Laparoscopic extrahepatic Glissonian versus hilar dissection approach for major hepatectomy in patients with HCC: a randomized controlled trial

During laparoscopic major hepatectomy (LMH) for patients with hepatocellular carcinoma (HCC), an appropriate approach for hepatic hilum treatment is crucial. However, to date, there is still controversy about whether the Glissonian approach or hilar dissection approach is more advantageous for hepatic hilum treatment.

Thus, we performed this randomized controlled trial to compare the short- and long-term outcomes between the Glissonian and hilar dissection approaches for LMH. Between November 2017 and July 2021, 256 HCC patients who initially met the criteria via preoperative evaluation were randomly assigned to this trial.

After surgical exploration, 119 patients in the Glissonian group and 121 patients in the hilar dissection group were eventually enrolled in the modified intention-to treat (ITT) principled analysis. Perioperative data and survival outcomes between both groups were recorded and compared, and subgroup analysis was further performed.

The 5-year OS rates and 5-year DFS rates were comparable between the two groups. In addition, postoperative overall complications, including bile duct injury, leakage, and stricture, did not differ between the groups.