Ischemic preconditioning versus intermittent vascular occlusion in liver resections performed under selective vascular exclusion: a prospective randomized study.
BACKGROUND
The aim of this study was to compare ischemic preconditioning with the intermittent vascular occlusion technique in liver resections performed under inflow and outflow occlusion.


METHODS
Fifty-four patients with resectable liver tumors assigned were randomly to undergo surgery with either ischemic preconditioning (IP group, n = 27) or with intermittent vascular occlusion (IVO group, n = 27). Both groups were compared regarding surgical parameters, aspartate transaminase levels, and apoptosis.


RESULTS
For warm ischemic time less than 40 minutes, no significant difference was noticed between the 2 groups apart from caspase-3 activity, which was higher in the IVO group than in the IP group (17.2 +/- 3.4 vs. 10.3 +/- 5.2, P < .05). When warm ischemia exceeded 40 minutes, the IP group showed higher levels in blood aspartate transaminase levels on day 3 (442 +/- 178 IU/L vs. 305 +/- 104 IU/L, P < .05) and higher caspase-3 levels (26.5 +/- 5.7 count/high-power field [hpf] vs. 20.7 +/- 3.6 count/hpf, P < .05) and apoptotic activity (28.5 +/- 7.5 count/hpf vs. 20.2 +/- 4.1 count/hpf, P < .05), as compared with the IVO group.


CONCLUSIONS
Although both techniques showed comparable efficacy for short ischemic times, intermittent vascular occlusion provided better cytoprotection when ischemia exceeded 40 minutes.
Smyrniotis
Vassilios
V
Second Department of Surgery, University of Athens, School of Medicine, Areteion Hospital, 76 Vas. Sofias Av., 115 28, Athens, Greece. vsmyrniotis@hotmail.com
Theodoraki
Kassiani
K
Arkadopoulos
Nikolaos
N
Fragulidis
Georgios
G
Condi-Pafiti
Agathi
A
Plemenou-Fragou
Matrona
M
Voros
Dionysios
D
Vassiliou
John
J
Dimakakos
Panagiotis
P
D017209:Apoptosis; D001219:Aspartate Aminotransferases / Q000097:blood; D003250:Constriction; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D007511:Ischemia; D019194:Ischemic Preconditioning; D008099:Liver / Q000098:blood supply* / Q000473:pathology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000503:physiopathology / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000517:prevention & control*; D013997:Time Factors
D001219:Aspartate Aminotransferases