Modified technique of hepatic vascular exclusion: effect on blood loss during complex mesohepatectomy in hepatocellular carcinoma patients with cirrhosis.
BACKGROUND
Hepatic veins remain patent during complete inflow occlusion (CIO) and bleeding from them may continue. Occlusion of the inferior vena cava (ICV) during CIO may reduce blood loss from hepatic veins. This study was designed to compare the overall outcomes after application of CIO with or without occlusion of the ICV below the liver in complex mesohepatectomy for hepatocellular carcinoma (HCC) patients with cirrhosis.


METHODS
One hundred and eighteen (118) patients were randomly assigned to CIO or a modified technique of hepatic vascular exclusion (MTHVE). Hemodynamic parameters were evaluated and the amount of blood loss, measurement of liver enzymes, and postoperative progress were recorded.


RESULTS
Blood loss during liver transection in CIO groups was significantly greater than that in MTHVE group (P=0.046). Thus, incidence of blood transfusion was significantly greater in patients of the CIO group (P=0.041). There were no significant differences in liver enzyme changes, bilirubin, or morbidity in the postoperative period between the two groups.


CONCLUSIONS
CIO with occlusion of the ICV below the liver is a safe, effective, and feasible technique during mesohepatectomy in HCC patients with cirrhosis. Excellent results were obtained with minimized bleeding, limited hepatic function damage, and low rate of postoperative complications.
Chen
Xiao-ping
XP
Hepatic Surgery Center, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China. chenxp@medmail.com.cn
Zhang
Zhi-wei
ZW
Zhang
Bi-xiang
BX
Chen
Yi-fa
YF
Huang
Zhi-yong
ZY
Zhang
Wan-guang
WG
He
Song-qing
SQ
Qiu
Fa-zu
FZ
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D016009:Chi-Square Distribution; D003250:Constriction; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008103:Liver Cirrhosis / Q000150:complications*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*