ABSTRACT
Objective To evaluate the clinical value of total hemihepatic vascular exclusion (THHVE) for liver resection in hepatocellular carcinoma (HCC) patients and its effect on tumor recurrence, metastasis and patient survival. Methods Consecutive patients who were scheduled for elective hepatic resection were screened and allocated randomly to THHVE and Pringle maneuver groups. The total intraoperative blood loss, blood loss during transection, blood transfusion rate, operation time, vascular clamping time, complication, mortality, postoperative hospital stay, postoperative liver function index, overall survival time and diseasefree survival time were analyzed and compared between the two groups. Results From Aug. 2011 to Aug. 2013, 143 patients were eligible and were analyzed, with 71 in THHVE group and 72 in Pringle group. Baseline data were similar between the two groups. Total blood loss (250. 0 [150. 0-400. 0] mL vs 350. 0 [200. 0-637. 5] mL,P<0. 001) and blood loss during hepatic transection (100. 0 [50. 0-200. 0] mL vs 215. 0 [100. 0-380. 0] mL, P<0. 001) in the THHVE group were significantly less than those in the Pringle group. The vascular clamping time in THHVE group was significantly longer than that in Pringle group (27. 0 [20. 0-31. 0] min vs 20. 0 [16. 0-24. 0] min, P<0. 001); the serum ALT levels (P<0. 05) on postoperative day 1, 3, 7 and the serum total bilirubin levels (P = 0. 013) on postoperative day 7 in the THHVE group were significantly lower than those in the Pringle group, and the serum pre-albumin level was significantly higher in the THHVE group than that in the Pringle group on postoperative day 7 (P = 0. 038). The incidence rate of postoperative complication in THHVE group was significantly lower than that in Pringle group (21. 1% vs 37. 5%,P = 0. 032). The overall survival time in THHVE group was significantly longer than that in Pringle group (P = 0. 036). Multivariate analysis by the Cox proportional hazard regressionmodel showed that THHVE was one of the independent factors affecting overall survival, and the death risk of the patients in THHVE group was 47. 6% that of the patients in Pringle group. Conclusion THHVE is a safe and effective method in liver resection for patients with HCC, and the method is associated with less intraoperative bleeding, better postoperative liver function recovery, lower incidence rate of complication and better overall survival compared with Pringle maneuver.
ABSTRACT
<p><b>OBJECTIVE</b>To study the clinical value of total hemihepatic vascular exclusion (THHVE) in liver resection for patients with hepatocellular carcinoma (HCC) and impaired liver function.</p><p><b>METHODS</b>The data of 70 patients who underwent liver resection for HCC with impaired liver function between January 2009 and October 2011 were analyzed retrospectively. THHVE was applied in 38 patients (THHVE group), Pringle maneuver in 25 patients (Pringle group) and no vascular occlusion in 7 patients. In the THHVE group, 36 patients were male, 2 were female, average age was (54 ± 9) years. And in Pringle group, 23 patients were male, 2 were female, average age was (53 ± 10) years. Total intraoperative blood loss, blood transfusion rate, clamping time, postoperative complication rate, postoperative hospital stay and postoperative liver function were compared between the THHVE and Pringle group.</p><p><b>RESULTS</b>Total blood loss ((317 ± 186) ml vs. (506 ± 274) ml, t = -3.025, P = 0.004) and transfusion rate (10.5% vs. 32.0%, χ(2) = 4.509, P = 0.034) were significantly lower in the THHVE group than in the Pringle group. Although the clamping time was longer ((21 ± 5) minutes vs. (17 ± 5) minutes, t = 3.209, P = 0.002), the total bilirubin levels on postoperative day 3 and 7 and ALT levels on postoperative day 1, 3, 7 were significantly lower in the THHVE group than in the Pringle group, and the pre-albumin level on postoperative day 7 was higher in the THHVE group than in the Pringle group. Total complication rate (26.3% vs. 52.0%, χ(2) = 4.291, P = 0.038) and major complication rate (7.9% vs. 28.0%, χ(2) = 4.565, P = 0.033) were lower in the THHVE group than in the Pringle group. And postoperative hospital stay duration was shorter in the THHVE group than in the Pringle group ((14.0 ± 2.6) d vs. (16.4 ± 4.0) d, t = -2.625, P = 0.012).</p><p><b>CONCLUSIONS</b>THHVE is a safe and effective technique in liver resection for patients with HCC and impaired liver function. It is associated with less blood loss, lower transfusion requirements, better postoperative liver function recovery, lower postoperative complication rate and shorter postoperative hospital stay.</p>