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Azoulay D, Salloum C, Allard MA, Serrablo A, Moussa M, Romano P, Pietraz D, Golse N, Lim C. Complex Hepatectomy Under Total Vascular Exclusion of the Liver Preserving the Caval Flow with Portal Hypothermic Perfusion and Temporary Portacaval Shunt: A Proof of Concept. Ann Surg Oncol 2024:10.1245/s10434-024-15227-7. [PMID: 38592622 DOI: 10.1245/s10434-024-15227-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Hypothermic liver perfusion decreases ischemia/reperfusion injury during hepatectomy under standard total vascular exclusion (TVE) of the liver. This surgery needs venovenous bypass and is hampered by high morbi-mortality. TVE preserving the inferior vena cava (IVC) flow is hemodynamically well tolerated but remains limited in duration when performed under liver normothermia. The objective of this study was to report the results of TVE preserving the caval flow, modified to allow hypothermic liver perfusion and obviate splanchnic congestion. PATIENTS AND METHODS The technique, indicated for tumors abutting large tributaries of the hepatic veins but sparing their roots in IVC and the latter, was applied when TVE was anticipated to last for ≥ 60 min. It combines continuous TVE preserving the IVC flow with hypothermic liver perfusion and temporary portacaval shunt (PCS). Results are given as median (range). RESULTS Vascular control was achieved in 13 patients with excellent hemodynamical tolerance. PCS was direct or via an interposed synthetic graft (five and eight cases, respectively). Liver temperature dropped to 16.5 (6-24) °C under perfusion of 2 (2-4) L of cold perfusate. TVE lasted 67 (54-125) min and 4.5 (0-8) blood units were transfused. Resection was major in nine cases and was complete in all cases. Five complications occurred in four patients, and the 90-day mortality rate was zero. CONCLUSIONS This technique maintains stable hemodynamics and combines the advantages of in situ or ex situ standard TVE with hypothermic liver perfusion, without their inherent prolongation of ischemia time and need for venovenous bypass.
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Affiliation(s)
- Daniel Azoulay
- Centre Hépato-Biliaire, Department of Surgery, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France.
| | - Chady Salloum
- Centre Hépato-Biliaire, Department of Surgery, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | - Marc-Antoine Allard
- Centre Hépato-Biliaire, Department of Surgery, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Maya Moussa
- Centre Hépato-Biliaire, Department of Anesthesiology, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | - Pierluigi Romano
- Centre Hépato-Biliaire, Department of Surgery, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | - Daniel Pietraz
- Centre Hépato-Biliaire, Department of Surgery, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | - Nicolas Golse
- Centre Hépato-Biliaire, Department of Surgery, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | - Chetana Lim
- Department of Surgery, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Villejuif, France
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Balci D, Ozcelik M, Kirimker EO, Cetinkaya A, Ustuner E, Cakici M, Inan B, Alanoglu Z, Bilgic S, Akar AR. Extended left hepatectomy for intrahepatic cholangiocarcinoma: hepatic vein reconstruction with in-situ hypothermic perfusion and extracorporeal membrane oxygenation. BMC Surg 2018; 18:7. [PMID: 29386002 PMCID: PMC5793354 DOI: 10.1186/s12893-018-0342-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/25/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Liver resection for intrahepatic cholangiocarcinoma (ICC) with invasion of the inferior vena cava (IVC) and hepatic veins (HV) is a challenging procedure. CASE PRESENTATION We report a case of a 63-year-old woman with a 6-cm, centrally located liver mass. Her biochemistry results were normal except for a Ca19-9 level of 1199 U/ml. The liver biopsy was consistent with ICC and 60% macrosteatosis. Abdominal CT scans revealed a large central mass invading the left HV, middle HV and right HV, infringing on their junction with the vena cava. An operation was planned using a 3-dimensional (3D) computer simulation model using dedicated software. We also describe a novel veno-portal-venous extracorporeal membrane oxygenation (VPV-ECMO) support with in-situ hypothermic perfusion (IHP) during this procedure. We aimed to perform an extended left hepatectomy and reconstruct 3 right HV orifices with an interposition jump graft to the IVC with total vascular exclusion (TVE) and IHP A supplemental video describing the preoperative planning, the operative procedure with the postoperative follow-up in detail is presented. After the patient was discharged, she developed a hepatic venous outflow obstruction 3 months postoperatively, which was effectively managed with hepatic venous stenting by interventional radiology. She is currently symptom free and without tumour recurrence at the 1-year follow-up. CONCLUSIONS This report demonstrates that extended left hepatectomy for IHC with IHP and VPV-ECMO is safe and feasible under the supervision of a highly experienced team.
