Segmental and subsegmental resections of the cirrhotic liver under hepatic inflow and outflow occlusion

Abstract

Segmental and subsegmental resections of the cirrhotic liver were carried out on 44 patients with hepatocellular carcinoma (HCC) and three cases with regenerating liver nodules. Seventeen patients underwent hepatectomies without hepatic vascular arrest (Group 1). In Group 2 (19 occasions), the Pringle manoeuvre was used for 8-46 min during parenchymal dissection. Hepatic resections were performed during simultaneous occlusion of hepatic inflow and outflow for 20-47 min in 11 patients (Group 3). The estimated blood loss during surgery was 2924 ml in Group 1, 1239 in Group 2, and 765 in Group 3 (Group 1 versus Group 2; P less than 0.02, Group 1 versus Group 3; P less than 0.02). Haemorrhagic shock occurred in three patients of Group 1, one of Group 2, and none of Group 3. Life-threatening postoperative complications occurred in four patients in Group 1, two in Group 2, and none in Group 3. Hospital death rate was 23.5 per cent in Group 1, 10.5 per cent in Group 2, and nil in Group 3. The present results may indicate that in performing nonanatomical resection of cirrhotic livers temporary occlusion of both hepatic inflow and outflow can be achieved for at least 30 min and is useful in reducing postoperative morbidity and mortality.

Vascular occlusion in hepatic resections in cirrhotic rat livers: An experimental study in rats

“…Rats were classified in the following three groups according to the dose of CCl 4 administered. Group A was composed of 14 rats treated with 8 to 10 doses of CCl 4 ; parameters of liver function are shown in Table 1. Group B was composed of 21 rats treated with 11 to 14 doses of CCl 4 ; parameters of liver function are shown in Table 1.…”

“…Group A was composed of 14 rats treated with 8 to 10 doses of CCl 4 ; parameters of liver function are shown in Table 1. Group B was composed of 21 rats treated with 11 to 14 doses of CCl 4 ; parameters of liver function are shown in Table 1. Group C was composed of 12 rats treated with more than 12 doses of CCl 4 in which ascites was clinically evident (Table 1).…”

“…3). Features of portal hypertension and splenomegaly were observed in animals that were administered more than 10 doses of CCl 4 . Ascites was present in all animals in group C. There were no significant differences between the control group and group A except for AT III levels and body weight.…”

“…Intraoperative transfusion is one of the main risk factors associated with postoperative complications in cirrhotic patients. 3 Temporary inflow occlusion is often performed to prevent massive bleeding during hepatectomy, 4 but it is not clear whether this arrest of circulation is tolerated equally by cirrhotic and normal livers.…”

Vascular occlusion in hepatic resections in cirrhotic rat livers: An experimental study in rats

“…Livers from all of the animals that were administered CCl 4 showed the features of micronodular cirrhosis (Fig. 2).…”