Advertisement

Infrahepatic Inferior Vena Cava Semi-Clamping can Reduce Blood Loss During Hepatic Resection but Still Requires Monitoring to Avoid Acute Kidney Injury

  • Taisuke Imamura
  • Yusuke YamamotoEmail author
  • Teiichi Sugiura
  • Yukiyasu Okamura
  • Takaaki Ito
  • Ryo Ashida
  • Katsuhisa Ohgi
  • Katsuhiko Uesaka
Original Scientific Report
  • 13 Downloads

Abstract

Background

The efficacy of infrahepatic inferior vena cava (IVC) semi-clamping for reducing blood loss during hepatic resection and its safety remain unclear. The aim of this study was to validate the effectiveness of IVC semi-clamping for reducing blood loss during hepatic resection and to confirm its safety.

Methods

Patients who underwent anatomical hepatic resection between January 2011 and May 2018 were analysed by propensity score-matched and multivariate analyses.

Results

Of 437 patients who underwent anatomical hepatic resection, IVC semi-clamping was performed in 196 patients (44.9%; clamping group). A propensity score-matched analysis demonstrated that even though there was no significant difference in the characteristics of the 141 patients in each group, IVC semi-clamping reduced the blood loss during hepatic resection (clamping group versus non-clamping group: 836 ± 123 vs. 1198 ± 124 ml, P = 0.04). Regarding post-operative complications, the multivariate analysis identified IVC semi-clamping as an independent risk factor for acute kidney injury on post-operative day 1 (P = 0.01, odds ratio = 9.23). A significant positive correlation was found between the duration of IVC semi-clamping and an increased level of serum creatinine (sCre) (P = 0.03), and a significant inverse correlation was found between the blood pressure after clamping and an increased level of sCre (P = 0.02). A receiver operating characteristic analysis revealed the duration and mean blood pressure after clamping that indicated a high risk of acute kidney injury to be 116 min and 65 mmHg, respectively.

Conclusion

IVC semi-clamping can reduce blood loss during hepatic resection but still necessitates monitoring in order to avoid acute kidney injury.

Notes

Compliance with ethical standards

Conflict of interest

All authors have no conflicts of interest or financial to disclose.

Informed consent

The study was approved by the institutional review board, and each study subject provided their written informed consent.

