Abstract
Background Data:
Hepatic resection of a large HCC represents a surgical challenge. In patients with large HCC in the right liver, the conventional technique for hepatectomy, i.e., mobilization of the right liver from the retro peritoneum and anterior surface of the inferior vena cava may be difficult because of the tumor volume and local adhesions. Likewise, even if the mobilization can be accomplished, the forceful manipulation of the liver can result in tumor rupture and dissemination of malignant disease.
Objective:
To report the efficacy of using the anterior approach versus the conventional approach, in surgical resection for large hepatocellular carcinoma (HCC) in terms of surgical and long-term outcomes.

Methods:
Between 2000 and 2006, 126 consecutive patients who underwent hepatic resection with curative intent for large right HCC ≥7 cm were identified from a prospective database. The 36 patients who had anterior approach were compared with the remaining 90 patients who had conventional approach .Clinicopathological features and surgical results were analyzed and prognostic factors were evaluated by multivariate analysis.
Results:
There was no significant difference between the 2 groups as regard clinical, laboratory and pathological parameters. The operative results had shown a comparable proportion of patients experienced massive operative blood loss and postoperative complications in the 2 groups. The AA group had a lower recurrence rate (P = 0•015), better disease-free survival (DFS) (P = 0•001) and overall survival than the CA group. Our study identified that AA is prognostic factor of both overall survival and disease-free survival for large HCC ≥7cm.

Conclusion:
The anterior approach is a safe and effective technique for right hepatic resection for large HCC and achieves more advantageous long survival outcome over the conventional approach.