Effectiveness of Routine Application Of Anterior Approach During Right Hepatectomy: A Randomized Trial
Mobilization of the liver during right hepatectomy with classic approach is performed before
parenchymal transection. In this phase severe bleeding may occur due to laceration of the
inferior vena cava (IVC) wall, rupture or ligation falling off the hepatic short vein (HSV)
or bleeding from the right liver attachments. Besides, the twisting of the portal pedicle
during mobilization can render the left hepatic lobe ischemic for transient interruption of
the hepatopetal flow. These events are more frequent in case of large hepatic lesions
(mainly HCC) that involves surrounding structures (such as diaphragm). Two of the most
important factors that affect the postoperative course of patients undergoing liver
resections are indeed intraoperative bleeding and postoperative liver dysfunction. For these
reasons Lai et al proposed anterior approach as alternative to classic right hepatectomy. In
this case liver mobilization is performed only at the end of parenchymal transection, when
all vascular connections are already interrupted. Liu et al published the results of a
retrospective study in which 54 patients with, right sided HCC greater than 5 cm underwent
right hepatectomy using the anterior approach technique. The anterior approach group had
significantly less intraoperative blood loss, less need of blood transfusion and a lower
hospital mortality rate. The same group reported results of a prospective randomized
controlled study analyzing 120 patients with large (>5 cm) right liver HCC. The overall
operative blood loss, morbidity, and duration of hospital stay were comparable in both
groups. However, a higher number of patients in classic approach group experienced mayor
operative blood loss (> 2000 cc) and required blood transfusions (8.3% vs. 28.3%).
Interventional
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
OVERALL BLOOD LOSS
UP TO 7 DAYS
No
Lorenzo Capussotti, MD
Principal Investigator
Ospedale Mauriziano di Torino
Italy: Ethics Committee
AA001
NCT01180088
August 2010
August 2011
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