Hepatectomy using Glissonean pedicle transection for hepatocellular carcinoma

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Objective To investigate the application value of hepatectomy using Glissonean pedicle transection for hepatocellular carcinoma (HCC). Methods Clinical data of 54 patients with HCC undergoing radical hepatectomy in the First Affiliated Hospital of Medical College, Xi’an Jiaotong University from January 2002 to December 2012 were analyzed retrospectively. According to different surgical procedure, the patients were divided into hepatectomy with Glissonean pedicle transection group (Glisson group) and hepatectomy with Pringle maneuver (Pringle group) with 27 cases in each group. The informed consents of all patients were obtained and the ethical committee approval was received. In Glisson group, hepatectomy was performed after Glissonean pedicles were dissected and occluded. In Pringle group, hepatectomy was performed after the first porta was occluded using Pringle maneuver. The intraoperative situation, the variation of liver function and incidence of complications after operation of two groups were observed. The patients received follow-up after operation and survival analysis was conducted. The comparison of measurement data between two groups was conducted using t test, the comparison of rates using Chi-square test or Fisher's exact probability test, and the survival analysis using Kaplan-Meier method and Log-rank test. Results The mean of intraoperative blood loss in Glisson group [(135±57) ml] was significantly less than that in Pringle group[(248±87) ml] (t=-5.62, P 0.05). The 1-, 3-, 5-year cumulative survival rates were 89%, 50%, 39% in Glisson group and were 82%, 55%, 41% in Pringle group. The 1-, 3-, 5-year disease-free survival rates were 89%, 43%, 34% in Glisson group and were 82%, 47%, 41% in Pringle group. No significant difference was observed in the cumulative survival rates and disease free survival rates between two groups (χ2=0.001, 0.011; P>0.05). Conclusion Hepatectomy using Glissonean pedicle transection is a safe, effective, and feasible surgical procedure for HCC with advantages of less blood loss, milder liver damage. Key words: Carcinoma, hepatocellular; Hepatectomy; Glissonean pedicle transection method; Pringle maneuver vascular control; Blood loss, surgical; Liver function tests; Reperfusion injury