World Journal of Surgery

, Volume 29, Issue 11, pp 1374–1383 | Cite as

Evaluation of Effect of Hemihepatic Vascular Occlusion and the Pringle Maneuver during Hepatic Resection for Patients with Hepatocellular Carcinoma and Impaired Liver Function

  • Gar-Yang ChauEmail author
  • Wing-Yiu Lui
  • Kuang-Liang King
  • Chew-Wun Wu


Reducing blood loss during resection of hepatocellular carcinoma (HCC) in patients with impaired liver function is important. This study evaluated the effect and safety of inflow occlusion (hemihepatic vascular occlusion and the Pringle maneuver) in reducing blood loss during hepatectomy. A total of 120 HCC patients with impaired liver function (with a preoperative indocyanine green retention rate at 15 minutes > 10%) who underwent hepatectomy were included in this retrospective study. Patients were divided into three groups, no-occlusion (n = 30), hemihepatic vascular occlusion (n = 49), and Pringle maneuver (n = 41). There was one hospital death in each group. Of all three groups, 50 patients (41.7%) had blood loss less than 1000 ml. The three groups were similar in terms of clinocopathological features. All patients underwent minor resection. Blood loss was significantly greater in the no-occlusion group; there was no difference between the hemihepatic group and the Pringle group. Multivariate analysis revealed that risk factors related to blood loss included no inflow occlusion [odds ratios (ORs), 2.93; 95% confidence intervals (CIs) 1.13–7.59], tumor centrally located (ORs, 3.85; 95% CIs, 1.50–9.90), serum albumin level < 3.5 gm/dl (ORs, 5.15; 95% CIs, 1.20–22.07), and serum alanine aminotransferase >120 U/l (ORs, 3.58; 95% CIs, 1.19–10.80). For patients with occlusion time ≥ 45 minutes, postoperative serum total bilirubin and aspartate aminotransferase levels in the Pringle group were significantly higher than those in the hemihepatic and no-occlusion groups (P < 0.05). In HCC patients with impaired liver function undergoing hepatectomy, both hemihepatic vascular occlusion and the Pringle maneuver are safe and effective in reducing blood loss. Patients subjected to hemihepatic vascular occlusion responded better than those subjected to the Pringle maneuver in terms of earlier recovery of postoperative liver function, especially when occlusion time was ≥ 45 minutes.


Liver Resection Hepatic Resection Impaired Liver Function Pringle Maneuver Occlusion Time 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was supported by a grant from Taipei Veterans General Hospital (VGH-92-82).


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Copyright information

© Société Internationale de Chirurgie 2005

Authors and Affiliations

  • Gar-Yang Chau
    • 1
    • 2
    Email author
  • Wing-Yiu Lui
    • 1
    • 2
  • Kuang-Liang King
    • 1
    • 2
  • Chew-Wun Wu
    • 1
    • 2
  1. 1.Division of General SurgeryDepartment of Surgery, Taipei Veterans General HospitalTaipei 112Republic of China
  2. 2.School of MedicineNational Yang-Ming UniversityTaipei 112Republic of China

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