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Transdiaphragmatic Hepatectomy for Cirrhotic Patients With Hepatocellular Carcinoma

Mitsuo Shimada, MD; Takashi Matsumata, MD; Akinobu Taketomi, MD; Ken Shirabe, MD; Kazuharu Yamamoto, MD; Hidetoshi Itasaka, MD; Keizo Sugimachi, MD

Arch Surg. 1995;130(2):157-160.

Abstract
Objective
To clarify the efficacy of transdiaphragmatic hepatectomy.

Design
Transdiaphragmatic hepatectomy and transabdominal hepatectomy were retrospectively compared.

Setting
This technique is used in cirrhotic patients with hepatocellular carcinoma located near the diaphragm.

Patients
Thirty-six cirrhotic patients with hepatocellular carcinoma who underwent transdiaphragmatic (group 1 [n=8]) or transabdominal (group 2 [n=28]) hepatectomies between April 1985 and March 1993 were investigated. All patients underwent a partial hepatectomy for hepatocellular carcinoma less than 3 cm in diameter located in segment VII or VIII or near the confluence of the hepatic veins.

Main Outcome Measure
Intraoperative and postoperative clinical parameters, including operative time, blood loss, and length of hospital stay.

Results
The mean±SD operative time was significantly shorter in group 1 (184±25 minutes) than in group 2 (270±79 minutes). The intraoperative blood loss was significantly smaller in group 1 (857±622 mL) than in group 2(1318±926 mL). The rate of postoperative complications was lower in group 1 (13% [n=1]) than in group 2 (43% [n=12]). The postoperative hospital stay was significantly shorter in group 1 (16±5 days) than in group 2(23±16 days).

Conclusions
Transdiaphragmatic hepatectomy is a useful technique for cirrhotic patients with hepatocellular carcinoma located near the diaphragm.

(Arch Surg. 1995;130:157-160)

Author Affiliations
From the Second Department of Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.

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