title: In situ hypothermic perfusion of the liver versus standard total vascular exclusion for complex liver resection.
abstract: BACKGROUND
  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.
authors.affiliation: Centre Hépato-Biliaire, Département de Chirurgie Hépato-Biliaire, IFR 89.9, Hôpital Paul Brousse, Villejuif, France. daniel.azoulay@pbr.ap-hop-paris.fr
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.forename: Rony
authors.initials: R
authors.lastname: Eshkenazy
authors.forename: Paola
authors.initials: P
authors.lastname: Andreani
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: René
authors.initials: R
authors.lastname: Adam
authors.forename: Philippe
authors.initials: P
authors.lastname: Ichai
authors.forename: Salima
authors.initials: S
authors.lastname: Naili
authors.forename: Eric
authors.initials: E
authors.lastname: Vinet
authors.forename: Faouzi
authors.initials: F
authors.lastname: Saliba
authors.forename: Antoinette
authors.initials: A
authors.lastname: Lemoine
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Gillon
authors.forename: Henri
authors.initials: H
authors.lastname: Bismuth
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004621:Embolization, Therapeutic; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods; D006498:Hepatectomy / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D007431:Intraoperative Complications; D007677:Kidney Function Tests; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D010477:Perfusion
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase