Mesohepatectomy for centrally located hepatocellular carcinoma: An appraisal of a rare procedure

Background: For centrally located hepatocellular carcinoma (HCC), extended major hepatectomy is usually recommended, but the risk of postoperative liv er failure is high when liver function is not sound. Mesohepatectomy (en bl oc resection of Goldsmith and Woodburne's left medial and right anterior se gments or Couinaud's segments IV, V, and VIII) is a rare procedure, so its role in treating HCC is unclear. Study Design: We retrospectively reviewed 364 patients who underwent a cura tive resection for HCC. Among them, 15 patients were treated by mesohepatec tomy, Their nontumorous liver revealed cirrhosis in 11 and chronic hepatiti s in 4. The mean tumor diameter was 12.8 cm. In 10 of the 15 patients, HCC also invaded adjacent organs. The operative results of another 25 patients with different disease extent who underwent extended major hepatectomy were compared. Results: The hepatic inflow occlusion time for mesohepatectomy was longer t han for extended hepatectomy (p = 0.01). The mean operative blood loss, amo unt of blood transfusion, operating time, and postoperative hospital stay i n the mesohepatectomy group were 2,450 mL, 1,100 mL, 7.9 hours, and 14.9 da ys, respectively. In the extended-hepatectomy group, the: values were 1,863 mL, 768 mL, 5.8 hours, and 16.8 days, respectively (all p > 0.05 compared with mesohepatectomy). No patient died after mesohepatectomy; but after ext ended hepatectomy there was one death from liver failure. The Union Interna tionale contre le cancer (UICC) TNM stages of patients who underwent mesohe patectomy were as follows: stage II in 1, stage III in 4, and stage IVA in 10. All patients who underwent extended hepatectomy presented with stage IV A disease. The 6-year disease-free and actuarial survival rates after mesoh epatectomy were 21% and 30%, respectively The 6-year disease-free survival rate after extended hepatectomy was 9% (p = 0.11 compared with mesohepatect omy). Conclusion: Although mesohepatectomy is time-consuming, it is justified for selected patients with centrally located large HCC in a diseased liver. (J Am Coll Surg 1999;188:508-515. (C) 1999 by the American College of Surgeon s).