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Continuous Occlusion of Hepatic Artery Proper for Prevention of Blood Loss in Partial Hepatectomy for Ruptured Hepatocellular Carcinoma: A Case-Matched Comparative Study

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To investigate the efficacy and safety of adding continuous occlusion of hepatic artery proper to intermittent Pringle maneuver in partial hepatectomy for ruptured hepatocellular carcinoma.

Materials and Methods

This is a retrospective study on data that were prospectively collected and entered into a computer database. A total of 36 patients who underwent partial hepatectomy for ruptured HCC by adding continuous occlusion of hepatic artery proper to intermittent Pringle maneuver at a tertiary care university hospital were compared with a historical case-matched control group of 36 patients who received intermittent Pringle maneuver only.

Results

The patient characteristics were comparable for the 2 groups of patients. The mean hepatic artery occlusion time was 58 min (range 36–98 min). Intraoperative blood loss and blood transfusion rate in the study group were significantly lower than the control group (P < .001 and P = .004, respectively). There were no significant differences in the postoperative serum aspartate transaminase and total bilirubin levels (P = .087, P = .135, respectively), and in the postoperative hospital stay and surgical complications according to Clavien’s classification between the two groups (P = 0.213, P = 1.000, respectively). The disease-free survival rates in the study group was significantly better than the control group (P = .023). Overall, HCC patients with rupture had poor prognosis.

Conclusions

The addition of continuous occlusion of hepatic artery proper to intermittent Pringle maneuver significantly reduced intraoperative blood loss for partial hepatectomy in patients with ruptured HCC when compared with intermittent Pringle maneuver alone. The procedure was found to be safe even for patients with liver cirrhosis.

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References

  1. Bosch FX, Ribes J, Diaz M, Cleries R. Primary liver cancer: worldwide incidence and trends. Gastroenterology. 2004;127:S5–6.

    Article  PubMed  Google Scholar 

  2. Clavien PA, Petrowsky H, DeOliveira ML, Graf R. Strategies for safer liver surgery and partial liver transplantation. N Engl J Med. 2007;356:1545–59.

    Article  PubMed  Google Scholar 

  3. Lai ECH, Lau WY. Spontaneous rupture of hepatocellular carcinoma: a systematic review. Arch Surg. 2006;141:191–8.

    Article  PubMed  Google Scholar 

  4. Liu CL, Fan ST, Lo CM, Ng IO, Poon RT, Wong J. Intraoperative iatrogenic rupture of hepatocellular carcinoma. World J Surg. 2002;26:348–52.

    Article  PubMed  Google Scholar 

  5. Wayne JD, Lauwers GY, Ikai I, Doherty DA, Belghiti J, Yamaoka Y, et al.: Preoperative predictors of survival after resection of small hepatocellular carcinomas. Ann Surg. 2002;235:722–30; discussion 721–30.

    Article  PubMed  Google Scholar 

  6. Yeh CN, Chen MF, Lee WC, Jeng LB. Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis: Univariate and multivariate analysis. J Surg Oncol. 2002;81:195–202.

    Article  PubMed  Google Scholar 

  7. Tsochatzis EA, Germani G, Burroughs AK. Transarterial chemoembolization, transarterial chemotherapy, and intra-arterial chemotherapy for hepatocellular carcinoma treatment. Semin Oncol. 2010;37:89–93.

    Article  PubMed  CAS  Google Scholar 

  8. Xia F, Lau WY, Qian C, Wang SG, Ma KS, Bie P. Surgical treatment of giant liver hemangiomas: enucleation with continuous occlusion of hepatic artery proper and intermittent Pringle maneuver. World J Surg. 2010;34:2162–7.

    Article  PubMed  Google Scholar 

  9. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  10. Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet. 2003;362:1907–17.

    Article  PubMed  Google Scholar 

  11. Ong GB, Taw JL. Spontaneous rupture of hepatocellular carcinoma. BMJ. 1972;4:146–9.

    Article  PubMed  CAS  Google Scholar 

  12. Tanaka A, Takeda R, Mukaihara S, Hayakawa K, Shibata T, Itoh K, et al. Treatment of ruptured hepatocellular carcinoma. Int J Clin Oncol. 2001;6:291–5.

