Significance of Liver Hanging Maneuver for Anatomical Hepatectomy in Patients with a Large Hepatocellular Carcinoma Compressing Intrahepatic Vasculatures

Overview

Journal Ann Hepatobiliary Pancreat Surg

Date 2017 Dec 22

PMID 29264580

Citations 1

Authors

Atsushi Nanashima

Yorihisa Sumida

Tetsuro Tominaga

Takeshi Nagayasu

Affiliations

Soon will be listed here.

Abstract

Backgrounds/aims: To achieve complete anatomic hepatectomy in a large hepatocellular carcinoma (HCC), hepatic transection through an anterior approach is required. Liver hanging maneuver (LHM) is a useful procedure for transection of an adequately cut plane in anatomical liver resection. It may reduce intraoperative bleeding and transection time.

Methods: We examined records of 27 patients with large HCC (over 10 cm in size) who underwent anatomic hepatic resection with LHM (n=11, between 2001 and 2007) or without LHM (n=16, between 2000 and 2003). The two groups were retrospectively compared in terms of patient demographics, preoperative hepatic function, surgical records, and post-hepatectomy outcome.

Results: Although transection time was not significantly different between the two groups, the amount of intraoperative blood loss was significantly lower in the LHM group than that in the non-LHM group (1,269±1,407 ml vs. 2,197±1,281 ml, =0.039). Related blood transfusion or total operation time in the LHM group tended to be lower than those in the non-LHM group, although differences between the two groups were not statistically significant (<1.0). Prevalence of total complications in the LHM group tended to be lower than that in the LHM group (36% vs. 88%, =0.011). However, prevalence of hepatectomy-related complications or length of hospital stay was not significantly different between the two groups.

Conclusions: LHM can reduce intraoperative blood loss. It is useful for transecting adequately cut plane in a hepatectomy for a large HCC. However, postoperative outcomes are not improved by LHM compared to those by non-LHM.

Citing Articles

Liver hanging maneuver is suitable in major hepatectomy for liver malignancies over 5 cm.

Nanashima A, Hiyoshi M, Imamura N, Yano K, Hamada T, Kitamura E Turk J Surg. 2023; 38(3):215-220.

PMID: 36846068 PMC: 9948658. DOI: 10.47717/turkjsurg.2022.5731.

References

Suh K, Lee H, Kim S, Kim S, Lee K . Hanging maneuver in left hepatectomy. Hepatogastroenterology. 2004; 51(59):1464-6. View

Nanashima A, Abo T, Arai J, Takagi K, Matsumoto H, Takeshita H . Usefulness of vessel-sealing devices combined with crush clamping method for hepatectomy: a retrospective cohort study. Int J Surg. 2013; 11(9):891-7. DOI: 10.1016/j.ijsu.2013.07.012. View

Nanashima A, Sumida Y, Abo T, Nagayasu T, Sawai T . Usefulness and application of the liver hanging maneuver for anatomical liver resections. World J Surg. 2008; 32(9):2070-6. DOI: 10.1007/s00268-008-9606-9. View

Suzuki M, Unno M, Katayose Y, Takeuchi H, Rikiyama T, Onogawa T . Hepatic resection through an anterior approach employing a modified liver hanging maneuver in patients with a massive liver tumor severely oppressing the inferior vena cava. Hepatogastroenterology. 2004; 51(59):1459-63. View

Belghiti J, Guevara O, Noun R, Saldinger P, Kianmanesh R . Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg. 2001; 193(1):109-11. DOI: 10.1016/s1072-7515(01)00909-7. View

Makuuchi M, Yamamoto J, Takayama T, Kosuge T, Gunven P, Yamazaki S . Extrahepatic division of the right hepatic vein in hepatectomy. Hepatogastroenterology. 1991; 38(2):176-9. View

Ogata S, Belghiti J, Varma D, Sommacale D, Maeda A, Dondero F . Two hundred liver hanging maneuvers for major hepatectomy: a single-center experience. Ann Surg. 2007; 245(1):31-5. PMC: 1867932. DOI: 10.1097/01.sla.0000224725.40979.0a. View

Nanashima A, Nagayasu T . Development and clinical usefulness of the liver hanging maneuver in various anatomical hepatectomy procedures. Surg Today. 2015; 46(4):398-404. DOI: 10.1007/s00595-015-1166-7. View

Kim S, Park S, Lee S, Lee W, Park J, Kim C . Isolated caudate lobectomy using the hanging maneuver. Surgery. 2006; 139(6):847-50. DOI: 10.1016/j.surg.2006.01.004. View

10.

