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01-11-2005

Evaluation of Effect of Hemihepatic Vascular Occlusion and the Pringle Maneuver during Hepatic Resection for Patients with Hepatocellular Carcinoma and Impaired Liver Function

Authors: Gar-Yang Chau, MD, MPH, Wing-Yiu Lui, MD, Kuang-Liang King, MD, Chew-Wun Wu, MD

Published in: World Journal of Surgery | Issue 11/2005

Abstract

Reducing blood loss during resection of hepatocellular carcinoma (HCC) in patients with impaired liver function is important. This study evaluated the effect and safety of inflow occlusion (hemihepatic vascular occlusion and the Pringle maneuver) in reducing blood loss during hepatectomy. A total of 120 HCC patients with impaired liver function (with a preoperative indocyanine green retention rate at 15 minutes > 10%) who underwent hepatectomy were included in this retrospective study. Patients were divided into three groups, no-occlusion (n = 30), hemihepatic vascular occlusion (n = 49), and Pringle maneuver (n = 41). There was one hospital death in each group. Of all three groups, 50 patients (41.7%) had blood loss less than 1000 ml. The three groups were similar in terms of clinocopathological features. All patients underwent minor resection. Blood loss was significantly greater in the no-occlusion group; there was no difference between the hemihepatic group and the Pringle group. Multivariate analysis revealed that risk factors related to blood loss included no inflow occlusion [odds ratios (ORs), 2.93; 95% confidence intervals (CIs) 1.13–7.59], tumor centrally located (ORs, 3.85; 95% CIs, 1.50–9.90), serum albumin level < 3.5 gm/dl (ORs, 5.15; 95% CIs, 1.20–22.07), and serum alanine aminotransferase >120 U/l (ORs, 3.58; 95% CIs, 1.19–10.80). For patients with occlusion time ≥ 45 minutes, postoperative serum total bilirubin and aspartate aminotransferase levels in the Pringle group were significantly higher than those in the hemihepatic and no-occlusion groups (P < 0.05). In HCC patients with impaired liver function undergoing hepatectomy, both hemihepatic vascular occlusion and the Pringle maneuver are safe and effective in reducing blood loss. Patients subjected to hemihepatic vascular occlusion responded better than those subjected to the Pringle maneuver in terms of earlier recovery of postoperative liver function, especially when occlusion time was ≥ 45 minutes.

Arii S, Yamaoka Y, Futagawa S, et al. Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinoma: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan. Hepatology 2000;32:1224–1229CrossRefPubMed

Chen YJ, Chau GY, Lui WY, et al. Clinicopathologic features and factors related to survival of patients with small hepatocellular carcinoma after hepatic resection. World J Surg 2003;27:294–298PubMed

Nonami T, Nakao A, Kurokawa T, et al. Blood loss and ICG clearance as best prognostic markers of post-hepatectomy liver failure. Hepatogastroenterology 1999;46:1669–1677PubMed

Belghiti J, Noun R, Zante E, et al. Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study. Ann Surg 1996;224:155–161CrossRefPubMed

Pringle JH. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg 1908;48:541–549

Man K, Fan ST, Ng IOL, et al. Tolerance of the liver to intermittent Pringle maneuver in hepatectomy for liver tumors. Ann Surg 1999;134:533–539

Malassagne B, Cherqui D, Alon R, et al. Safety of selective vascular clamping for major hepatectomies. J Am Coll Surg 1998;187:482–486CrossRefPubMed

Makuuchi M, Mori T, Gunven P, et al. Safety of hemihepatic vascular occlusion during resection of the liver. Surg Gynecol Obstet 1987;164:155–158PubMed

Yamamoto Y, Ikai I, Kume M, et al. New simple technique for hepatic parenchymal resection using a Cavitron Ultrasonic Surgical Aspirator and bipolar cautery equipped with a channel for water dripping. World J Surg 1999;23:1032–1037PubMed

10.

