A NEW APPROACH FOR LIVER SURGERY - TRANSDIAPHRAGMATIC HEPATECTOMY FORCIRRHOTIC-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 cirr hotic patients with hepatocellular carcinoma located near the diaphrag m. Patients: Thirty-six cirrhotic patients with hepatocellular carcino ma 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 hepatoc ellular carcinoma less than 3 cm in diameter located in segment VII or VIII or near the confluence of the hepatic veins. Main Outcome Measur e: Intraoperative and postoperative clinical parameters, including ope rative time, blood loss, and length of hospital stay. Results: The mea n+/-SD operative time was significantly shorter in group 1 (184+/-25 m inutes) than in group 2 (270+/-79 minutes). The intraoperative blond l oss was significantly smaller in group 1 (857+/-622 mL) than in group 2 (1318+/-926 mL). The rate of postoperative complications was lower i n 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 i n group 2 (23+/-16 days). Conclusions: Transdiaphragmatic hepatectomy is a useful technique for cirrhotic patients with hepatocellular carci noma located near the diaphragm.