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Determinants of the approach for hepatectomy: outcome of a prospective analytical study
Dinesh Zirpe1,   Azaz Ahmed1,  Rochita Venkataramanan2, Balasubramaniam Ramakrishnan3, Anand Khakhar1, Anil Vaidya1, Anand Ramamurthy1
1Centre for Liver, Pancreas and Small Bowel Transplantation and 2Department of Radiology, 3Biostatistics Department, Apollo Hospitals (Main), Greams  Road, Chennai, Tamilnadu, India.

Corresponding Author
Dr. Dinesh Zirpe


Background: The anterior approach (AA) technique has been advocated recently for right hepatectomy. However, the indications to opt for AA or conventional approach (CA) remain inconsistent. 
Objective: To evaluate  preoperative factors influencing the approach for hepatectomy.
Methods: A prospective study was performed on 17 patients who underwent hepatic resection from January 2014 to December 2015. All patients were planned to undergo hepatectomy with CA. The decision to adopt an AA was determined by the operating surgeon at the time of laparotomy when mobilization of the tumor before parenchymal transection was considered dangerous or difficult. 
Results: Comparing the pre operative characteristics of AA group with CA, there was no significant difference except for the total liver volume (TLV) (p = 0.0001), Tumor volume (TV) (p = 0.0001),  and Largest Tumor Dimension (LTD) (p = 0.0001). Using Receiver Operating Characteristic Curve the volume with optimal sensitivity and specificity which may alter the intra-operative plan from conventional to anterior approach was at 1858 cc, 1130 cc and 11 cm for TLV, TV and LTD respectively. Outcome of hepatectomy in both groups were comparable to each other and to the available data. 
Conclusion: Of all the analyzed preoperative factors which may affect the approach for hepatectomy TLV, TV and LTD appear to be significant determinant factors.