A New Approach for Liver Surgery

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Abstract
Objective: To clarify the efficacy of transdiaphragmatic hepatectomy. Design: Transdiaphragmatic hepatectomy and transabdominal hepatectomy were retrospectively compared. Setting: This technique is used in cirrhotic patients with hepatocellular carcinoma located near the diaphragm. Patients: Thirty-six cirrhotic patients with hepatocellular carcinoma 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 hepatocellular carcinoma less than 3 cm in diameter located in segment VII or VIII or near the confluence of the hepatic veins. Main Outcome Measure: Intraoperative and postoperative clinical parameters, including operative time, blood loss, and length of hospital stay. Results: The mean±SD operative time was significantly shorter in group 1 (184±25 minutes) than in group 2 (270±79 minutes). The intraoperative blood loss was significantly smaller in group 1 (857±622 mL) than in group 2(1318±926 mL). The rate of postoperative complications was lower in 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 in group 2(23±16 days). Conclusions: Transdiaphragmatic hepatectomy is a useful technique for cirrhotic patients with hepatocellular carcinoma located near the diaphragm. (Arch Surg. 1995;130:157-160)