TRANSTHORACIC TRANSDIAPHRAGMATIC APPROACH FOR HEPATECTOMY OF COUINAUDSEGMENT-VII AND SEGMENT-VIII

For hepatectomy of Couinaud's segment VII or WI, severe compression an d mobilization of the liver is required to establish the operative hel d via the usual transabdominal approach, Compression of the cirrhotic liver impairs hepatic and systemic blood circulation, which may cause liver dysfunction. We adopted a transthoracic transdiaphragmatic appro ach for hepatectomy of segment VII or VIII in cirrhotic patients to es tablish a good operative field without compressing the liver. The aim of this study was to evaluate the benefits of this approach. Forty-fou r patients with hepatocellular carcinoma (HCC) complicating liver cirr hosis who underwent limited hepatectomy of Couinaud's segment VII or V III were studied. The patients were randomized to two groups preoperat ively: group I(n = 22), transabdominal approach; group II (n 22), tran sthoracic transdiaphragmatic approach. There were no differences in pr eoperative liver function tests, hepatic functional reserve, or extent of tumor between the two groups. The operative time in group II was s ignificantly shorter than that in group I (243 +/- 50 versus 313 +/- 8 0 minutes; p < 0.01). Operative blood loss in group II was also signif icantly smaller than that in group I (1190 +/- 1098 versus 2679 +/- 22 67 g; p < 0.01). Serum lactate dehydrogenase levels on postoperative d ay 1 in group II mere significantly lower than those in group I (587 /- 154 versus 791 +/- 383 IU/L; p < 0.05). Major postoperative complic ations were significantly fewer in group II. It was concluded that the transthoracic transdiaphragmatic approach is a useful method for hepa tectomy of segments VII and VIII in cirrhotic patients.