title: Intermittent clamping of the hepatic pedicle in simultaneous ultrasonography-guided liver resection and colorectal resection with intestinal anastomosis: is it safe?
abstract: OBJECTIVE
  In patients with colorectal cancer (CRC) and synchronous colorectal liver metastases (CRLM) potentially candidates to combined liver (LR) and colorectal resection (CRR), the extent of LR and the need of hepatic pedicle clamping (HPC) in selected cases are considered risk factors for the outcome of the intestinal anastomosis. This study aimed to determine whether intermittent HPC is predictive of anastomotic leakage (AL) and has an adverse effect on the clinical outcome in patients undergoing combined restorative CRR and LR.
  
  
  METHODS
  One hundred six LR have been performed for CRLM in our unit from July 2005. Patients who received CRR with anastomosis and simultaneous intraoperative ultrasonography (IOUS)-guided LR/ablation for resectable CRLM were included in this study. CRR was performed first. Intermittent HPC was decided at the discretion of the liver surgeon. The perioperative outcome was evaluated according to occurrence of AL and overall postoperative morbidity and mortality.
  
  
  RESULTS
  Thirty-eight patients underwent simultaneous IOUS-guided LR/ablation and CRR with intestinal anastomosis; 19 underwent intermittent HPC (group ICHPY) while 19 did not (group ICHPN); the mean ± SD (range) duration of clamping in group ICHPY was 58.6 ± 32.2 (10.0-125.0) min. Postoperative results were similar between groups. One asymptomatic AL occurred in group ICHPY (5.2 %). Major postoperative complications were none in group ICHPY and one (5.2 %) in group ICHPN, respectively. One patient in group ICHPY died postoperatively (5.2 %).
  
  
  CONCLUSIONS
  This study suggests that intermittent HPC during LR is not predictive of AL and has no adverse effect on the overall clinical outcome in patients undergoing combined restorative colorectal surgery and hepatectomy for advanced CRC.
authors.affiliation: U.O. di Chirurgia Generale, Dipartimento dell'Apparato Digerente, Azienda Ospedaliero-Universitaria di Bologna, Università degli Studi di Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy, e.deraffele@aosp.bo.it.
authors.forename: Emilio
authors.initials: E
authors.lastname: De Raffele
authors.forename: Mariateresa
authors.initials: M
authors.lastname: Mirarchi
authors.forename: Samuele
authors.initials: S
authors.lastname: Vaccari
authors.forename: Dajana
authors.initials: D
authors.lastname: Cuicchi
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Lecce
authors.forename: Barbara
authors.initials: B
authors.lastname: Dalla Via
authors.forename: Bruno
authors.initials: B
authors.lastname: Cola
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D003250:Constriction; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011446:Prospective Studies; D014463:Ultrasonography