term survival outcomes when compared with the conventional approach technique. SUMMARY BACKGROUND DATA: The anterior approach technique has been advocated recently for large right liver tumors. However, its beneficial effects on the operative and survival outcomes of the patients have not been evaluated prospectively. METHODS: A prospective randomized controlled study was performed on 120 patients who had large (≥5 cm) right liver HCC and underwent curative major right hepatic resection during a 57-month period. The patients were randomized to undergo resection of the tumor using the anterior approach technique (AA group, n = 60) or the conventional approach technique (CA group, n = 60). The anterior approach technique involved initial vascular inflow control, completion of parenchymal transection, and complete venous outflow control before the right liver was mobilized. Operative and long-term survival outcomes of the two groups were analyzed. Quantitative assessments of markers of circulating tumor cells at various stages of surgery of the two techniques were also assessed by plasma albumin-mRNA. RESULTS: The overall operative blood loss, morbidity, and duration of hospital stay were comparable in both groups. Major operative blood loss of ≥2 L occurred less frequently in the AA group (8.3% vs. 28.3%, P = 0.005). As a result, blood transfusion requirement and number of patients requiring blood transfusion were significantly lower in the AA group. Hospital mortality occurred in 1 patient in the AA group and 6 patients in the CA group (P = 0.114). Median disease-free survival was 15.5 months in the AA group and 13.9 months in the CA group (P = 0.882). Overall survival was significantly better in the AA group (median >68.1 months) than in the CA group (median = 22.6 months, P = 0.006). The survival benefit appeared more obvious in patients with stage II disease and patients with lymphovascular permeation of the tumor. The anterior approach was also found to associate with significantly lower plasma albumin-mRNA levels at various stages of surgery compared with the CA technique. On multivariate analysis, tumor staging, anterior approach hepatic resection, and resection margin involved by the tumor were independent factors affecting overall survival. CONCLUSION: The anterior approach results in better operative and survival outcomes compared with the conventional approach. It is the preferred technique for major right hepatic resection for large HCC. Copyright © 2006 by Lippincott Williams & Wilkins.
Persistent Identifierhttp://hdl.handle.net/10722/88419
ISSN
2015 Impact Factor: 8.569
2015 SCImago Journal Rankings: 4.503
PubMed Central ID
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLiu, CLen_HK
dc.contributor.authorFan, STen_HK
dc.contributor.authorCheung, STen_HK
dc.contributor.authorLo, CMen_HK
dc.contributor.authorNg, IOen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2010-09-06T09:43:07Z-
dc.date.available2010-09-06T09:43:07Z-
dc.date.issued2006en_HK
dc.identifier.citationAnnals Of Surgery, 2006, v. 244 n. 2, p. 194-203en_HK
dc.identifier.issn0003-4932en_HK
dc.identifier.urihttp://hdl.handle.net/10722/88419-
dc.description.abstractOBJECTIVE: To evaluate whether major right hepatectomy using the anterior approach technique for large hepatocellular carcinoma (HCC) results in better operative and long-term survival outcomes when compared with the conventional approach technique. SUMMARY BACKGROUND DATA: The anterior approach technique has been advocated recently for large right liver tumors. However, its beneficial effects on the operative and survival outcomes of the patients have not been evaluated prospectively. METHODS: A prospective randomized controlled study was performed on 120 patients who had large (≥5 cm) right liver HCC and underwent curative major right hepatic resection during a 57-month period. The patients were randomized to undergo resection of the tumor using the anterior approach technique (AA group, n = 60) or the conventional approach technique (CA group, n = 60). The anterior approach technique involved initial vascular inflow control, completion of parenchymal transection, and complete venous outflow control before the right liver was mobilized. Operative and long-term survival outcomes of the two groups were analyzed. Quantitative