Background: A study is carried out to assess the possible advantages of operative and postoperative outcomes of
the anterior approach (AA) over the conventional approach (CA) in major right hepatectomy for large hepatocellular
carcinoma (HCC).
Patients and Methods: A prospective randomized controlled study was performed on 50 patients who had a large (≥5
cm) right lobe of the liver HCC and underwent curative right formal hepatectomy during a 28-month period. The patients
were randomized to undergo resection of the tumor using the anterior approach technique (AA group, n=25) or the
conventional approach technique (CA group, n=25). The CA involves initial complete mobilization of the right liver
followed by extrahepatic vascular control then hepatic parenchymatous dissection is performed. AA consists of initial
vascular inflow control and parenchymal transection before mobilization of the right lobe.
Results: There was no significant difference between the two groups as regards clinical, laboratory, and pathological
parameters. The operative results showed a significant blood loss in the CA group in comparison to the AA group. The
AA group had better disease-free survival and overall survival than the CA group.
Conclusion: The anterior approach is the recommended technique for right formal hepatectomy for large HCC as it
results in improved operative and survival outcomes of the patients.