Surgical benefits of liver hanging maneuver for hepatectomy of huge liver tumor

摘要

Background. In hepatic surgery, it is very important to control bleeding during liver resection. However, in hepatectomy for a huge liver tumor it is often difficult to reduce bleeding volume and maintain an excellent surgical view. The anterior approach, which is hepatectomy done using the liver hanging maneuver, has beneficial effects reducing bleeding volume and preventing scattering of cancer cells from huge liver tumors. We investigated the surgical benefits of the liver hanging maneuver during hepatectomy for huge liver tumors in our department. Materials and Methods. Between April 2003 and August 2008, we reviewed 182 patients who had to undergo liver resection in our department. The diagnoses of these patients were 114 cases of hepatocellular carcinoma, 48 of colorec-tal metastasis, 6 of echinococcus, 5 of heman-gioma, 5 of cholangiocellular carcinoma, 2 of focal nodular hyperplasia, 1 of angiomyolipoma, and 1 of embryonal sarcoma. In the huge-tumor group, with tumor diameters of 10 cm or more, 20 patients underwent liver resection. In the small and medium-sized tumor groups, in which the tumors were 5 cm or less and between 5 and 10 cm in diameter, respectively, 124 and 38 patients underwent liver resection, respectively. Twelve patients underwent right or left lobec-tomy in the huge-tumor group. Of these, 8 patients underwent liver resection using the hanging maneuver. Results. The mean maximum tumor diameter, operation time, and amount of bleeding volume in the huge-tumor group were significantly larger, longer, and larger, respectively, than those of the small and medium groups. We found that the intraoperative bleeding volume of the group in which the hanging maneuver was used was significantly smaller than that of the group in which it was not for patients who underwent right or left lobectomy in the huge-tumor group Conclusions. The liver hanging maneuver is useful when liver tumors are 10 cm or more in diameter because it can reduce the intraopera...