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Affiliation(s)
- Deniz Balci
- Department of General Surgery, Ankara University School of Medicine, K4 06590 Sihhiye, Ankara, Turkey.
| | - Menekse Ozcelik
- Department of Anesthesiology, Ankara University School of Medicine, Ankara, Turkey
| | - Elvan Onur Kirimker
- Department of General Surgery, Ankara University School of Medicine, K4 06590 Sihhiye, Ankara, Turkey
| | - Arda Cetinkaya
- Department of General Surgery, Ankara University School of Medicine, K4 06590 Sihhiye, Ankara, Turkey
| | - Evren Ustuner
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Mehmet Cakici
- Department of Cardiovascular Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Bahadir Inan
- Department of Cardiovascular Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Zekeriyya Alanoglu
- Department of Anesthesiology, Ankara University School of Medicine, Ankara, Turkey
| | - Sadik Bilgic
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Ahmet Ruchan Akar
- Department of Cardiovascular Surgery, Ankara University School of Medicine, Ankara, Turkey
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Complex Liver Resection Using Standard Total Vascular Exclusion, Venovenous Bypass, and In Situ Hypothermic Portal Perfusion. Ann Surg 2015; 262:93-104. [DOI: 10.1097/sla.0000000000000787] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
Hepatobiliary surgery outcomes have significantly improved since the early 1970s. Surgical and anesthetic advances related to patient selection, alternative surgical management options, and reduction of operative blood loss have been important. Postoperative analgesic regimens are being modified to include intrathecal opiates and to embrace enhanced recovery regimens.
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Stättner S, Yip V, Jones RP, Lacasia C, Fenwick SW, Poston GJ, Malik H. Liver resection with concomitant inferior vena cava resection: experiences without veno-venous bypass. Surg Today 2013; 44:1063-71. [DOI: 10.1007/s00595-013-0652-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/13/2013] [Indexed: 12/13/2022]
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Complex Hepatectomy under Total Vascular Exclusion of the Liver: Impact of Ischemic Preconditioning on Clinical Outcomes. World J Surg 2013; 37:838-46. [DOI: 10.1007/s00268-012-1865-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dixon E, Vollmer CM, Bathe OF, Sutherland F. Vascular occlusion to decrease blood loss during hepatic resection. Am J Surg 2005; 190:75-86. [PMID: 15972177 DOI: 10.1016/j.amjsurg.2004.10.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2004] [Revised: 10/05/2004] [Accepted: 10/05/2004] [Indexed: 02/06/2023]
Abstract
BACKGROUND Historically, the primary hazard with liver surgery has been intraoperative blood loss. This led to the refinement of inflow and outflow occlusive techniques. The utility of the different methods of inflow and outflow techniques for hepatic surgery were reviewed. METHODS A search of the English literature (Medline, Embase, Cochrane library, Cochrane clinical trials registry, hand searches, and bibliographic reviews) using the terms "liver," "hepatic," "Pringle," "total vascular exclusion," "ischemia," "reperfusion," "inflow," and "outflow occlusion" was performed. RESULTS A multitude of techniques to minimize blood loss during hepatic resection have been studied. The evidence suggests that inflow occlusion techniques are generally well tolerated. These should be used with caution in patients with cirrhosis, fibrosis, steatosis, cholestasis, and recent chemotherapy, and for prolonged time intervals. CONCLUSIONS Harmful effects of intraoperative blood loss and transfusion occur during hepatic resection. Portal triad clamping (PTC) is associated with less blood loss compared with no clamping. In procedures with ischemic times <1 hour in length, PTC-C (continuous) is likely equal to PTC-I (intermittent). In patients with chronic liver disease or undergoing lengthy operations, PTC-I is likely superior to PTC-C. PTC is superior to total vascular exclusion except in patients with tumors that are large and deep seated, hypervascular, and/or abutting the hepatic veins or vena cava and in patients with increased right-sided heart pressures.
