Survival outcomes of the combination of extrafascial extrahepatic and extrafascial intrahepatic pedicle approaches in hepatectomy for hepatocellular carcinoma.

Introduction: This study was conducted to evaluate the results of hepatectomy for hepatocellular carcinoma (HCC) by the combination of extrafascial extrahepatic (Takasaki method) and extrafascial intrahepatic pedicle approaches (Ton That Tung method).

Material and methods: A longitudinal follow-up study was conducted on 83 patients undergoing hepatectomy for HCC using the combination of extrafascial extrahepatic (Takasaki method) and extrafascial intrahepatic pedicle approaches at Nghe An Provincial Hospital from April 2017 to July 2021. Survival analysis was applied.

Results: The cumulative overall survival (OS) rates after 1, 2, 3 and 4 years were 88.4%, 76.3%, 69.5% and 56.9%, respectively. The mean OS time was 40.68 ±2.17 months. The 1-, 2-, 3- and 4-year disease-free survival (DFS) rates were 67.1%, 56%, 53.1% and 50%, respectively. The mean DFS time was 32.58 ±2.56 months. Surgical margin > 1 cm was an independent predictor of both overall and disease-free survival (HR = 5.194, 95% CI = 1.467-18,385, p = 0.011 for OS; HR = 2.822, 95% CI = 1.231-6.468, p = 0.014 for DFS).

Conclusions: Hepatectomy for HCC by a combination of extrafascial extrahepatic (Takasaki method) and extrafascial intrahepatic pedicle approaches (Ton That Tung method) is effective and safe, and side effects and complications can be controlled. Patient selection is a key issue and plays a very important role in the outcome of treatment.