Randomized clinical trial of open hepatectomy with or without intermittent Pringle manoeuvre

Lee, K F; Cheung, Yu‐San; Wong, Janus Siu Him; Chong, Charing Ching‐Ning; Lai, Paul B.S.

doi:10.1002/bjs.8863

Cited by 39 publications

(34 citation statements)

References 24 publications

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“…The types of surgery included were laparoscopic liver resection (non-anatomical wedge resections, or resection of one or two segments), minor open liver resection (fewer than three segments including multiple non-anatomical resections), major open liver resections (three or more segments), liver resection with biliary reconstruction11 12 and pancreatic surgery. Pancreatic surgery included Whipple's procedure, double bypass (hepaticojejunostomy and gastrojejunostomy in unresectable cancer of the head of pancreas) and distal pancreatectomy.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with failure of enhanced recovery protocol in patients undergoing major hepatobiliary and pancreatic surgery: a retrospective cohort study

et al. 2014

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ObjectiveThis study examined the risk factors associated with failure of enhanced recovery protocol after major hepatobiliary and pancreatic (HBP) surgery.Setting and participantsA retrospective cohort of 194 adult patients undergoing major HBP surgery at a university hospital in Hong Kong was followed up for 30 days. The patients were from a larger cohort study of 736 consecutive adults with preoperative urinary cotinine concentration to examine the association between passive smoking and risk of perioperative respiratory complications and postoperative morbidities.Outcome measuresThe primary outcome was failure of enhanced recovery protocol. This was defined as a composite measure of the following events: intensive care unit (ICU) stay more than 24 h after surgery, unplanned admission to ICU within 30 days after surgery, hospital readmission, reoperation and mortality.ResultsThere were 25 failures of enhanced recovery after HBP surgery (12.9%, 95% CI 8.5% to 18.4%). After adjusting for elective ICU admission, smokers (relative risk (RR ) 2.21, 95% CI 1.10 to 4.46), high preoperative alanine transaminase/glutamic-pyruvic transaminase (RR 3.55,95% CI 1.68 to 7.49) and postoperative morbidities (RR 2.69, 95% CI 1.30 to 5.56) were associated with failures of enhanced recovery in the generalised estimating equation risk model. Compared with those managed successfully, failures stayed longer in ICU (median 19 vs 25 h, p<0.001) and in hospital for postoperative care (median 7 vs 13 days, p=0.003).ConclusionsSmokers and patients having high preoperative alanine transaminase/glutamic-pyruvic transaminase concentration or have a high risk of postoperative morbidities are likely to fail enhanced recovery protocol in HBP surgery programmes.

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Section: Methodsmentioning

confidence: 99%

Factors associated with failure of enhanced recovery protocol in patients undergoing major hepatobiliary and pancreatic surgery: a retrospective cohort study

et al. 2014

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“…While results from Man et al showed reduced blood loss when using intermittent occlusion in both senior and junior surgeons, Capussotti et al demonstrated no difference in operative blood loss with significant increased post‐operative transfusion requirements in those undergoing intermittent occlusion . A recent randomized control trial showed no benefit to intermittent hepatic inflow occlusion and a higher complication rate when compared to no inflow occlusion . Alternatively, the ischemic preconditioning technique utilizes total hepatic inflow occlusion for 10 min followed by 10 min of reperfusion prior to transection followed by continuous occlusion for parenchymal transection .…”

Section: Methodsmentioning

confidence: 99%

“…Similar to total hepatic inflow occlusion, hemi‐hepatic inflow occlusion requires isolation of the inflow portal venous and hepatic arterial systems except that the inflow bundle must then be followed to identify the right and left branches for each lobe of the liver . The purpose of controlling individual hepatic lobar inflow vessels is to potentially prevent ischemia to the non‐resected liver.…”

Section: Methodsmentioning

confidence: 99%

Minimizing blood loss during hepatectomy: A literature review

Huntington

Royall

Schmidt

2013

Journal of Surgical Oncology

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There are numerous techniques surgeons employ to reduce blood loss during partial hepatectomy. In this literature review, prospective studies from the last 20 years are examined to determine the techniques that are best supported by the literature. Some of the techniques include vascular control, multiple parenchymal transection techniques, various hemostatic agents, low central venous pressure, and hemodilution. The strategies supported most convincingly by the literature include low CVP and total hepatic inflow occlusion.

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“…[1,[3][4][5] In the past decade, large-scale studies have demonstrated mortalities down to 0 -2% in highvolume centres. [2,[6][7][8][9][10][11][12] The drastic decline in operative morbidity and mortality is attributed to improvements in meticulous patient selection, surgical techniques and equipment, as well as perioperative care. [8,[13][14][15][16] It is also attributed to the early detection and removal of smaller hepatomas.…”

Section: Introductionmentioning

confidence: 99%

Current advances in liver surgery

Chan

Lai

2015

J Health Spec

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Hepatobiliary surgery has taken a big step forward in recent decades especially in the minimally invasive approach for hepatectomy. From being sceptical at the beginning of the 1990s when laparoscopic surgery had become prevalent, to now, where laparoscopic hepatectomy has been well-established, especially in minor hepatectomies; this new technique has evolved rapidly over the past 20-years demonstrating better short-term outcomes and equivalent oncological outcomes in selected patients and in expert hands. Laparoscopic hepatectomy is indeed, more difficult to master than the open procedure with restrictions in working space, difficulty in haemostasis and the potential risk of gas embolism. However, with better visibility of the operative field around the liver, especially beneath the costal margin, the magnified view and theoretical advantage of pneumoperitoneum acting as haemostatic pressure have made laparoscopic hepatectomy increasingly popular. Another important advancement is the new surgical technique of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). This procedure induces more rapid liver hypertrophy within a median period of 9-days, allowing resection to be performed in candidates with borderline functional liver remnant and at an earlier date. However, studies have shown that ALPPS is associated with a relatively higher rate of morbidity and mortality. Therefore, it remains a highly controversial treatment option and more studies have to be performed to establish its usefulness and define its role in liver surgery.

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Randomized clinical trial of open hepatectomy with or without intermittent Pringle manoeuvre

Abstract: NCT00730743 (http://www.clinicaltrials.gov).

Cited by 39 publications

References 24 publications

Factors associated with failure of enhanced recovery protocol in patients undergoing major hepatobiliary and pancreatic surgery: a retrospective cohort study

Factors associated with failure of enhanced recovery protocol in patients undergoing major hepatobiliary and pancreatic surgery: a retrospective cohort study

Minimizing blood loss during hepatectomy: A literature review

Current advances in liver surgery

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