Surgical excision of giant primary carcinoma in the medial liver lobe.

OBJECTIVE: To assess the techniques for surgical excision of giant primary carcinoma in the medial liver lobe. METHODS: Operative managements, complications and their causes during and after resection of giant carcinoma in the medial liver lobe were analyzed retrospectively in 166 cases treated from October 1996 through December 2001. RESULTS: Of the 166 patients, 123 (74.1 %) underwent tumor resection and 43 (25.9 %) regular lobectomy, including left trilobectomy (8, 4.8 %), medial lobectomy (21, 12.7 %), right anterior lobectomy (11, 6.6 %), and hemihepatectomy (3, 1.8 %). All patients were subjected to surgery with intermittent interruption of the first porta hepatis under normothermia. The total interruption time was 7-68 minutes and average time was 24.5 minutes. The maximum single interruption time was 41 minutes. Intraoperative blood loss was 50-4000 ml, averaging 726 ml. The maximum blood transfusion was 5200 ml, averaging was 811 ml, and transfusion was not needed in 54 patients. Postoperative complications occurred in 9 patients (5.4%), of whom, 2 (1.2%) died of liver failure and acute respiratory distress syndrome respectively. CONCLUSIONS: An adequate reserve of liver function is a prerequisite for a smooth recovery after operation. Careful intraoperative management is crucial to decrease postoperative complications.