Skip to main content

Advertisement

SpringerLink
Log in

Intermittent clamping of the hepatic pedicle in simultaneous ultrasonography-guided liver resection and colorectal resection with intestinal anastomosis: is it safe?

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

In patients with colorectal cancer (CRC) and synchronous colorectal liver metastases (CRLM) potentially candidates to combined liver (LR) and colorectal resection (CRR), the extent of LR and the need of hepatic pedicle clamping (HPC) in selected cases are considered risk factors for the outcome of the intestinal anastomosis. This study aimed to determine whether intermittent HPC is predictive of anastomotic leakage (AL) and has an adverse effect on the clinical outcome in patients undergoing combined restorative CRR and LR.

Methods

One hundred six LR have been performed for CRLM in our unit from July 2005. Patients who received CRR with anastomosis and simultaneous intraoperative ultrasonography (IOUS)-guided LR/ablation for resectable CRLM were included in this study. CRR was performed first. Intermittent HPC was decided at the discretion of the liver surgeon. The perioperative outcome was evaluated according to occurrence of AL and overall postoperative morbidity and mortality.

Results

Thirty-eight patients underwent simultaneous IOUS-guided LR/ablation and CRR with intestinal anastomosis; 19 underwent intermittent HPC (group ICHPY) while 19 did not (group ICHPN); the mean ± SD (range) duration of clamping in group ICHPY was 58.6 ± 32.2 (10.0–125.0) min. Postoperative results were similar between groups. One asymptomatic AL occurred in group ICHPY (5.2 %). Major postoperative complications were none in group ICHPY and one (5.2 %) in group ICHPN, respectively. One patient in group ICHPY died postoperatively (5.2 %).

Conclusions

This study suggests that intermittent HPC during LR is not predictive of AL and has no adverse effect on the overall clinical outcome in patients undergoing combined restorative colorectal surgery and hepatectomy for advanced CRC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59(4):225–249. doi:10.3322/caac.20006

    Article  PubMed  Google Scholar 

  2. Brown RE, Bower MR, Martin RC (2010) Hepatic resection for colorectal liver metastases. Surg Clin N Am 90(4):839–852. doi:10.1016/j.suc.2010.04.012

    Article  PubMed  Google Scholar 

  3. Reddy SK, Barbas AS, Clary BM (2009) Synchronous colorectal liver metastases: is it time to reconsider traditional paradigms of management? Ann Surg Oncol 16(9):2395–2410. doi:10.1245/s10434-009-0372-1

    Article  PubMed  Google Scholar 

  4. Reddy SK, Pawlik TM, Zorzi D, Gleisner AL, Ribero D, Assumpcao L, Barbas AS, Abdalla EK, Choti MA, Vauthey JN, Ludwig KA, Mantyh CR, Morse MA, Clary BM (2007) Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol 14(12):3481–3491

    Article  PubMed  Google Scholar 

  5. Chen J, Li Q, Wang C, Zhu H, Shi Y, Zhao G (2011) Simultaneous vs. staged resection for synchronous colorectal liver metastases: a metaanalysis. Int J Colorectal Dis 26(2):191–199. doi:10.1007/s00384-010-1018-2

    Article  PubMed  Google Scholar 

  6. Mentha G, Majno P, Terraz S, Rubbia-Brandt L, Gervaz P, Andres A, Allal AS, Morel P, Roth AD (2007) Treatment strategies for the management of advanced colorectal liver metastases detected synchronously with the primary tumour. Eur J Surg Oncol 33(Suppl 2):S76–S83

    Article  PubMed  Google Scholar 

  7. Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O (2000) Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 191(1):38–46

    Article  CAS  PubMed  Google Scholar 

  8. Capussotti L, Ferrero A, Viganò L, Ribero D, Lo Tesoriere R, Polastri R (2007) Major liver resections synchronous with colorectal surgery. Ann Surg Oncol 14(1):195–201

    Article  PubMed  Google Scholar 

  9. Martin RC 2nd, Augenstein V, Reuter NP, Scoggins CR, McMasters KM (2009) Simultaneous versus staged resection for synchronous colorectal cancer liver metastases. J Am Coll Surg 208(5):842–850. doi:10.1016/j.jamcollsurg.2009.01.031, discussion 850–2