Chau GY, Lui WY, Tsay SH, et al. Prognostic significance of surgical margin in hepatocellular carcinoma resection: an analysis of 165 Childs’ A patients. J Surg Oncol 1997;66:122–126CrossRefPubMed

11.

Lui WY, Chau GY, Loong CC, et al. Hepatic segmentectomy for curative resection of primary hepatocellular carcinoma. Arch Surg 1995;130:1090–1097PubMed

12.

Lui WY, Chau GY. Operative approaches to hepatocellular carcinoma in the cirrhotic patient. In Wanebo HJ, editor, Surgery for Gastrointestinal Cancer: A Multidisciplinary Approach, Philadelphia, Pennsylvania, Lippincott-Raven, 1997;533–539

13.

Chang CH, Chau GY, Lui WY, et al. Long-term results of hepatic resection for hepatocellular carcinoma originating from the noncirrhotic liver. Arch Surg 2004;139:320–325PubMed

14.

Goseki N, Kato S, Takamatsu S, et al. Hepatic resection under the intermittent selective portal branch occlusion by balloon catheter. J Am Coll Surg 1994;179:673–678PubMed

15.

Stephen MS, Sheil AGR, Thompson JF, et al. Aortic occlusion and vascular isolation allowing avascular hepatic resection. Arch Surg 1990;125:1482–1485PubMed

16.

Taniguchi H, Takahashi T, Shioaki Y, et al. Vascular inflow exclusion and hepatic resection. Br J Surg 1992;79:672–675PubMed

17.

Ezaki T, Seo Y, Tomoda H, et al. Partial hepatic resection under intermittent hepatic inflow occlusion in patients with chronic liver disease. Br J Surg 1992;79:224–226PubMed

18.

Hasselgren PO. Prevention and treatment of ischemia of the liver. Surg Gynecol Obstet 1987;164:187–196PubMed

19.

Miyagawa S, Makuuchi M, Kawasaki S, et al. Serum amylase elevation following hepatic resection in patients with chronic liver disease. Am J Surg 1996;171:235–238CrossRefPubMed

20.

Couinaud C. The Vasculo-biliary Sheaths. Surgical Anatomy of the Liver Revisited. Paris, Couinaud, 1989;29–39

21.

Launois B, Jamieson GG. The posterior intrahepatic approach for hepatectomy or removal of segments of the liver. Surg Gynecol Obstet 1992;174:155–158PubMed

22.

Clavien PA, Selzner M, Rudiger HA, et al. A prospective randomized study in 100 consecutive patients undergoing major liver resection with versus without ischemic preconditioning. Ann Surg 2003;238:843–852PubMed

23.

Millat B, Hay JM, Descottes B, et al. Prospective evaluation of ultrasonic surgical dissectors in hepatic resection: a cooperative multicenter study. HPB Surg 1992;5:135–144PubMed

24.

Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection. Br J Surg 1998;85:1058–1060PubMed

25.

Chouker A, Schachtner T, Schauer R, et al. Effects of Pringle manoeuvre and ischaemic preconditioning on haemodynamic stability in patients undergoing elective hepatectomy: a randomized trial. Br J Anaesth 2004;93:204–211CrossRefPubMed

26.

Chen H, Merchant NB, Didolkar MS. Hepatic resection using intermittent vascular inflow occlusion and low central venous pressure anesthesia improves morbidity and mortality. J Gastrointest Surg 2000;4:162–167CrossRefPubMed

Title: Evaluation of Effect of Hemihepatic Vascular Occlusion and the Pringle Maneuver during Hepatic Resection for Patients with Hepatocellular Carcinoma and Impaired Liver Function
Authors: Gar-Yang Chau, MD, MPH
Wing-Yiu Lui, MD
Kuang-Liang King, MD
Chew-Wun Wu, MD
Publication date: 01-11-2005
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 11/2005
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-005-7766-4

At a glance: The STEP trials

Springer Medicine

Evaluation of Effect of Hemihepatic Vascular Occlusion and the Pringle Maneuver during Hepatic Resection for Patients with Hepatocellular Carcinoma and Impaired Liver Function

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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