Major Hepatic Resection Using Vascular Isolation and Hypothermic Perfusion

Fortner, Joseph G.; Shiu, Man H.; Kinne, David W.; Kim, D. K.; Castro, El B.; Watson, Robin C.; Howland, William S.; Beattie, Edward J.

doi:10.1097/00000658-197410000-00030

Cited by 257 publications

(130 citation statements)

References 8 publications

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“…More extensive involvement of the IVC requires the use of a patch or segmental resection with graft replacement. In such cases, TVE may be used [6][7][8][9] . This may be achieved by applying vascular clamps to the IVC below and above the liver, with concomitant interruption of hepatic blood inflow using a Pringle maneuver [10] .…”

Section: Discussionmentioning

confidence: 99%

Resection and reconstruction of the inferior vena cava for neoplasms

Vladov¹,

Mihaylov²,

Belev³

et al. 2012

WJGS

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AIM:To evaluate the results of an aggressive surgical approach of resection and reconstruction of the inferior vena cava (IVC). METHODS:The approach to caval resection depends on the extent and location of tumor involvement. The supra-and infra-hepatic portion of the IVC was dissected and taped. Left and right renal veins were also taped to control the bleeding. In 12 of the cases with partial tangential resection of the IVC, the flow was reduced to less than 40% so that the vein was primarily closed with a running suture. In 3 of the cases, the lumen of the vein was significantly reduced, requiring the use of a polytetrafluoroethylene (PTFE) patch. In 2 of the cases with segmental resection of the IVC, a PTFE prosthesis was used and in 1 case, the IVC was resected without reconstruction due to shunting the blood through the azygos and hemiazygos veins. RESULTS:The mean operation time was 266 min (230-310 min) with an average intraoperative blood loss of 300 mL (200-2000 mL). The patients stayed in intensive care unit for 1.8 d (1-3 d). Mean hospital stay was 9 d (7-15 d). Twelve patients (66.7%) had no complications and 6 patients (33.3%) had the following complications: acute bleeding in 2 patients; bile leak in 2 patients; intra abdominal abscess in 1 patient; pulmonary embolism in 2 patients; and partial thrombosis of the patch in 1 patient. General complications such as pneumonia, pleural effusion and cardiac arrest were observed in the same group of patients. In all but 1 case, the complications were transient and successfully controlled. The mortality rate was 11.1% (n = 2). One patient died due to cardiac arrest and pulmonary embolism in the operation room and the second one died 2 d after surgery due to coagulopathy. With a median follow-up of 24 mo, 5 (27.8%) patients died of tumor recurrence and 11 (61.1%) are still alive, but three of them have a recurrence on computed tomography. CONCLUSION:There are a variety of options for reconstruction after resection of the IVC that offers a higher resectable rate and better prognosis in selected cases.

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Section: Discussionmentioning

confidence: 99%

Resection and reconstruction of the inferior vena cava for neoplasms

Vladov¹,

Mihaylov²,

Belev³

et al. 2012

WJGS

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“…In situ hypothermic perfusion (HP) of the liver during TVE is an option to reduce hepatic I-R injury during extensive liver resections [7][8][9][10][11][12]. The protective effect of HP is based on the concept that hypothermia leads to diminished metabolism and, hence, decreased energy and oxygen demand.…”

Section: Introductionmentioning

confidence: 99%

“…The protective effect of HP is based on the concept that hypothermia leads to diminished metabolism and, hence, decreased energy and oxygen demand. Ringer-lactate (RL) is one of the most often used solutions for HP [7,11]. It is a crystalloid solution without any additives and without buffering capacity.…”

Section: Introductionmentioning

confidence: 99%

Hypothermic in situ perfusion of the porcine liver using Celsior or Ringer-lactate solution

Dinant

Roseboom

Levi

et al. 2008

Langenbecks Arch Surg

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Background Hypothermic perfusion (HP) of the liver is applied during total vascular exclusion (TVE) to reduce ischemic injury during liver resection. No studies have been performed comparing different perfusion solutions for HP. The aim of this experimental study was to compare Ringerlactate solution (RL) with Celsior solution (Cs) for HP in a pig model of 60-min TVE. Method Twenty pigs underwent 60-min TVE of the liver. Groups were TVE without HP (no-HP, n=9), TVE with HP using RL (n=6), and TVE with HP using Cs (n=5). Blood and liver tissue samples were taken before TVE and during 24-h reperfusion. Results In the no-HP group, plasma aspartate aminotransferase values were significantly increased during reperfusion (p<0.05), while liver tissue pO 2 levels (p< 0.01) were decreased when compared to the HP groups. After 24-h reperfusion, bile production and liver tissue glutathione content were significantly higher (p<0.05) in the Cs group (42.0±1.7 mL/h and 44.9±2.2 nmol/mg, respectively) as compared to the RL group (31.5±3.5 mL/h and 19.6±1.8 nmol/mg, respectively). ConclusionThe protective effect of HP during TVE was confirmed in this study. HP with Cs was more effective in reducing ischemic injury as compared to HP with RL.

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“…The first report on IHP described dual perfusion with chilled Ringer lactate (4°C) through the gastroduodenal artery and the portal vein (5). VIO durations up to 2 h were well tolerated using this technique, enabling the removal of tumors that were otherwise considered not resectable, albeit at the expense of a considerable (10.3%) mortality rate.…”

Section: Clinical Status Quo Of Organ Cooling In Liver Surgery Liver mentioning

confidence: 99%

“…Whereas the use of liver cooling for liver preservation and transplantation purposes are well known (see Liver Transplantation), livers can also be cooled in situ during liver resection by perfusing the organ with a chilled solution through the afferent hepatic vasculature. This technique is known as in situ hypothermic perfusion (IHP) (5), and various adaptations of this technique have been recently used to improve ischemic tolerance during major liver surgery (see Liver Resection) (6,7).…”

mentioning

confidence: 99%

Protective Mechanisms of Hypothermia in Liver Surgery and Transplantation

Olthof

Reiniers

Dirkes

et al. 2015

Mol Med

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Hepatic ischemia/reperfusion (I/R) injury is a side effect of major liver surgery that often cannot be avoided. Prolonged periods of ischemia put a metabolic strain on hepatocytes and limit the tolerable ischemia and preservation times during liver resection and transplantation, respectively. In both surgical settings, temporarily lowering the metabolic demand of the organ by reducing organ temperature effectively counteracts the negative consequences of an ischemic insult. Despite its routine use, the application of liver cooling is predicated on an incomplete understanding of the underlying protective mechanisms, which has limited a uniform and widespread implementation of liver-cooling techniques. This review therefore addresses how hypothermia-induced hypometabolism modulates hepatocyte metabolism during ischemia and thereby reduces hepatic I/R injury. The mechanisms underlying hypothermia-mediated reduction in energy expenditure during ischemia and the attenuation of mitochondrial production of reactive oxygen species during early reperfusion are described. It is further addressed how hypothermia suppresses the sterile hepatic I/R immune response and preserves the metabolic functionality of hepatocytes. Lastly, a summary of the clinical status quo of the use of liver cooling for liver resection and transplantation is provided.

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Major Hepatic Resection Using Vascular Isolation and Hypothermic Perfusion

Cited by 257 publications

References 8 publications

Resection and reconstruction of the inferior vena cava for neoplasms

Resection and reconstruction of the inferior vena cava for neoplasms

Hypothermic in situ perfusion of the porcine liver using Celsior or Ringer-lactate solution

Protective Mechanisms of Hypothermia in Liver Surgery and Transplantation

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