    Article  PubMed  Google Scholar 

  10. Daams F, Luyer M, Lange JF (2013) Colorectal anastomotic leakage: aspects of prevention, detection and treatment. World J Gastroenterol 19(15):2293–2297. doi:10.3748/wjg.v19.i15.2293

    Article  PubMed Central  PubMed  Google Scholar 

  11. Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253(5):890–899. doi:10.1097/SLA.0b013e3182128929

    Article  PubMed  Google Scholar 

  12. Belghiti J, Marty J, Farges O (1998) Techniques, hemodynamic monitoring, and indications for vascular clamping during liver resections. J Hepatobiliary Pancreat Surg 5(1):69–76

    Article  CAS  PubMed  Google Scholar 

  13. Sheen-Chen SM, Su FI, Tang RP, Huang CC, Eng HL (2011) Cellular changes in hepatocytes and intestinal endothelium after hepatoduodenal ligament occlusion and protective effects of caspase inhibition. Ann Surg 253(3):561–565. doi:10.1097/SLA.0b013e31820652f4

    Article  PubMed  Google Scholar 

  14. Dello SA, Reisinger KW, van Dam RM, Bemelmans MH, van Kuppevelt TH, van den Broek MA, Olde Damink SW, Poeze M, Buurman WA, Dejong CH (2012) Total intermittent Pringle maneuver during liver resection can induce intestinal epithelial cell damage and endotoxemia. PLoS One 7(1):e30539. doi:10.1371/journal.pone.0030539

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Qureshi MS, Goldsmith PJ, Maslekar S, Prasad KR, Botterill ID (2012) Synchronous resection of colorectal cancer and liver metastases: comparative views of colorectal and liver surgeons. Colorectal Dis 14(8):e477–e485. doi:10.1111/j.1463-1318.2012.02992.x

    Article  CAS  PubMed  Google Scholar 

  16. Lombardi R, Cuicchi D, Pinto C, Di Fabio F, Iacopino B, Neri S, Tardio ML, Ceccarelli C, Lecce F, Ugolini G, Pini S, Di Tullio P, Taffurelli M, Minni F, Martoni A, Cola B (2010) Clinically-staged T3N0 rectal cancer: is preoperative chemoradiotherapy the optimal treatment? Ann Surg Oncol 17(3):838–845. doi:10.1245/s10434-009-0796-7

    Article  PubMed  Google Scholar 

  17. Torzilli G, Montorsi M, Donadon M, Palmisano A, Del Fabbro D, Gambetti A, Olivari N, Makuuchi M (2005) “Radical but conservative” is the main goal for ultrasonography-guided liver resection: prospective validation of this approach. J Am Coll Surg 201(4):517–528

    Article  PubMed  Google Scholar 

  18. Torzilli G, Procopio F, Botea F, Marconi M, Del Fabbro D, Donadon M, Palmisano A, Spinelli A, Montorsi M (2009) One-stage ultrasonographically guided hepatectomy for multiple bilobar colorectal metastases: a feasible and effective alternative to the 2-stage approach. Surgery 146(1):60–71. doi:10.1016/j.surg.2009.02.017

    Article  PubMed  Google Scholar 

  19. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed Central  PubMed  Google Scholar 

  20. Mayo SC, Pulitano C, Marques H, Lamelas J, Wolfgang CL, de Saussure W, Choti MA, Gindrat I, Aldrighetti L, Barrosso E, Mentha G, Pawlik TM (2013) Surgical management of patients with synchronous colorectal liver metastasis: a multicenter international analysis. J Am Coll Surg 216(4):707–716. doi:10.1016/j.jamcollsurg.2012.12.029, discussion 716–8

    Article  PubMed Central  PubMed  Google Scholar 

  21. Yin Z, Liu C, Chen Y, Bai Y, Shang C, Yin R, Yin D, Wang J (2013) Timing of hepatectomy in resectable synchronous colorectal liver metastases (SCRLM): simultaneous or delayed? Hepatology 57(6):2346–2357. doi:10.1002/hep.26283