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Affiliation(s)
- Elijah Dixon
- Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Azoulay D, Eshkenazy R, Andreani P, Castaing D, Adam R, Ichai P, Naili S, Vinet E, Saliba F, Lemoine A, Gillon MC, Bismuth H. In situ hypothermic perfusion of the liver versus standard total vascular exclusion for complex liver resection. Ann Surg 2005; 241:277-85. [PMID: 15650638 PMCID: PMC1356913 DOI: 10.1097/01.sla.0000152017.62778.2f] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
SUMMARY BACKGROUND DATA We compare the results of liver resection performed under in situ hypothermic perfusion versus standard total vascular exclusion (TVE) of the liver <60 minutes and > or =60 minutes in terms of liver tolerance, liver and renal functions, postoperative morbidity, and mortality. The safe duration of TVE is still debated. Promising results have been reported following TVE associated with hypothermic perfusion of the liver with durations of up to several hours. The 2 techniques have not been compared so far. METHODS The study population includes 69 consecutive liver resections under TVE <60 minutes (group TVE<60', 33 patients), > or =60 minutes (group TVE> or =60', 16 patients), and in situ hypothermic perfusion (group TVEHYOPOTH, 20 patients). Liver tolerance (peaks of transaminases), liver and kidney function (peak of bilirubin, minimum prothrombin time, and peak of creatinine), morbidity, and in-hospital mortality were compared within the 3 groups. RESULTS The postoperative peaks of aspartate aminotransferase (IU/L) and alanine aminotransferase (IU/L) were significantly lower (P[r] < 0.05) in group TVE HYPOTH (450 +/- 298 IU/L and 390 +/- 391 IU/L) compared with the groups TVE<60' (1000 +/- 808; 853 +/- 743) and TVE> or =60' (1519 +/- 962; 1033 +/- 861). In the group TVEHYPOTH, the peaks of bilirubin (micromol/L) (84 +/- 31), creatinine (micromol/L) (75 +/- 22), and the number of complications per patient (1.2 +/- 0.9) were comparable to those of the group TVE<60' (80 +/- 111; 109 +/- 77; and 0.8 +/- 1.1 respectively) and significantly lower to those of the group TVE> or =60' (196 +/- 173; 176 +/- 176, and 2.6 +/- 1.8). In-hospital mortality rates were 1 in 33, 2 in 16, and 0 in 20 for the groups TVE<60', TVE> or =60', and TVEHYOPOTH, respectively, and were comparable. On multivariate analysis, the size of the tumor, portal vein embolization, and a planned vascular reconstruction were significantly predictive of TVE > or =60 minutes. CONCLUSIONS Compared with standard TVE of any duration, hypothermic perfusion of the liver is associated with a better tolerance to ischemia. In addition, compared with TVE > or =60 minutes, it is associated with better postoperative liver and renal functions and a lower morbidity. Predictive factors for TVE > or =60 minutes may help to indicate hypothermic perfusion of the liver.
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Affiliation(s)
- Daniel Azoulay
- Centre Hépato-Biliaire, Département de Chirurgie Hépato-Biliaire, IFR 89.9, Hôpital Paul Brousse, Villejuif, France.
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Geller DA, Tsung A, Maheshwari V, Rutstein LA, Fung JJ, Wallis Marsh J. Hepatic resection in 170 patients using saline-cooled radiofrequency coagulation. HPB (Oxford) 2005; 7:208-13. [PMID: 18333192 PMCID: PMC2023954 DOI: 10.1080/13651820510028945] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic resection for malignancies or symptomatic benign liver lesions remains the standard of treatment. Historically, the principal cause of mortality during liver resection was intraoperative bleeding. Advances in surgical and anesthetic techniques, along with application of new technologies, have decreased blood loss and dramatically improved the outcomes for major liver surgery. METHODS The purpose of this prospective study was to determine the utility of a saline-cooled radiofrequency coagulation device (TissueLink Medical, Inc.) for hepatic resection. Intraoperative bleeding, blood transfusion, postoperative bile leak, and other complications were noted. RESULTS The results are described for 170 patients undergoing hepatic resection over a three-year period. There were no intraoperative or postoperative deaths. Six patients in the series received blood transfusions for a transfusion rate of 3.5%. Four patients experienced a transient postoperative bile leak. Three of the four closed spontaneously prior to discharge home, and the fourth closed promptly after ERCP. There were no episodes of postoperative hemorrhage, hepatic failure, liver abscess, or reoperation. CONCLUSIONS The saline-cooled radiofrequency coagulation device is very effective in achieving intraoperative hemostasis and facilitates liver parenchymal transection during hepatic resection.
