Different approaches of laparoscopic anatomic hepatectomy of segment 7 for hepatocellular carcinoma: A multicenter study.

[BACKGROUND] Laparoscopic anatomic hepatectomy of segment 7 (LAH-S7) is a challenging surgery. In this study we aimed to investigate surgical and oncological outcomes of various approaches of LAH-S7 in patients with hepatocellular carcinoma (HCC). A particular focus was placed on identifying the Glissonean pedicle of segment 7 (G7) and the intersegmental plane. Given the scarcity of comprehensive reviews or comparative studies on clinical outcomes, we also sought to analyze the experiences and advantages associated with different approaches in relation to the anatomic variations of G7.

[METHODS] The clinical data of 124 patients who underwent LAH-S7 for HCC across seven tertiary referral medical centers in China were retrospectively analyzed. Three surgical approaches were categorized based on the procedures used for G7 identification: the indocyanine green (ICG) fluorescence positive staining approach (IFPA), the Glissonean approach (GA), and the hepatic vein-guided approach (HVGA). Subsequently, the postoperative short-term results and oncological outcomes of the three different approaches were compared.

[RESULTS] The distribution of surgical approaches among the patients was as follows: IFPA in 16 (12.9%), GA in 62 (50.0%), and HVGA in 46 (37.1%) patients. Complications were observed in 27 (21.8%) patients. The 1-, 3-, and 5-year overall survival (OS) rates were 99.1%, 89.2%, and 84.7%, respectively. The 1-, 3-, and 5-year recurrence-free survival (RFS) rates were 99.0%, 84.7%, and 69.3%, respectively. The OS and RFS rates were comparable across the three approaches.

[CONCLUSIONS] Following a standardized surgical procedure, LAH-S7 is demonstrated to be safe and yields favorable oncological outcomes. Surgeons performing LAH-S7 should select the appropriate surgical approach based on the anatomical characteristics and variations of G7.