title: Liver ischemia for hepatic resection: where is the limit?
abstract: BACKGROUND
  A consecutive series of 50 patients who submitted to 53 hepatic resections with use of continuous normothermic liver ischemia is reported.
  
  
  METHODS
  Portal triad clamping has been used in 28 cases, with associated inferior vena caval clamping above and below the liver (hepatic vascular exclusion) in 25 patients. The size of the tumor required major hepatic resection in 38 cases (71.7%). Malignant tumors (83%) were the most common indication for liver resection. Patients were placed in three groups according to the duration of liver ischemia: group A, less than 30 minutes (9 patients); group B, 30 to 60 minutes (29 patients); and group C, 60 or more (15 patients).
  
  
  RESULTS
  No differences in mortality rates (5.7% in the entire series and 0% in group C) and morbidity rate could be shown. No significant difference was found in postoperative liver test results, and no persistent alteration remained thereafter. Liver biopsy at 6 and 12 months after operation did not reveal any chronic damage. Liver capability to regenerate was maintained as documented by postoperative computerized tomography scan or magnetic resonance imaging.
  
  
  CONCLUSIONS
  Because interruption of hepatic blood flow in normothermia is safe for at least 60 minutes (up to 85 minutes in this study), vascular clamping is recommended for hazardous liver resections to minimize blood loss, which appears to be the main factor of death and morbidity.
authors.affiliation: Department of Surgery, Centre Hospitalier Princesse Grace, Principality of Monaco.
authors.forename: C
authors.initials: C
authors.lastname: Huguet
authors.forename: A
authors.initials: A
authors.lastname: Gavelli
authors.forename: P A
authors.initials: PA
authors.lastname: Chieco
authors.forename: S
authors.initials: S
authors.lastname: Bona
authors.forename: J
authors.initials: J
authors.lastname: Harb
authors.forename: J M
authors.initials: JM
authors.lastname: Joseph
authors.forename: J
authors.initials: J
authors.lastname: Jobard
authors.forename: M
authors.initials: M
authors.lastname: Gramaglia
authors.forename: M
authors.initials: M
authors.lastname: Lasserre
mesh_terms: D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007511:Ischemia; D008102:Liver Circulation; D008107:Liver Diseases / Q000473:pathology / Q000601:surgery*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies
chemical_list: D001663:Bilirubin