BACKGROUND: Hepatic veins remain patent during complete inflow occlusion (CIO) and bleeding from them may continue. Occlusion of the inferior vena cava (ICV) during CIO may reduce blood loss from hepatic veins. This study was designed to compare the overall outcomes after application of CIO with or without occlusion of the ICV below the liver in complex mesohepatectomy for hepatocellular carcinoma (HCC) patients with cirrhosis. MATERIALS AND METHODS: One hundred and eighteen (118) patients were randomly assigned to CIO or a modified technique of hepatic vascular exclusion (MTHVE). Hemodynamic parameters were evaluated and the amount of blood loss, measurement of liver enzymes, and postoperative progress were recorded. RESULTS:Blood loss during liver transection in CIO groups was significantly greater than that in MTHVE group (P=0.046). Thus, incidence of blood transfusion was significantly greater in patients of the CIO group (P=0.041). There were no significant differences in liver enzyme changes, bilirubin, or morbidity in the postoperative period between the two groups. CONCLUSIONS: CIO with occlusion of the ICV below the liver is a safe, effective, and feasible technique during mesohepatectomy in HCC patients with cirrhosis. Excellent results were obtained with minimized bleeding, limited hepatic function damage, and low rate of postoperative complications.
RCT Entities:
BACKGROUND:Hepatic veins remain patent during complete inflow occlusion (CIO) and bleeding from them may continue. Occlusion of the inferior vena cava (ICV) during CIO may reduce blood loss from hepatic veins. This study was designed to compare the overall outcomes after application of CIO with or without occlusion of the ICV below the liver in complex mesohepatectomy for hepatocellular carcinoma (HCC) patients with cirrhosis. MATERIALS AND METHODS: One hundred and eighteen (118) patients were randomly assigned to CIO or a modified technique of hepatic vascular exclusion (MTHVE). Hemodynamic parameters were evaluated and the amount of blood loss, measurement of liver enzymes, and postoperative progress were recorded. RESULTS: Blood loss during liver transection in CIO groups was significantly greater than that in MTHVE group (P=0.046). Thus, incidence of blood transfusion was significantly greater in patients of the CIO group (P=0.041). There were no significant differences in liver enzyme changes, bilirubin, or morbidity in the postoperative period between the two groups. CONCLUSIONS:CIO with occlusion of the ICV below the liver is a safe, effective, and feasible technique during mesohepatectomy in HCCpatients with cirrhosis. Excellent results were obtained with minimized bleeding, limited hepatic function damage, and low rate of postoperative complications.
Authors: Ser Yee Lee; Eran Sadot; Joanne F Chou; Mithat Gönen; Thomas Peter Kingham; Peter J Allen; Ronald P DeMatteo; William R Jarnagin; Michael I D'Angelica Journal: HPB (Oxford) Date: 2015-09-10 Impact factor: 3.647
Authors: Nuh N Rahbari; Moritz Koch; Arianeb Mehrabi; Kathrin Weidmann; Edith Motschall; Christoph Kahlert; Markus W Büchler; Jürgen Weitz Journal: J Gastrointest Surg Date: 2008-07-12 Impact factor: 3.452