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Complex Hepatectomy under Total Vascular Exclusion of the Liver: Impact of Ischemic Preconditioning on Clinical Outcomes

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Abstract

Background

Hepatic inflow clamping during hepatectomy introduces ischemia–reperfusion (I/R) injury, and many authors regard the addition of caval occlusion as adding increased risk. Ischemic preconditioning (IPC) is one of the protective strategies employed to reduce I/R injury in animal experiments and limited clinical series. The aim of the present study was to determine the impact of systematic adoption of IPC in patients undergoing complex hepatectomy under total hepatic vascular exclusion (TVE) based on outcomes review.

Methods

The records of 93 patients who underwent major hepatectomy involving TVE at our center from February 1998 to December 2008 were reviewed. These patients were divided into two groups: group 1 (n = 55, TVE alone) and group 2 (n = 38, TVE with IPC). IPC was performed by portal triad clamping for 10 min followed by 3–5 min of reperfusion prior to TVE and resection.

Results

The two groups were comparable regarding demographics, underlying liver diseases, indications for hepatectomy, duration of TVE, and preoperative liver and kidney function tests. Overall postoperative laboratory results of liver function tests were not significantly different between the two groups. Creatinine levels and prothrombin times were not significantly different between the groups. The use of IPC had no impact on the duration of the operation, blood loss, or hospital stay. The morbidity rates were 37.5 and 34.2 %, respectively.

Conclusions

Our adoption of IPC as a protective strategy against I/R injury under TVE did not affect operative or laboratory parameters and clinical outcomes when compared to continuous clamping for comparable ischemic periods.

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Authors and Affiliations

  1. Department of Surgery, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 431-070, Republic of Korea

    JangYong Jeon

  2. Department of Surgery, Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, 622 West 168th Street, New York, 10032, USA

    Anthony Watkins, Benjamin Samstein, James Guarrera, Michael Goldstein, Tomoaki Kato & Jean C. Emond

  3. Department of Anesthesia, Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, 622 West 168th Street, New York, 10032, USA

    Gebhard Wagener & Joseph Meltzer

  4. Department of Surgery, Columbia University College of Physicians & Surgeons, 630 West 168th Street, New York, 10032, USA

    Jean C. Emond

Authors
  1. JangYong Jeon
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  2. Anthony Watkins
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  3. Gebhard Wagener
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  4. Benjamin Samstein
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  5. James Guarrera
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  6. Michael Goldstein
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  7. Joseph Meltzer
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  8. Tomoaki Kato
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  9. Jean C. Emond
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Correspondence to Jean C. Emond.

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Jeon, J., Watkins, A., Wagener, G. et al. Complex Hepatectomy under Total Vascular Exclusion of the Liver: Impact of Ischemic Preconditioning on Clinical Outcomes. World J Surg 37, 838–846 (2013). https://doi.org/10.1007/s00268-012-1865-9

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  • DOI: https://doi.org/10.1007/s00268-012-1865-9

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