    Article  PubMed  Google Scholar 

  22. Makuuchi M, Hasegawa H, Yamazaki S, Takayasu K (1987) Four new hepatectomy procedures for resection of the right hepatic vein and preservation of the inferior right hepatic vein. Surg Gynecol Obstet 164(1):68–72

    CAS  PubMed  Google Scholar 

  23. Trencheva K, Morrissey KP, Wells M, Mancuso CA, Lee SW, Sonoda T, Michelassi F, Charlson ME, Milsom JW (2013) Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg 257(1):108–113. doi:10.1097/SLA.0b013e318262a6cd

    Article  PubMed  Google Scholar 

  24. Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, O'Callaghan C, Myint AS, Bessell E, Thompson LC, Parmar M, Stephens RJ, Sebag-Montefiore D (2009) MRC CR07/NCIC-CTG CO16 Trial Investigators; NCRI Colorectal Cancer Study Group. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373(9666):821–828

    Article  PubMed Central  PubMed  Google Scholar 

  25. Lesurtel M, Lehmann K, de Rougemont O, Clavien PA (2009) Clamping techniques and protecting strategies in liver surgery. HPB (Oxford) 11(4):290–295. doi:10.1111/j.1477-2574.2009.00066.x

    Article  Google Scholar 

  26. Elias D, Detroz B, Lasser P, Plaud B, Jerbi G (1995) Is simultaneous hepatectomy and intestinal anastomosis safe? Am J Surg 169(2):254–260

    Article  CAS  PubMed  Google Scholar 

  27. Ariyan C, Wong D, Fong Y (2007) Editorial on “Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis”. Ann Surg Oncol 14(12):3295–3296

    Article  PubMed Central  PubMed  Google Scholar 

  28. Moug SJ, Smith D, Leen E, Roxburgh C, Horgan PG (2010) Evidence for a synchronous operative approach in the treatment of colorectal cancer with hepatic metastases: a case matched study. Eur J Surg Oncol 36(4):365–370. doi:10.1016/j.ejso.2009.11.007

    Article  CAS  PubMed  Google Scholar 

  29. Kim SH, Lim SB, Ha YH, Han SS, Park SJ, Choi HS, Jeong SY (2008) Laparoscopic-assisted combined colon and liver resection for primary colorectal cancer with synchronous liver metastases: initial experience. World J Surg 32(12):2701–2706. doi:10.1007/s00268-008-9761-z

    Article  PubMed  Google Scholar 

  30. Hatwell C, Bretagnol F, Farges O, Belghiti J, Panis Y (2013) Laparoscopic resection of colorectal cancer facilitates simultaneous surgery of synchronous liver metastases. Colorectal Dis 15(1):e21–e28. doi:10.1111/codi.12068

    Article  CAS  PubMed  Google Scholar 

  31. Nakajima K, Takahashi S, Saito N, Kotaka M, Konishi M, Gotohda N, Kato Y, Kinoshita T (2012) Predictive factors for anastomotic leakage after simultaneous resection of synchronous colorectal liver metastasis. J Gastrointest Surg 16(4):821–827. doi:10.1007/s11605-011-1782-5

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Ethical standards

This study has been approved by the ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

All persons gave their informed consent prior to their inclusion in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. U.O. di Chirurgia Generale, Dipartimento dell’Apparato Digerente, Azienda Ospedaliero-Universitaria di Bologna, Università degli Studi di Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy

    Emilio De Raffele, Mariateresa Mirarchi, Samuele Vaccari, Dajana Cuicchi, Ferdinando Lecce, Barbara Dalla Via & Bruno Cola

Authors
  1. Emilio De Raffele
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mariateresa Mirarchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samuele Vaccari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dajana Cuicchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ferdinando Lecce
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Barbara Dalla Via
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bruno Cola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emilio De Raffele.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De Raffele, E., Mirarchi, M., Vaccari, S. et al. Intermittent clamping of the hepatic pedicle in simultaneous ultrasonography-guided liver resection and colorectal resection with intestinal anastomosis: is it safe?. Int J Colorectal Dis 29, 1517–1525 (2014). https://doi.org/10.1007/s00384-014-2004-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-014-2004-x

Keywords

Search

Navigation