To investigate the safety and effect of precise pedicle transection in anatomical hepatic segmentectomy of hepatocellular carcinoma(HCC).

Sixty HCC patients, who underwent hepatic segmentectomy in Department of Hepatobiliary Surgery, the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January 2008 to April 2010, were enrolled in this prospective non-randomized controlled study. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were divided into 2 groups according to the procedure of hepatectomy: the precise pedicle transection group(precise group) and the traditional surgery group(traditional group) with 30 cases in each group. There were 25 males and 5 females in the precise group with the mean age of (51±14) years old and 23 males, 7 females in the traditional group with the mean age of (52±12) years old. Three-dimensional reconstruction was performed in patients of precise group by multi-slice spiral computed tomography (MSCT). The anatomic constructions of hepatic pedicle branches and intersegmental branch of hepatic vein of liver segment to be resected were evaluated precisely. The liver parenchyma was split using precise clamping and the pedicle of liver segment was transected. The intersegmental branch of hepatic vein was positioned by ultrasonic as the section of liver parenchyma and single or combined segmental resection was performed. Patients in the traditional group received conventional preoperative examination and evaluation. The tumor was positioned by ultrasonic during the operation and the liver segment to be resected was confirmed according to the anatomical mark of liver. The liver parenchyma was split using cavitron ultrasonic surgical aspirator(CUSA) and the pedicle was transected finally, single or combined segmental resection was completed. The comparison of measurement data of preoperative, intraoperative and postoperative between two groups was conducted using t test. The comparison of classification data was conducted using Chi-square test or Fisher definite probability test.

There was no significant difference in the patients' preoperative data, amount of intraoperative bleeding, blood transfusion, duration of surgery, surgical procedures, postoperative liver function indexes as well as postoperative length of hospital stay(P>0.05). The length of tumor incisal edge in the precise group and traditional group were(2.3±0.7)cm, (1.5±0.6)cm respectively, and significant difference was observed between two groups (t=4.950, P<0.05) . No severe postoperative complication was observed in the precise group and traditional group. The incidences of postoperative complications of the precise group and traditional group were 23% (7/30) , 50% (15/30) respectively, and significant difference was observed between two groups (χ²=4.593, P<0.05) . The 1-year HCC recurrence rate in precise group was lower than that in traditional group, but there was no significant difference between two groups [10% (3/30) vs. 17% (5/30) ; χ²=0.577, P>0.05].

The precise pedicle transection has the same safety as the conventional surgery in anatomic hepatic segmentectomy of HCC. It can reduce the incidence of postoperative complications, ensure negative tumor incisal edge, reduce the postoperative recurrence rate and improve the curative rate for HCC.