Ettorre G, Vennarecci G, Santoro R, Antonini M, Lonardo M, Carlini M . Modified liver hanging maneuver during orthotopic liver transplantation with inferior vena cava preservation. Transplantation. 2003; 75(2):247-9. DOI: 10.1097/01.TP.0000044000.51778.4B. View

11.

Hirai I, Murakami G, Kimura W, Kanamura T, Sato I . How should we treat short hepatic veins and paracaval branches in anterior hepatectomy using the hanging maneuver without mobilization of the liver? An anatomical and experimental study. Clin Anat. 2003; 16(3):224-32. DOI: 10.1002/ca.10092. View

12.

Capussotti L, Ferrero A, Russolillo N, Langella S, Lo Tesoriere R, Vigano L . Routine anterior approach during right hepatectomy: results of a prospective randomised controlled trial. J Gastrointest Surg. 2012; 16(7):1324-32. DOI: 10.1007/s11605-012-1894-6. View

13.

Beppu T, Ishiko T, Chikamoto A, Komori H, Masuda T, Hayashi H . Liver hanging maneuver decreases blood loss and operative time in a right-side hepatectomy. Hepatogastroenterology. 2012; 59(114):542-5. DOI: 10.5754/hge09737. View

14.

Sheen I, Jeng K, Shih S, Wang P, Chang W, Wang H . Does surgical resection of hepatocellular carcinoma accelerate cancer dissemination?. World J Gastroenterol. 2003; 10(1):31-6. PMC: 4717073. DOI: 10.3748/wjg.v10.i1.31. View

15.

Gaujoux S, Douard R, Ettorre G, Delmas V, Chevallier J, Cugnenc P . Liver hanging maneuver: an anatomic and clinical review. Am J Surg. 2007; 193(4):488-92. DOI: 10.1016/j.amjsurg.2006.04.006. View

16.

Wang C, Jawade K, Yap A, Concejero A, Lin C, Chen C . Resection of large hepatocellular carcinoma using the combination of liver hanging maneuver and anterior approach. World J Surg. 2010; 34(8):1874-8. DOI: 10.1007/s00268-010-0546-9. View

17.

Rahbari N, Zimmermann J, Koch M, Bruckner T, Schmidt T, Elbers H . IVC CLAMP: infrahepatic inferior vena cava clamping during hepatectomy--a randomised controlled trial in an interdisciplinary setting. Trials. 2009; 10:94. PMC: 2770522. DOI: 10.1186/1745-6215-10-94. View

18.

Nanashima A, Sumida Y, Abo T, Takeshita H, Hidaka S, Sawai T . Trisectionectomy for large hepatocellular carcinoma using the liver hanging maneuver. Eur J Surg Oncol. 2008; 35(3):326-30. DOI: 10.1016/j.ejso.2008.01.023. View

19.

Yamanaka N, Okamoto E, Fujihara S, Kato T, Fujimoto J, Oriyama T . Do the tumor cells of hepatocellular carcinomas dislodge into the portal venous stream during hepatic resection?. Cancer. 1992; 70(9):2263-7. DOI: 10.1002/1097-0142(19921101)70:9<2263::aid-cncr2820700909>3.0.co;2-m. View

20.

Liddo G, Buc E, Nagarajan G, Hidaka M, Dokmak S, Belghiti J . The liver hanging manoeuvre. HPB (Oxford). 2009; 11(4):296-305. PMC: 2727082. DOI: 10.1111/j.1477-2574.2009.00068.x. View