Liver ischemia for hepatic resection: where is the limit?

Details

Serval ID
serval:BIB_4FBEB2479985
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Liver ischemia for hepatic resection: where is the limit?
Journal
Surgery
Author(s)
Huguet  C., Gavelli  A., Chieco  P. A., Bona  S., Harb  J., Joseph  J. M., Jobard  J., Gramaglia  M., Lasserre  M.
ISSN
0039-6060 (Print)
Publication state
Published
Issued date
03/1992
Volume
111
Number
3
Pages
251-9
Notes
Journal Article --- Old month value: Mar
Abstract
BACKGROUND. A consecutive series of 50 patients who submitted to 53 hepatic resections with use of continuous normothermic liver ischemia is reported. METHODS. Portal triad clamping has been used in 28 cases, with associated inferior vena caval clamping above and below the liver (hepatic vascular exclusion) in 25 patients. The size of the tumor required major hepatic resection in 38 cases (71.7%). Malignant tumors (83%) were the most common indication for liver resection. Patients were placed in three groups according to the duration of liver ischemia: group A, less than 30 minutes (9 patients); group B, 30 to 60 minutes (29 patients); and group C, 60 or more (15 patients). RESULTS. No differences in mortality rates (5.7% in the entire series and 0% in group C) and morbidity rate could be shown. No significant difference was found in postoperative liver test results, and no persistent alteration remained thereafter. Liver biopsy at 6 and 12 months after operation did not reveal any chronic damage. Liver capability to regenerate was maintained as documented by postoperative computerized tomography scan or magnetic resonance imaging. CONCLUSIONS. Because interruption of hepatic blood flow in normothermia is safe for at least 60 minutes (up to 85 minutes in this study), vascular clamping is recommended for hazardous liver resections to minimize blood loss, which appears to be the main factor of death and morbidity.
Keywords
Bilirubin/blood Carcinoma, Hepatocellular/pathology/*surgery Female Hepatectomy Humans *Ischemia *Liver Circulation Liver Diseases/pathology/*surgery Liver Function Tests Liver Neoplasms/pathology/secondary/*surgery Male Middle Aged Postoperative Complications Retrospective Studies
Pubmed
Web of science
Create date
28/01/2008 10:07
Last modification date
20/08/2019 15:05
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