title: Vascular inflow control during hemi-hepatectomy: a comparison between intrahepatic pedicle ligation and extrahepatic vascular ligation.
abstract: BACKGROUND
  Intrahepatic pedicle ligation (IPL) is an alternative to extrahepatic portal dissection (EPD). Although IPL has been well described, concern has arisen over a possible association with increased complication rates.
  
  
  METHODS
  Patients who underwent hemi-hepatectomy during January 1995 to December 2010 were reviewed and the inflow control technique (IPL versus EPD) documented. Patient, tumour, treatment and outcome variables were compared.
  
  
  RESULTS
  A total of 798 patients underwent hemi-hepatectomy, 568 (71.2%) of the right and 230 (28.8%) of the left liver. In univariate analysis, factors associated with the choice of IPL included surgeon, right hepatectomy, preoperative portal vein embolization, diagnosis of colorectal cancer liver metastasis, and smaller tumour size (P < 0.011). In multivariate analysis, right hepatectomy [versus left: hazard ratio (HR) 3.878, 95% confidence interval (CI) 1.15-13.14; P = 0.029] and smaller tumour size (median of 4.5 cm versus 5.5 cm: HR 0.72, 95% CI 0.59-0.88; P = 0.002) were associated with IPL. Pringle manoeuvre time was longer in IPL procedures (40 min versus 29 min; P < 0.001). Complication rates (49.8% in IPL versus 48.4% in EPD; P = 0.706) were similar in both groups, as was the severity of complications; 17.6% of EPD and 22.3% of IPL patients experienced complications of grade ≥3 (P = 0.225).
  
  
  CONCLUSIONS
  Patients with small tumours undergoing right hepatectomy were more likely to undergo IPL. In selected patients, IPL was not associated with an increased complication rate and thus it should be considered a safe approach.
authors: Department of Surgery, Hepatopancreatobiliary Division, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors: Francesco E
authors: FE
authors: D'Amico
authors: Peter J
authors: PJ
authors: Allen
authors: Anne A
authors: AA
authors: Eaton
authors: Ronald P
authors: RP
authors: DeMatteo
authors: Yuman
authors: Y
authors: Fong
authors: T Peter
authors: TP
authors: Kingham
authors: Leslie H
authors: LH
authors: Blumgart
authors: William R
authors: WR
authors: Jarnagin
authors: Michael I
authors: MI
authors: D'Angelica
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D061847:Hospitals, High-Volume; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008026:Ligation; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
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