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Affiliation(s)
- David A. Geller
- UPMC Liver Cancer Center, Starzl Transplant Institute, Department of Surgery, University of PittsburghUSA
| | - Allan Tsung
- UPMC Liver Cancer Center, Starzl Transplant Institute, Department of Surgery, University of PittsburghUSA
| | - Vivek Maheshwari
- UPMC Liver Cancer Center, Starzl Transplant Institute, Department of Surgery, University of PittsburghUSA
| | - Lisa A. Rutstein
- UPMC Liver Cancer Center, Starzl Transplant Institute, Department of Surgery, University of PittsburghUSA
| | - John J. Fung
- UPMC Liver Cancer Center, Starzl Transplant Institute, Department of Surgery, University of PittsburghUSA
| | - J. Wallis Marsh
- UPMC Liver Cancer Center, Starzl Transplant Institute, Department of Surgery, University of PittsburghUSA
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Abstract
This article demonstrates the broad range of considerations that affect the outcome of patients undergoing hepatectomy. The progressive improvements in survival, despite the increasing complexity of the surgery, area testament to advances in both surgery and anesthesia. The key elements include careful patient selection, appropriate monitoring, and mechanical and pharmacologic protection of the liver and other vital organs.
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Affiliation(s)
- Imre Redai
- Department of Anesthesiology, College of Physicians and Surgeons at Columbia University, New York Presbyterian Hospital, PH-5, 622 West 168th Street, New York, NY 10032, USA
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Abstract
The resection of primary and secondary liver tumors has become accepted as the only curative therapy that can be offered to patients with these cancers. Technical advances made over the last two decades have improved the ability of the surgeon to perform these procedures with decreased morbidity. This article reviews hepatic anatomy, the preoperative evaluation of patients and various technical aspects involved in liver resections. The latter includes the role of intraoperative ultrasound and techniques of vascular occlusion and hepatic parenchymal dissection.
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Affiliation(s)
- Ming-Hui Fan
- Division of Surgical Oncology, 3302 Cancer Center, University of Michigan Medical Center, 1500 E. Medical Center Drive, Ann Arbor 48109, USA
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Curley SA, Cusack JC, Tanabe KK, Stoelzing O, Ellis LM. Advances in the treatment of liver tumors. Curr Probl Surg 2002; 39:449-571. [PMID: 12019420 DOI: 10.1067/msg.2002.122810] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Steven A Curley
- The University of Texas M.D. Anderson Cancer Center, Houston, USA
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Pszenny C, Krawczyk M, Paluszkiewicz R, Hevelke P, Zieniewicz K, Grzelak I, Tomaszewski P, Kuczyńska J, Pachecka J. Biochemical function of the donor liver in living related liver transplantation. Transplant Proc 2002; 34:621-2. [PMID: 12009642 DOI: 10.1016/s0041-1345(01)02863-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Cezary Pszenny
- Department of General and Liver Surgery, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland.
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Ji JF, Gu J, Su XQ, Jiao CY, Wang Y, Ou Yang XH, Dong PD, Yang CW. Major hepatic resection under total vascular exclusion. Chin J Cancer Res 2001. [DOI: 10.1007/s11670-001-0032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Torzilli G, Makuuchi M, Midorikawa Y, Sano K, Inoue K, Takayama T, Kubota K. Liver resection without total vascular exclusion: hazardous or beneficial? An analysis of our experience. Ann Surg 2001; 233:167-75. [PMID: 11176121 PMCID: PMC1421197 DOI: 10.1097/00000658-200102000-00004] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate retrospectively the safety and radicality of liver resection performed without total vascular exclusion (TVE). SUMMARY BACKGROUND DATA TVE is recommended for safe liver surgery, at least in the case of resection of the paracaval portion of the liver. However, it has some drawbacks because of its invasiveness. METHODS The authors retrospectively evaluated 329 of 471 consecutive patients who underwent liver resection from October 1994 to October 1999. All of these patients had tumors involving segments 1, 7, or 8 or the cranial portion of segment 4, or underwent major hepatectomies that required exposure of the inferior vena cava (IVC), the main trunks of the hepatic veins, or both. Sixty-four patients underwent resection that included segment 1, with or without the reconstruction of the IVC, the hepatic vein, or both. RESULTS Three hundred twenty-four of 329 procedures were done under intermittent warm ischemia; no clamping methods were used in 6. TVE was never needed. There were no postoperative 30-day deaths. The complication rate was 25.5%, and only 2.1% had major complications. Only 13 (3.9%) patients required whole blood transfusion. Part of the wall of the IVC was resected in six patients, and the hepatic veins were reconstructed in four. Surgical clearance was achieved in all patients undergoing surgery for a tumor. CONCLUSIONS These results show that liver surgery performed without TVE is safe and effective even in aggressive procedures for liver tumors involving the cavohepatic junction. Therefore, TVE should be further restricted to exceptional patients.