assessments of markers of circulating tumor cells at various stages of surgery of the two techniques were also assessed by plasma albumin-mRNA. RESULTS: The overall operative blood loss, morbidity, and duration of hospital stay were comparable in both groups. Major operative blood loss of ≥2 L occurred less frequently in the AA group (8.3% vs. 28.3%, P = 0.005). As a result, blood transfusion requirement and number of patients requiring blood transfusion were significantly lower in the AA group. Hospital mortality occurred in 1 patient in the AA group and 6 patients in the CA group (P = 0.114). Median disease-free survival was 15.5 months in the AA group and 13.9 months in the CA group (P = 0.882). Overall survival was significantly better in the AA group (median >68.1 months) than in the CA group (median = 22.6 months, P = 0.006). The survival benefit appeared more obvious in patients with stage II disease and patients with lymphovascular permeation of the tumor. The anterior approach was also found to associate with significantly lower plasma albumin-mRNA levels at various stages of surgery compared with the CA technique. On multivariate analysis, tumor staging, anterior approach hepatic resection, and resection margin involved by the tumor were independent factors affecting overall survival. CONCLUSION: The anterior approach results in better operative and survival outcomes compared with the conventional approach. It is the preferred technique for major right hepatic resection for large HCC. Copyright © 2006 by Lippincott Williams & Wilkins.en_HK
dc.languageengen_HK
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.comen_HK
dc.relation.ispartofAnnals of Surgeryen_HK
dc.rightsAnnals of Surgery. Copyright © Lippincott Williams & Wilkins.en_HK
dc.subject.meshBlood Loss, Surgicalen_HK
dc.subject.meshBlood Transfusionen_HK
dc.subject.meshCarcinoma, Hepatocellular - pathology - surgeryen_HK
dc.subject.meshCause of Deathen_HK
dc.subject.meshDisease-Free Survivalen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshFollow-Up Studiesen_HK
dc.subject.meshHepatectomy - classification - methodsen_HK
dc.subject.meshHumansen_HK
dc.subject.meshLength of Stayen_HK
dc.subject.meshLiver Circulation - physiologyen_HK
dc.subject.meshLiver Neoplasms - pathology - surgeryen_HK
dc.subject.meshLongitudinal Studiesen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshNeoplasm Stagingen_HK
dc.subject.meshNeoplastic Cells, Circulating - pathologyen_HK
dc.subject.meshPostoperative Complicationsen_HK
dc.subject.meshProspective Studiesen_HK
dc.subject.meshRNA, Messenger - analysisen_HK
dc.subject.meshSerum Albumin - analysisen_HK
dc.subject.meshSurvival Rateen_HK
dc.subject.meshTreatment Outcomeen_HK
dc.titleAnterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma: A prospective randomized controlled studyen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0003-4932&volume=244&issue=2&spage=194&epage=203&date=2006&atitle=Anterior+approach+versus+conventional+approach+right+hepatic+resection+for+large+hepatocellular+carcinoma:+a+prospective+randomized+controlled+studyen_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.emailCheung, ST: stcheung@hkucc.hku.hken_HK
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_HK
dc.identifier.emailNg, IO: iolng@hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.identifier.authorityCheung, ST=rp00457en_HK
dc.identifier.authorityLo, CM=rp00412en_HK
dc.identifier.authorityNg, IO=rp00335en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1097/01.sla.0000225095.18754.45en_HK
dc.identifier.pmid16858181-
dc.identifier.pmcidPMC1602174-
dc.identifier.scopuseid_2-s2.0-33748093763en_HK
dc.identifier.hkuros117707en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-33748093763&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume244en_HK
dc.identifier.issue2en_HK
dc.identifier.spage194en_HK
dc.identifier.epage203en_HK
dc.identifier.isiWOS:000239358700005-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLiu, CL=7409789712en_HK
dc.identifier.scopusauthoridFan, ST=7402678224en_HK
dc.identifier.scopusauthoridCheung, ST=7202473497en_HK
dc.identifier.scopusauthoridLo, CM=7401771672en_HK
dc.identifier.scopusauthoridNg, IO=7102753722en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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