title: Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients: a randomized comparison of hemihepatic and total hepatic occlusion techniques.
abstract: BACKGROUND
  Intermittent occlusion of hepatic blood inflow by means of a hemihepatic or total hepatic occlusion technique is essential for reducing operative blood loss. Central liver resection to preserve more functioning liver parenchyma is mandatory for centrally located liver tumors in patients with cirrhosis, but it requires a longer overall hepatic ischemic time because of a wide transection plane. No controlled comparison has been performed for the 2 techniques in these operations.
  
  
  OBJECTIVE
  Hemihepatic inflow occlusion may be beneficial in cirrhotic patients who undergo complex central hepatectomy with a wide liver transection plane.
  
  
  METHODS
  A prospective, randomized study.
  
  
  METHODS
  University hospital and tertiary referral center.
  
  
  METHODS
  During liver parenchymal transection, 58 cirrhotic patients who underwent complex central liver resections with a wide transection plane were prospectively randomized into 2 groups. In the group undergoing total hepatic inflow clamping (group T; n = 28), occlusion of hepatic blood inflow was performed for 15 minutes with declamping for 5 minutes. In the group undergoing selective clamping of ipsilateral blood inflow (group H; n = 30), clamping was performed for 30 minutes with declamping for 5 minutes.
  
  
  METHODS
  Comparison of patient backgrounds, operative procedures, and early postoperative results.
  
  
  METHODS
  Operative blood loss, need for blood transfusion, and postoperative morbidity.
  
  
  RESULTS
  The patients' backgrounds, operative procedures, and area of liver transection plane were not significantly different between the 2 groups. In all patients, the liver transection areas were greater than 60 cm(2) and overall liver ischemic times were greater than 60 minutes. The amount of operative blood loss and incidence of blood transfusion were significantly greater in group T because of greater blood loss during declamping. Overall liver ischemic and total operative times, postoperative morbidity, and postoperative changes in liver enzyme levels were not significantly different between groups. No in-hospital deaths occurred in either group.
  
  
  CONCLUSIONS
  Intermittent hemihepatic and total occlusion of hepatic blood inflow are safe in cirrhotic patients with an overall ischemic time of greater than 60 minutes. However, for complex liver resections with an estimated liver transection plane of greater than 60 cm(2), hemihepatic occlusion of blood inflow, if feasible, may be recommended in cirrhotic patients to reduce operative blood loss and the incidence of blood transfusion under our defined occlusion time.
authors.affiliation: Department of Surgery, Taichung Veterans General Hospital, Section 3, 160 Chung-Kang Rd, Taichung, Taiwan.
authors.forename: Cheng-Chung
authors.initials: CC
authors.lastname: Wu
authors.forename: Dah-Cherng
authors.initials: DC
authors.lastname: Yeh
authors.forename: Wai-Meng
authors.initials: WM
authors.lastname: Ho
authors.forename: Chu-Leng
authors.initials: CL
authors.lastname: Yu
authors.forename: Shao-Bin
authors.initials: SB
authors.lastname: Cheng
authors.forename: Tse-Jia
authors.initials: TJ
authors.lastname: Liu
authors.forename: Fang-Ku
authors.initials: FK
authors.lastname: P'eng
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003250:Constriction; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008103:Liver Cirrhosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies