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.