Background/Aims: Thoraco-abdominal approach is a suitable choice for hepatectomy to secure good view for mobilization. The aim of this study was to assess efficacy of thoraco-abdominal approach (TAA) for hepatectomy. Methodology: There were compared clinicopathological data, surgical results and postoperative complications of 425 consecutive patients who underwent hepatectomy via abdominal (AA) (n=147) or TAA (n=278). Results: Blood loss and operating time were significantly higher in TAA than AA group (970 vs. 830ml and 408 vs. 372 min.)(p<0.05). Prevalence of pleural effusion was significantly higher in TAA than AA group (24 vs. 9%) (p<0.01). However, proportions of patients who developed hepatic complications such as biloma (14 vs. 23%), and wound infection (8 vs.25%) were significantly less in TAA than AA group (p<0.05). Hospital stay after hepatectomy and mortality were similar between both groups. Presence of chronic viral hepatitis, lower platelet count, higher level of serum hyaluronic acid, larger blood loss and TAA correlated significantly with thoracic complications (p<0.05). Multivariate analysis showed that increased blood loss (p=0.011), but not TAA, was a significant determinant of thoracic complications (p=0.08). Conclusions: TAA can be considered a relatively safe approach for hepatectomy with minimal abdominal complications nevertheless of frequent pleural effusion
