10cm 이상의 거대 간세포암의 우엽 절제술에서의 전방 접근법

Right Hemihepatectomy Using an Anterior Approach Technique for a Hepatocellular Carcinoma>10 cm in Size

  • 김태환 (울산대학교 의과대학, 서울아산병원, 간이식 및 간담도외과) ;
  • 이승규 (울산대학교 의과대학, 서울아산병원, 간이식 및 간담도외과) ;
  • 송기원 (울산대학교 의과대학, 서울아산병원, 간이식 및 간담도외과) ;
  • 황신 (울산대학교 의과대학, 서울아산병원, 간이식 및 간담도외과) ;
  • 김기훈 (울산대학교 의과대학, 서울아산병원, 간이식 및 간담도외과) ;
  • 안철수 (울산대학교 의과대학, 서울아산병원, 간이식 및 간담도외과) ;
  • 문덕복 (울산대학교 의과대학, 서울아산병원, 간이식 및 간담도외과) ;
  • 하태용 (울산대학교 의과대학, 서울아산병원, 간이식 및 간담도외과) ;
  • 정동환 (울산대학교 의과대학, 서울아산병원, 간이식 및 간담도외과)
  • Kim, Tae-Hwan (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Lee, Sung-Gyu (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Song, Gi-Won (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Hwang, Shin (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Kim, Ki-Hun (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Ahn, Chul-Soo (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Moon, Deok-Bog (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Ha, Tae-Yong (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Jung, Dong-Hwan (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine)
  • 발행 : 2008.12.30

초록

Purpose: This study was conducted to evaluate the technical feasibility and the impact on survival of the anterior approach technique for resecting a huge hepatocelluar carcinoma (HCC) as compared with the conventional approach technique. Methods: We performed a retrospective observational study on 57 patients who underwent right hemihepatectomy for a huge HCC over than 10cm in diameter. A total of 57 patients were divided into two groups; the anterior approach technique group (AA group, n=23) and the conventional approach group (CA group, n=34). The overall perioperative data was collected and analyzed. The post-hepatectomy liver function, the operative mortality and morbidity and the survival outcome were compared between the two groups. Results: The post-hepatectomy liver function profile was not significantly different between the two groups. The operative mortality and morbidity were comparable in both groups. The transfusion requirement was not significantly different in both groups (p=0.470), but the cases without transfusion were more common in the AA group (p=0.046). The tumor with an advanced stage (UICC stage III/IV) was significantly more frequent in the AA group (p=0.014). The overall patient survival and disease-free survival was not significantly different between the two groups despite of the difference of the disease stage between the 2 groups (p=0.050, p=0.822). Pulmonary metastasis was more common in the CA group (p=0.035). Conclusions: Despite of the advanced disease state, the anterior approach technique resulted in comparable operative and survival outcomes as compared with the outcomes of the conventional approach technique. In terms of the technical feasibility, the anterior approach technique may reduce the required amount of transfusion when performing hepatectomy for a huge HCC.

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