title: Right hepatectomy with extra-hepatic vascular division prior to transection: intention-to-treat analysis of a standardized policy.
abstract: BACKGROUND
  Right hepatectomy (RH) is the most common type of major hepatectomy and can be achieved without portal triad clamping (PTC) in non-cirrhotic liver. The present study reviews our standardized policy of performing RH without systematic PTC.
  
  
  METHODS
  One hundred and eighty-one consecutive RH were performed in non-cirrhotic patients, with division of the right afferent and efferent blood vessels prior to transection, without systematically using PTC. Prospectively collected data were analysed, focusing on the following endpoints: need for salvage PTC, ischaemic time, blood loss and post-operative outcome.
  
  
  RESULTS
  Extra-hepatic division of the right hepatic vessels was feasible in all patients, but was ineffective in 48 patients (26.5%) who required salvage PTC during transection. In those patients, the median ischaemic time was 20 min. The median blood loss was 500 ml (50-3000). Six patients (3.3%) experienced post-operative liver failure. Overall morbidity, severe morbidity and mortality were 42%, 12.1% and 1.6%, respectively, with peri-operative transfusion rate (16.6%) being the only factor associated with morbidity.
  
  
  CONCLUSIONS
  By performing RH with extra-hepatic vascular division prior to transection, PTC can be safely avoided in the majority of patients.
authors.affiliation: Service de Chirurgie Digestive et Transplantations, Hôpital Huriez, Rue Michel Polonovski, CHU, Univ Nord-de-France, Lille, France. emmanuel.boleslawski@chru-lille.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Boleslawski
authors.forename: Gauthier
authors.initials: G
authors.lastname: Decanter
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Truant
authors.forename: Ahmed Fouad
authors.initials: AF
authors.lastname: Bouras
authors.forename: Lasha
authors.initials: L
authors.lastname: Sulaberidze
authors.forename: Olivier
authors.initials: O
authors.lastname: Oberlin
authors.forename: François-René
authors.initials: FR
authors.lastname: Pruvot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000592:standards; D006499:Hepatic Artery / Q000601:surgery; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D057194:Intention to Treat Analysis; D008099:Liver / Q000098:blood supply* / Q000601:surgery*; D017093:Liver Failure / Q000209:etiology / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011169:Portal Vein / Q000601:surgery; D011787:Quality of Health Care / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000592:standards; D055815:Young Adult