An approach for difficult hepatectomy - Retrograde hepatectomy in 29 patients with liver malignant tumor

BAGKGROUND/AIMS: Resection remained the best treatment for malignant Liver tumor. However, it is difficult to resect a tumor which is huge and tightly invaded or adhered to the surrounding organs by classical procedures becau se of poor exposure; The purpose of the present study was to verify that re trograde hepatectomy was an acceptable approach. METHODOLOGY: Retrograde hepatectomy means that the! operative procedure is reversed as compared with classical methods. Transection of the liver paren chymal was performed first, isolating adhesions between the resected liver and diaphragm or partial phrenectomy followed, and then after cutting corre sponding ligaments, the liver tumor was removed. If the adjacent organs wer e invaded or adhered too tightly to be separated, they were removed with th e resected liver. This approach was adopted in 29 patients with liver malig nancy (group A) for difficult hepatectomy from June 1994 to June 1997. In t he same period, classical hepatectomy was performed in 13 patients used as a control group (group B). The differences between these two groups were an alyzed. RESULTS: When group A was compared with group B, the operative mortality wa s 0% versus 7.7% (p>0.05), the operative time was shorter, being 175.9+/-49 .7min (range: 150-250min) versus 251.9+/-66.9min (range:180-360min) (p<0.05 ), the estimated intra-operative blood loss being 1430.0+/-807.6ml (600-420 0ml) versus 2907.7+/-1497.9ml (800-7000ml) (p<0.05), and the incidence of p ost-operative complications was lower (p<0.05). CONCLUSIONS: Retrograde hepatectomy is an alternative method to classical h epatectomy and suitable for resection of localized huge liver tumor when th e exposure is inadequate by classical approach, particularly when the tumor adheres or invades closely to the diaphragm and/or the surrounding structu res.