A THORACOABDOMINAL HEPATECTOMY AND A TRANSDIAPHRAGMATIC HEPATECTOMY FOR PATIENTS WITH CIRRHOSIS AND HEPATOCELLULAR-CARCINOMA

Objective: To evaluate the results of a thoracoabdominal hepatectomy a nd a transdiaphragmatic hepatectomy for hepatocellular carcinoma in pa tients with impaired liver function. Design: Retrospective study. Sett ing: A university hospital in Japan. Patients: Twenty-seven patients w ho from 1991 to 1996 underwent a thoracoabdominal hepatectomy for hepa tocellular carcinoma located mainly in the superior portion of the liv er and 20 patients who underwent a transdiaphragmatic hepatectomy for hepatocellular carcinoma located near the diaphragm. Main Outcome Meas ures: Morbidity, survival, and disease-free survival after each operat ion. Comparisons were then made with 183 patients who had undergone an ordinary transabdominal hepatectomy during the same period. Results: In the thoracoabdominal hepatectomy group, 17 patients underwent a par tial resection, 4 patients underwent a subsegmentectomy, and another 6 patients underwent either a segmentectomy or a procedure that was gre ater in size than a segmentectomy, whereas all of the patients in the transdiaphragmatic group underwent a partial resection. The morbiditie s in the thoracoabdominal group included pleural effusion in 6 patient s (22%); intra-abdominal infection in 5 patients (19%); and hepatic fa ilure in 3 patients (11%), of whom 1 died (mortality rate, 4%). In the transdiaphragmatic group, only 2 patients (10%) had non-life-threaten ing complications. The cumulative survival rates and the disease-free survival rates of tile patients at 3 years were 51% and 24% in the tho racoabdominal hepatectomy group and 62% and 30% in the transdiaphragma tic hepatectomy group; no significant differences were observed when t hese findings were compared with those of patients who had undergone a transabdominal hepatectomy. Conclusion: The outcomes of the patients undergoing thoracoabdominal hepatectomy and those undergoing a transdi aphragmatic hepatectomy were generally satisfactory in spite of the fa ct that these procedures were performed on patients with cirrhosis and impaired liver function.