References

  1. 1.
    Yanaga K, Kanematsu T, Takenaka K et al (1988) Hepatic resection for hepatocellular carcinoma in elderly patients. Am J Surg 155:238–241CrossRefGoogle Scholar
  2. 2.
    Nagao T, Inoue S, Goto S et al (1987) Hepatic resection for hepatocellular carcinoma. Clinical features and long-term prognosis. Ann Surg 205:33–40CrossRefGoogle Scholar
  3. 3.
    Jamieson GG, Corbel L, Campion JP et al (1992) Major liver resection without a blood transfusion: is it a realistic objective? Surgery 112:32–36Google Scholar
  4. 4.
    Yamamoto J, Kosuge T, Takayama T et al (1994) Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery 115:303–309Google Scholar
  5. 5.
    Belghiti J, Noun R, Malafosse R et al (1999) Continuous versus intermittent portal triad clamping for liver resection: a controlled study. Ann Surg 229:369–375CrossRefGoogle Scholar
  6. 6.
    Makuuchi M, Mori T, Gunven P et al (1987) Safety of hemihepatic vascular occlusion during resection of the liver. Surg Gynecol Obstet 164:155–158Google Scholar
  7. 7.
    Man K, Fan ST, Ng IO et al (1997) Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study. Ann Surg 226:704–711CrossRefGoogle Scholar
  8. 8.
    Yamamoto Y, Ikoma H, Morimura R et al (2014) Predictive scoring system assessing the need for intraoperative blood transfusions during hepatectomy for hepatocellular carcinoma. Anticancer Res 34:313–318Google Scholar
  9. 9.
    Yamamoto Y, Shimada K, Sakamoto Y et al (2011) Preoperative identification of intraoperative blood loss of more than 1,500 mL during elective hepatectomy. J Hepatobiliary Pancreat Sci 18:829–838CrossRefGoogle Scholar
  10. 10.
    Huguet C, Addario-Chieco P, Gavelli A et al (1992) Technique of hepatic vascular exclusion for extensive liver resection. Am J Surg 163:602–605CrossRefGoogle Scholar
  11. 11.
    Melendez JA, Arslan V, Fischer ME et al (1998) Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg 187:620–625CrossRefGoogle Scholar
  12. 12.
    Bismuth H, Castaing D, Garden OJ (1989) Major hepatic resection under total vascular exclusion. Ann Surg 210:13–19CrossRefGoogle Scholar
  13. 13.
    Rahbari NN, Koch M, Zimmermann JB et al (2011) Infrahepatic inferior vena cava clamping for reduction of central venous pressure and blood loss during hepatic resection: a randomized controlled trial. Ann Surg 253:1102–1110CrossRefGoogle Scholar
  14. 14.
    Otsubo T, Takasaki K, Yamamoto M et al (2004) Bleeding during hepatectomy can be reduced by clamping the inferior vena cava below the liver. Surgery 135:67–73CrossRefGoogle Scholar
  15. 15.
    Ueno M, Kawai M, Hayami S et al (2017) Partial clamping of the infrahepatic inferior vena cava for blood loss reduction during anatomic liver resection: a prospective, randomized, controlled trial. Surgery 161:1502–1513CrossRefGoogle Scholar
  16. 16.
    Kato M, Kubota K, Kita J et al (2008) Effect of infra-hepatic inferior vena cava clamping on bleeding during hepatic dissection: a prospective, randomized, controlled study. World J Surg 32:1082–1087.  https://doi.org/10.1007/s00268-007-9445-0 CrossRefGoogle Scholar
  17. 17.
    Couinaud C (1957) Etudes Anatomiques et Chiugicales. Masson, Paris, pp 400–409Google Scholar
  18. 18.
    Okamura Y, Ito T, Sugiura T et al (2014) Anatomic versus nonanatomic hepatectomy for a solitary hepatocellular carcinoma: a case-controlled study with propensity score matching. J Gastrointest Surg 18:1994–2002CrossRefGoogle Scholar
  19. 19.
    Makuuchi M, Hasegawa H, Yamazaki S (1985) Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 161:346–350Google Scholar
  20. 20.
    Yamamoto Y, Ikoma H, Morimura R et al (2014) Clinical analysis of anatomical resection for the treatment of hepatocellular carcinoma based on the stratification of liver function. World J Surg 38:1154–1163.  https://doi.org/10.1007/s00268-013-2369-y CrossRefGoogle Scholar
  21. 21.
    Imamura H, Kokudo N, Sugawara Y et al (2004) Pringle’s maneuver and selective inflow occlusion in living donor liver hepatectomy. Liver Transpl 10:771–778CrossRefGoogle Scholar
  22. 22.
    Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120:c179–c184Google Scholar
  23. 23.
    Jones RM, Moulton CE, Hardy KJ (1998) Central venous pressure and its effect on blood loss during liver resection. Br J Surg 85:1058–1060CrossRefGoogle Scholar
  24. 24.
    Hasegawa K, Takayama T, Orii R et al (2002) Effect of hypoventilation on bleeding during hepatic resection: a randomized controlled trial. Arch Surg 137:311–315CrossRefGoogle Scholar
  25. 25.
    Evans PM, Vogt DP, Mayes JT 3rd et al (1998) Liver resection using total vascular exclusion. Surgery 124:807–813CrossRefGoogle Scholar
  26. 26.
    Uchiyama K, Ueno M, Ozawa S et al (2009) Half clamping of the infrahepatic inferior vena cava reduces bleeding during a hepatectomy by decreasing the central venous pressure. Langenbeck’s Arch Surg Dtsch Ges Fur Chir 394:243–247CrossRefGoogle Scholar
  27. 27.
    Chertow GM, Burdick E, Honour M et al (2005) Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 16:3365–3370CrossRefGoogle Scholar
  28. 28.
    Lassnigg A (2004) Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 15:1597–1605CrossRefGoogle Scholar
  29. 29.
    Zhou YM, Sui CJ, Zhang XF et al (2016) Anterior approach combined with infrahepatic inferior vena cava clamping right hepatic resection for large hepatocellular carcinoma: a prospective randomized controlled trial. Medicine 95:e4159CrossRefGoogle Scholar
  30. 30.
    Lalu MM, Fayad A, Ahmed O et al (2015) Ultrasound-guided subclavian vein catheterization: a systematic review and meta-analysis. Crit Care Med 43:1498–1507CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Taisuke Imamura
    • 1
  • Yusuke Yamamoto
    • 1
    Email author
  • Teiichi Sugiura
    • 1
  • Yukiyasu Okamura
    • 1
  • Takaaki Ito
    • 1
  • Ryo Ashida
    • 1
  • Katsuhisa Ohgi
    • 1
  • Katsuhiko Uesaka
    • 1
  1. 1.Divisions of Hepato-Biliary-Pancreatic SurgeryShizuoka Cancer CenterShizuokaJapan

Personalised recommendations