Anterior approach combined with infrahepatic inferior vena cava clamping right hepatic resection for large hepatocellular carcinoma: A prospective randomized controlled trial

BACKGROUND: The anterior approach (AA) technique has been reported to provide better operative and survival outcomes compared with the conventional approach for large right hepatocellular carcinoma (HCC) resection. However, this technique runs the risk of massive retrograde bleeding from the right hepatic vein or middle hepatic vein at the deeper plane of parenchymal transection. This study was designed to evaluate the efficacy of AA combined with infrahepatic inferior vena cava (IVC) clamping on the perioperative outcomes in patients undergoing right hepatic resection for large HCC in randomized clinical trial settings. METHODS: A total of 101 patients undergoing right hepatic resection for large HCC were randomized to receive AA combined with infrahepatic IVC clamping (group A, n = 50), or AA alone (group B, n = 51). RESULTS: The total blood loss (423 ± 154 vs 757 ± 338 mL; P = 0.001), blood loss during liver transection (272 ± 96 vs 563 ± 144 mL; P = 0.001), and intraoperative blood transfusion requirements (12.0% vs 29.4%; P = 0.031) were significantly less in group A patients compared with group B patients. There was no IVC clamping-associated morbidity in group A. CONCLUSION: AA combined with infrahepatic IVC clamping for large right HCC resection is a safe, feasible, and effective technique in reducing intraoperative blood loss.