title: Randomized clinical trial of ischaemic preconditioning in major liver resection with intermittent Pringle manoeuvre.
abstract: BACKGROUND
  Vascular inflow occlusion is effective in avoiding excessive blood loss during hepatic parenchymal transection but may cause ischaemic damage to the remnant liver. Intermittent portal triad clamping (IPTC) is superior to continuous hepatic pedicle clamping as it avoids severe ischaemia-reperfusion (IR) injury in the liver remnant. Ischaemic preconditioning (IPC) before continuous Pringle manoeuvre may protect against IR during major liver resection.
  
  
  METHODS
  This RCT assessed the impact of IPC in major liver resection with intermittent vascular inflow occlusion. Patients undergoing major liver resection with intermittent vascular inflow occlusion were randomized, during surgery, to receive IPC (10 min inflow occlusion followed by 10 min reperfusion) or no IPC (control group). Data analysis was on an intention-to-treat basis. The primary endpoint was serum alanine aminotransferase (ALT) level on the day after surgery.
  
  
  RESULTS
  Eighty four patients were enrolled and randomized to IPC (n = 41) and no IPC (n = 43). The groups were comparable in terms of demographic data, preoperative American Society of Anesthesiologists grade and extent of liver resection. Intraoperative morbidity and postoperative outcomes were also similar. ALT levels on the day after operation were not decreased by IPC (mean(s.d.) 537·6(358·5) versus 525·0(400·6) units/ml in IPC and control group respectively; P = 0·881). Liver biochemistry tests in the week after operation showed the same pattern in both groups.
  
  
  CONCLUSIONS
  IPC did not reduce liver damage in patients undergoing major liver resection with IPTC.
  
  
  BACKGROUND
  NCT00908245 (http://www.clinicaltrials.gov).
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Scatton
authors.forename: S
authors.initials: S
authors.lastname: Zalinski
authors.forename: D
authors.initials: D
authors.lastname: Jegou
authors.forename: P
authors.initials: P
authors.lastname: Compagnon
authors.forename: M
authors.initials: M
authors.lastname: Lesurtel
authors.forename: J
authors.initials: J
authors.lastname: Belghiti
authors.forename: K
authors.initials: K
authors.lastname: Boudjema
authors.forename: C
authors.initials: C
authors.lastname: Lentschener
authors.forename: O
authors.initials: O
authors.lastname: Soubrane
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D001663:Bilirubin / Q000378:metabolism; D003250:Constriction; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D007902:Length of Stay; D008099:Liver / Q000098:blood supply; D008113:Liver Neoplasms / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011517:Prothrombin Time; D016896:Treatment Outcome
chemical_list: D000410:Alanine Transaminase; D001663:Bilirubin