Significance of Liver Hanging Maneuvers for Invasive Liver Lesions in No-routine Anterior Approach Policy

Background: Liver hanging maneuver is a widely used novel suspending technique to facilitate liver resection using the "anterior approach" where hepatic mobilization is preceded by parenchymal transection. However, its true indication and surgical advantages in the conventional "liver mobilization approach" are still controversial.

Study Design: The medical records of 1,451 consecutive patients who underwent hepatectomy at a single institute, where conventional liver mobilization technique is routinely adopted, were retrospectively reviewed. Surgical situations in which the hanging maneuvers could actually be expected to be advantageous and the clinical outcomes of the tape-assist techniques were investigated.

Results: Of the 1,451 hepatectomies, 1,446 (99.6%) were successfully performed using the conventional approach. Of the 1,446 patients, 42 (2.9%) required tape-assist techniques to secure safe surgical manipulation of bulky lesions (61.9%), tumor infiltration (16.7%), massive tumor thrombi (9.5%), vascular protection (7.1%), and other technical reasons (4.8%). The perioperative morbidity/mortality rates were 19.0/0% in these 42 tape-assisted cases, and 21.9/0.14% in the remaining 1,404 cases (p = 0.82 and 0.06, respectively), with no significant difference in either the overall or the recurrence-free survival between the two groups.

Conclusions: Although liver resection may be accomplished safely by the conventional approach in most cases, its safety may be enhanced by the use of valid tape-assist techniques in selected situations.