BACKGROUND: To investigate the efficacy and safety of adding continuous occlusion of hepatic artery proper to intermittent Pringle maneuver in partial hepatectomy for ruptured hepatocellular carcinoma. MATERIALS AND METHODS: This is a retrospective study on data that were prospectively collected and entered into a computer database. A total of 36 patients who underwent partial hepatectomy for ruptured HCC by adding continuous occlusion of hepatic artery proper to intermittent Pringle maneuver at a tertiary care university hospital were compared with a historical case-matched control group of 36 patients who received intermittent Pringle maneuver only. RESULTS: The patient characteristics were comparable for the 2 groups of patients. The mean hepatic artery occlusion time was 58 min (range 36-98 min). Intraoperative blood loss and blood transfusion rate in the study group were significantly lower than the control group (P < .001 and P = .004, respectively). There were no significant differences in the postoperative serum aspartate transaminase and total bilirubin levels (P = .087, P = .135, respectively), and in the postoperative hospital stay and surgical complications according to Clavien's classification between the two groups (P = 0.213, P = 1.000, respectively). The disease-free survival rates in the study group was significantly better than the control group (P = .023). Overall, HCC patients with rupture had poor prognosis. CONCLUSIONS: The addition of continuous occlusion of hepatic artery proper to intermittent Pringle maneuver significantly reduced intraoperative blood loss for partial hepatectomy in patients with ruptured HCC when compared with intermittent Pringle maneuver alone. The procedure was found to be safe even for patients with liver cirrhosis.
BACKGROUND: To investigate the efficacy and safety of adding continuous occlusion of hepatic artery proper to intermittent Pringle maneuver in partial hepatectomy for ruptured hepatocellular carcinoma. MATERIALS AND METHODS: This is a retrospective study on data that were prospectively collected and entered into a computer database. A total of 36 patients who underwent partial hepatectomy for ruptured HCC by adding continuous occlusion of hepatic artery proper to intermittent Pringle maneuver at a tertiary care university hospital were compared with a historical case-matched control group of 36 patients who received intermittent Pringle maneuver only. RESULTS: The patient characteristics were comparable for the 2 groups of patients. The mean hepatic artery occlusion time was 58 min (range 36-98 min). Intraoperative blood loss and blood transfusion rate in the study group were significantly lower than the control group (P < .001 and P = .004, respectively). There were no significant differences in the postoperative serum aspartate transaminase and total bilirubin levels (P = .087, P = .135, respectively), and in the postoperative hospital stay and surgical complications according to Clavien's classification between the two groups (P = 0.213, P = 1.000, respectively). The disease-free survival rates in the study group was significantly better than the control group (P = .023). Overall, HCC patients with rupture had poor prognosis. CONCLUSIONS: The addition of continuous occlusion of hepatic artery proper to intermittent Pringle maneuver significantly reduced intraoperative blood loss for partial hepatectomy in patients with ruptured HCC when compared with intermittent Pringle maneuver alone. The procedure was found to be safe even for patients with liver cirrhosis.