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Affiliation(s)
- G Torzilli
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan.
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Evans PM, Vogt DP, Mayes JT, Henderson JM, Walsh RM. Liver resection using total vascular exclusion. Surgery 1998; 124:807-13; discussion 814-5. [PMID: 9781005 DOI: 10.1067/msy.1998.91225] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Total vascular exclusion (TVE) is a technique of liver resection that includes controlling both the suprahepatic and infrahepatic vena cava in addition to portal inflow at the time of parenchymal transection. We report a series of 61 liver resections in 60 patients using this technique. METHODS A retrospective review of 61 procedures in 60 patients using TVE between 1990 and 1997 was carried out. No patient had cirrhosis. Parameters analyzed included age, gender, diagnosis, procedure, operative time, clamp time, intraoperative transfusion requirements, postoperative laboratory studies, length of stay (intensive care unit, ward), mortality, and morbidity. RESULTS TVE was sustained hemodynamically in all patients. The mean age of the 34 men and 27 women was 56 years (+/- 15 years); 21% were older than 70 years. Eleven percent of the patients had benign lesions; 70% of the malignant tumors were metastatic. Seventy-five percent of the procedures were major or extended lobectomies. The mean operative and clamp times were 330 +/- 83 and 39 +/- 13.2 minutes, respectively; 68% had clamp times of < 45 minutes. The mean intraoperative red blood cell units was 1.45 +/- 1.93, with a range of 0 to 8 units; 48% required no transfusion and 80% received 2 units or less. There was 1 perioperative death for a mortality rate of 1.6%. The morbidity rate was 36%, which included 4 patients with postoperative liver dysfunction. Complications were not associated with transfusion but with clamp times exceeding 45 minutes. Liver dysfunction occurred with clamp times more than 60 minutes, particularly if the remaining liver parenchyma was histologically abnormal or the remnant was small. CONCLUSIONS TVE is hemodynamically safe, even in patients older than 70 years. Blood loss during parenchymal transection is minimal; mortality and morbidity are low. The optimal clamp time is less than 45 minutes. Liver dysfunction is associated with clamp times exceeding 1 hour, particularly if the remaining parenchyma is abnormal or small.
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Affiliation(s)
- P M Evans
- Department of General Surgery, Cleveland Clinic Foundation, Ohio 44195, USA
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Lee RG, Emond J. Prognostic Factors and Management of Carcinomas of the Gallbladder and Extrahepatic Bile Ducts. Surg Oncol Clin N Am 1997. [DOI: 10.1016/s1055-3207(18)30320-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
BACKGROUND Anatomical resection has become the basis for the treatment of hepatic tumors recognizing the portal-based intrahepatic architecture of the liver. In transplantation, these principles have been applied to the creation of partial liver grafts used to treat pediatric recipients with grafts from adult donors. In this study we reviewed the results of application of these techniques in 60 patients undergoing major hepatectomy and in 47 liver transplants in children. METHODS Records of patients undergoing resection and children undergoing transplantation were reviewed. A descriptive study was performed characterizing the methods and results achieved using anatomic hepatectomy. Outcomes analyzed included surgical morbidity and survival. RESULTS Sixty consecutive patients underwent major hepatectomy without operative mortality (60 days). Complications occurred in 26% of patients, requiring reoperation in 2 cases (3%); median hospital stay was 8.5 days. Of 47 liver transplants in children, 57% utilized partial grafts, and living donors were used in 15 cases. Actual patient survival is 91% 1-36 months after surgery. No patient deaths were due to technical graft failure. CONCLUSIONS Major hepatic surgery can be accomplished with low mortality applying portal-based anatomy. Surgical precision is made possible by vascular isolation for hepatectomy and operative ultrasonography. These principles are essential for successful use of partial liver grafts in children.
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Affiliation(s)
- J C Emond
- Department of Surgery, University of California, San Francisco, USA
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