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Effectiveness of Routine Application Of Anterior Approach During Right Hepatectomy: A Randomized Trial

18 Years
80 Years
Not Enrolling
Liver Neoplasm

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Trial Information

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%).

Inclusion Criteria:

- patients between 18 and 80 years

- patients scheduled to right hepatectomy or extended right hepatectomy

- the future remnant liver (FRL) ≥ 25% in patients with a normal liver or ≥ 30% in
those with chronic liver disease

- indocyanine green retention rate (ICG) at 15 minutes ≤ 10% in cirrhotic patients

Exclusion Criteria:

- resection of S1

- resection of bile duct

- infiltration of inferior vena cava

- America Society of Anesthesiologists (ASA) grade IV

- Emergency surgery

Type of Study:


Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:


Outcome Time Frame:


Safety Issue:


Principal Investigator

Lorenzo Capussotti, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Ospedale Mauriziano di Torino


Italy: Ethics Committee

Study ID:




Start Date:

August 2010

Completion Date:

August 2011

Related Keywords:

  • Liver Neoplasm
  • Neoplasms
  • Liver Neoplasms