title: Prolonged portal triad clamping increases postoperative sepsis after major hepatectomy in patients with sinusoidal obstruction syndrome and/or steatohepatitis.
abstract: BACKGROUND
  Portal triad clamping (PTC) has been widely adopted in an attempt to decrease bleeding during liver parenchymal transection. As a larger proportion of patients are treated with chemotherapy prior to liver resection, the safety of PTC in patients with chemotherapy-associated liver injury remains poorly investigated. This study aims to evaluate the influence of PTC on early postoperative outcomes in patients with chemotherapy-associated liver injury undergoing major hepatectomy for colorectal liver metastases (CLM).
  
  
  METHODS
  From January 2000 to October 2010, 53 patients with histologically proven chemotherapy-associated liver injuries [sinusoidal obstruction syndrome (SOS; n = 41), steatohepatitis (n = 5), and both SOS and steatohepatitis (n = 7)] who underwent major hepatectomy for CLM were divided into two groups; patients undergoing intermittent TPC (n = 20) and those who did not undergo TPC (n = 33). Perioperative clinicobiological factors, morbidity including septic complications, and mortality were analyzed and compared between the two groups.
  
  
  RESULTS
  Intraoperative blood transfusions and postoperative liver function were comparable between the two groups. Sepsis and biloma occurred more often in patients undergoing PTC longer than 30 min than in those undergoing PTC ≤ 30 min (66.7 % versus 17.1 %, p = 0.002, and 33.3 versus 0 %, p = 0.002, respectively). A multiple logistic regression analysis showed that prolonged PTC (>30 min) and the ratio of future liver remnant volume to total liver volume ≤ 43 % were independent factors for predicting postoperative sepsis [odds ratio (OR): 32.68; 95 % confidence interval (95 % CI): 2.86-372.82; p = 0.005--and odds ratio: 9.70; 95 % CI: 1.04-90.86; p = 0.047, respectively].
  
  
  CONCLUSIONS
  Portal triad clamping can be safely used in patients with chemotherapy-associated liver injury who require major liver resection. Prolonged PTC can increase the occurrence of postoperative biliary and septic complications.
authors.affiliation: Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Avenue Molière, 67098, Strasbourg Cedex, France.
authors.forename: Masato
authors.initials: M
authors.lastname: Narita
authors.forename: Elie
authors.initials: E
authors.lastname: Oussoultzoglou
authors.forename: Pascal
authors.initials: P
authors.lastname: Fuchshuber
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Chenard
authors.forename: Edoardo
authors.initials: E
authors.lastname: Rosso
authors.forename: Keiichi
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Daniel
authors.initials: D
authors.lastname: Jaeck
authors.forename: Philippe
authors.initials: P
authors.lastname: Bachellier
mesh_terms: D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology*; D003250:Constriction; D005234:Fatty Liver / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006504:Hepatic Veno-Occlusive Disease / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D018709:Statistics, Nonparametric; D013997:Time Factors; D014057:Tomography, X-Ray Computed