No-Touch en-bloc total hepatectomy technique in living-donor liver transplantation for hepatocellular carcinoma.

Abstract

Introduction: Although the survival benefit in patients with early HCC who underwent LDLT has been confirmed in clinical series, some studies suggested that LDLT has a higher HCC recurrence rate than DDLT. Their argument is that scrupulous dissection and mobilization of the liver might increase the possibility of tumor capsule violation or tumor dissemination through the hepatic veins. [51] To minimize these concerns, our institution, the Asan Medical Center, has its own surgical strategy named “No-Touch en-bloc total hepatectomy” Method: The operation of Lt. approach is performed as following sequence. Without hepatic mobilization, we first performed Hilar dissection & division. Then, the Liver was mobilized from Left & Caudate lobe, and HVs were divided. The Rt. Lobe was mobilized as a final procedure of Total Hepatectomy. Result: No-touch technique has been performed in 61 patients. 93% of them underwent Pre-LDLT treatment, and TACE was the most common treatment modality. Surgical resection of HCC comprise the 18%. After LDLT using No-touch technique, In-hospital mortality was absent. The 5-Year Recurrence free survival was 44%. However, the Overall survival was Extraordinary high, 80.5%. Conclusion: The no-touch en bloc method can decrease manipulation of the native liver during dissection of the retrohepatic short hepatic veins, and can be suggested as a optimal surgical technique which can be minimized tumor spread by surgical manipulation for patients with advanced hepatocellular carcinoma to improve long-term oncological outcomes in LDLT.