Extra‐hepatic Glissonean approach allows safe segmental liver resection in patients with cirrhosis with hepatocellular carcinoma

Abstract

AbstractAimThis study aims to report our experience with the extra‐hepatic Glissonean approach (EHGA) in liver resection in patients with cirrhosis.Patients and MethodsFrom a prospectively maintained database in Al‐Rajhi Liver Hospital, Assiut University, Egypt, all patients with cirrhosis with hepatocellular carcinoma (HCC) who had open liver resections of two or more segments from January 2014 to December 2016 were identified. As many as 49 patients received resection via the classical pedicle dissection technique (PDT) and 38 by EHGA.ResultsThere was no difference in age, sex, American Society of Anesthesiologists grade, aetiology of liver disease, alpha‐fetoprotein, tumour number, size, Child‐Turcotte‐Pugh or Model for End‐stage Liver Disease scores between groups. Patients in the EHGA group had shorter operative time (214 ± 54 vs. 249 ± 44 minutes in PDT; P = .001), lesser blood loss (647 ± 140 ml vs. 741 ± 192 ml, respectively; P = .010), wider safety margin (14 ± 3.5 mm vs. 11.5 ± 5.8 mm, respectively; P = .029), lesser decompensation (18.4% vs. 40.8%, respectively; P = .026) and shorter hospital stay (8, range 3‐26 vs. 9, range 4‐36 days, respectively; P = .015). There was no 30‐day mortalities in the EHGA group compared with two in the PDT group. There were no differences between groups in 1‐ and 3‐year overall and recurrence‐free survival rates.ConclusionsEHGA is a rapid, safe and oncologically sound approach for segmental anatomical liver resections of HCC in patients with cirrhosis.