title: Complex hepatectomy under total vascular exclusion of the liver: impact of ischemic preconditioning on clinical outcomes.
abstract: BACKGROUND
  Hepatic inflow clamping during hepatectomy introduces ischemia-reperfusion (I/R) injury, and many authors regard the addition of caval occlusion as adding increased risk. Ischemic preconditioning (IPC) is one of the protective strategies employed to reduce I/R injury in animal experiments and limited clinical series. The aim of the present study was to determine the impact of systematic adoption of IPC in patients undergoing complex hepatectomy under total hepatic vascular exclusion (TVE) based on outcomes review.
  
  
  METHODS
  The records of 93 patients who underwent major hepatectomy involving TVE at our center from February 1998 to December 2008 were reviewed. These patients were divided into two groups: group 1 (n = 55, TVE alone) and group 2 (n = 38, TVE with IPC). IPC was performed by portal triad clamping for 10 min followed by 3-5 min of reperfusion prior to TVE and resection.
  
  
  RESULTS
  The two groups were comparable regarding demographics, underlying liver diseases, indications for hepatectomy, duration of TVE, and preoperative liver and kidney function tests. Overall postoperative laboratory results of liver function tests were not significantly different between the two groups. Creatinine levels and prothrombin times were not significantly different between the groups. The use of IPC had no impact on the duration of the operation, blood loss, or hospital stay. The morbidity rates were 37.5 and 34.2 %, respectively.
  
  
  CONCLUSIONS
  Our adoption of IPC as a protective strategy against I/R injury under TVE did not affect operative or laboratory parameters and clinical outcomes when compared to continuous clamping for comparable ischemic periods.
authors: Department of Surgery, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 431-070, Republic of Korea. jangyongjeon@yahoo.com
authors: Jangyong
authors: J
authors: Jeon
authors: Anthony
authors: A
authors: Watkins
authors: Gebhard
authors: G
authors: Wagener
authors: Benjamin
authors: B
authors: Samstein
authors: James
authors: J
authors: Guarrera
authors: Michael
authors: M
authors: Goldstein
authors: Joseph
authors: J
authors: Meltzer
authors: Tomoaki
authors: T
authors: Kato
authors: Jean C
authors: JC
authors: Emond
mesh_terms: D000328:Adult; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D019194:Ischemic Preconditioning; D008099:Liver / Q000098:blood supply*; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015427:Reperfusion Injury / Q000517:prevention & control*; D016896:Treatment Outcome