Monitoring hepatic venous hemoglobin oxygen saturation during Appleby operation for pancreatic cancer.
OBJECTIVE
When an Appleby operation is performed for pancreatic body and tail carcinoma, it is necessary for prevention of hepatic ischemia to estimate accurately the hepatic circulation after resection of the celiac artery, the common hepatic artery and the portal vein. We studied the hepatic circulation by monitoring the ShvO2 (hepatic venous hemoglobin oxygen saturation) during an Appleby operation.


METHODS
We performed an Appleby operation on 8 patients with pancreatic cancer. In 6 of 8 patients, a 7-Fr fiberoptic flow direct catheter was inserted in the right hepatic vein. The ShvO2 values were monitored continuously during surgery.


RESULTS
The ShvO2 value was 76 +/- 3.5% just after laparotomy, and reduced to 61 +/- 13.2% after clamping the common hepatic artery. The values of the ShvO2 returned to 70.8 +/- 10.9% one hour after clamping. But, one patient underwent reconstruction of the common hepatic artery, because the ShvO2 value still stood at 50%. Combined resection of the portal vein was performed in 5 out of 8 patients. Two patients underwent resection of the portal vein without reconstruction due to the development of the collateral vein, one patients; resection of the portal vein with reconstruction, and two patients; wedge resection. In all 5 patients, the ShvO2 was stable during resection of the portal vein.


CONCLUSIONS
Monitoring the ShvO2 is a useful method to evaluate at real time the hepatic circulation during the Appleby operation, and to decide if reconstruction of the common hepatic artery or the portal vein is needed or not.
Miyakawa
Shuichi
S
Second Department of Gastroenterological Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutukake, Toyoake 470-11, Aichi, Japan. smiyaka@fujita-hu.ac.jp
Horiguchi
Akihiko
A
Hanai
Tsunekazu
T
Mizuno
Kenji
K
Ishihara
Shin
S
Niwamoto
Naotatsu
N
Iwase
Yuji
Y
Asano
Yukio
Y
Furusawa
Kouichi
K
Miura
Kaoru
K
Kainuma
Motoshi
M
D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006503:Hepatic Veins; D006801:Humans; D008102:Liver Circulation; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010100:Oxygen / Q000097:blood*; D010190:Pancreatic Neoplasms / Q000503:physiopathology / Q000601:surgery*; D011169:Portal Vein / Q000601:surgery
D006454:Hemoglobins; D010100:Oxygen