Anterior approach to improve the long-term outcome in patients with large-size hepatocellular carcinoma having liver resection.

BACKGROUND AND OBJECTIVE: A prospective study was conducted to investigate the effect of anterior approach for hepatectomy on long-term outcome of HCC patients with different tumor size.

METHODS: Long-term outcomes were investigated between patients with different tumor size underwent liver resection by either anterior or conventional approach (i.e., AA or CA group).

RESULTS: The recurrence rate in AA group was much lower than that in CA group (52.4% vs.73.1%, P = 0.001). The survival rate in AA group was much higher than that in CA group (60.0% vs. 38.0%, P < 0.001). Furthermore, the differences in recurrence and survival rates in patients with large-size tumor (>5 cm) between AA and CA groups were significant (80.0% vs. 54.7%, P = 0.002; 25.0% vs. 54.2%, P = 0.001, respectively), whereas the differences in tumor recurrence and survival rates in patients with small-size tumor between the two groups (≤5 cm) were not significant (64.6% vs. 50.0%, P = 0.141; 56.3% vs. 65.4%, P = 0.349, respectively). Multivariate analysis found that convention approach for hepatectomy was one of the independent risk factors for HCC recurrence and poor survival.

CONCLUSIONS: Prognosis of patients with large-size HCC tumor with the anterior approach was superior to that with the conventional approach. Large-size tumor (>5 cm) could be the clinical indicator for anterior approach for hepatectomy. J. Surg. Oncol. 2016;114:872-878. © 2016 2016 Wiley Periodicals, Inc.