101 hepatectomies under continuous inflow occlusion following simple in-situ liver cooling in patients with chronic liver diseases.
OBJECTIVE
Hepatic inflow occlusion involves the serious disadvantage of ischemic injury to the remnant liver, particularly in patients with injured parenchyma. Liver hypothermia is one of the solutions for this problem. The purpose of this study was to evaluate simple in-situ liver cooling method of performing hepatic resection under continuous inflow occlusion in patients with chronic liver disease.


METHODS
One hundred and one patients with chronic hepatitis (n = 26) and cirrhosis (n = 75) were included in this retrospective study. They underwent hepatectomy under conditions of continuous inflow occlusion immediately following simple in-situ liver cooling. Laboratory data and intraoperative and postoperative variables were analyzed for the three groups of patients stratified according to the lowest liver tissue temperature achieved: group 1 (> or = 30 degrees C, n = 16), group 2 (< 30 degrees C and > or = 25 degrees C, n = 62) and group 3 (< 25 degrees C, n = 20).


RESULTS
Our simple in-situ liver cooling method enabled us to safely resect chronically diseased liver under continuous inflow occlusion (49.8 +/- 7.7 min, mean +/- SD; range, 30 to 70 min) with acceptable operative blood loss (894 +/- 853mL), morbidity (22.7%, 23/101) and mortality (1.0%, 1/101); one patient died of complications unrelated to ischemic injury. Analysis demonstrated that simple liver hypothermia was substantially hepatoprotective against ischemic injury in terms of serum transaminase levels and duration of inflow occlusion, particularly when the liver tissue temperature fell below 30 degrees C (groups 2 and 3).


CONCLUSIONS
Hepatic inflow occlusion can be safely employed in a continuous manner for approximately 1 hour, even during resection of chronically diseased liver, particularly when the liver is cooled below 30 degrees C prior to hepatic clamping by our simple in-situ hypothermia technique.
Kim
Yang-Il
YI
Department of Surgery, Biomolecular Engineering Center, Liver Research Institute Kyungpook National University, School of Medicine, Taegu, Korea. yikim@kyungpook.ac.kr
Hwang
Yoon-Jin
YJ
Lee
Jong-Won
JW
Chun
Byung-Yeol
BY
Kawano
Katsunori
K
Kitano
Seigo
S
D000368:Aged; D002908:Chronic Disease; D003250:Constriction; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006505:Hepatitis / Q000097:blood / Q000601:surgery*; D006801:Humans; D007036:Hypothermia, Induced; D007511:Ischemia / Q000517:prevention & control; D008099:Liver; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000097:blood / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D000637:Transaminases / Q000097:blood
D000637:Transaminases