    Article  PubMed  CAS  Google Scholar 

  13. Cherqui D, Panis Y, Rotman N, Fagniez PL. Emergency liver resection for spontaneous rupture of hepatocellular carcinoma complicating cirrhosis. Br J Surg. 1993;80:747–9.

    Article  PubMed  CAS  Google Scholar 

  14. Chiappa A, Zbar A, Audisio RA, Paties C, Bertani E, Staudacher C. Emergency liver resection for ruptured hepatocellular carcinoma complicating cirrhosis. Hepatogastroenterology. 1999;46:1145–50.

    PubMed  CAS  Google Scholar 

  15. Vergara V, Muratore A, Bouzari H, Polastri R, Ferrero A, Galatola G, et al. Spontaneous rupture of hepatocellular carcinoma: surgical resection and long-term survival. Eur J Surg Oncol. 2000;26:770–2.

    Article  PubMed  CAS  Google Scholar 

  16. Marini P, Vilgrain V, Belghiti J. Management of spontaneous rupture of liver tumours. Dig Surg. 2002;19:109–13.

    Article  PubMed  CAS  Google Scholar 

  17. Benson AB III, Abrams TA, Ben-Josef E, Bloomston PM, Botha JF, Clary BM, et al. NCCN clinical practice guidelines in oncology: Hepatobiliary cancers. J Natl Compr Canc Netw. 2009;7:350–91.

    PubMed  CAS  Google Scholar 

  18. Chearanai O, Plengvanit U, Asavanich C, Damrongsak D, Sindhvananda K, Boonyapisit S. Spontaneous rupture of primary hepatoma: report of 63 cases with particular reference to the pathogenesis and rationale of treatment by hepatic artery ligation. Cancer. 1983;51:1532–6.

    Article  PubMed  CAS  Google Scholar 

  19. Lai ECS, Wu KM, Choi TK, Fan ST, Wong J. Spontaneous ruptured hepatocellular carcinoma: an appraisal of surgical treatment. Ann Surg. 1989;210:24–8.

    Article  PubMed  CAS  Google Scholar 

  20. Lesurtel M, Selzner M, Petrowsky H, McCormack L, Clavien PA. How should transection of the liver be performed? A prospective randomized study in 100 consecutive patients: comparing four different transection strategies. Ann Surg. 2005;242:814–22; discussion 822–3.

    Article  PubMed  Google Scholar 

  21. Poon RT, Fan ST, Lo CM, Ng IO, Liu CL, Lam CM, et al.: Improving survival results after resection of hepatocellular carcinoma: A prospective study of 377 patients over 10 years. Ann Surg. 2001;234:63–70.

    Article  PubMed  CAS  Google Scholar 

  22. Kanematsu T, Furui J, Yanaga K, Okudaira S, Shimada M, Shirabe K. A 16-year experience in performing hepatic resection in 303 patients with hepatocellular carcinoma: 1985–2000. Surgery. 2002;131:S153–8.

    Article  PubMed  Google Scholar 

  23. Zhu LX, Meng XL, Fan ST. Elasticity of small artery in patient with spontaneous rupture of hepatocellular carcinoma. Hepatol Res. 2004;29:13–7.

    Article  PubMed  Google Scholar 

  24. Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, et al.: One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg. 2003;138:1198–206; discussion 1206.

    Article  PubMed  Google Scholar 

  25. Liu CL, Fan ST, Lo CM, Tso WK, Poon RT, Lam CM, et al. Management of spontaneous rupture of hepatocellular carcinoma: single-center experience. J Clin Oncol. 2001;19:3725–32.

    PubMed  CAS  Google Scholar 

  26. Yeh CN, Lee WC, Jeng LB, Chen MF, Yu MC. Spontaneous tumour rupture and prognosis in patients with hepatocellular carcinoma. Br J Surg. 2002;89:1125–9.

    Article  PubMed  Google Scholar 

  27. Mizuno S, Yamagiwa K, Ogawa T, Tabata M, Yokoi H, Isaji S, et al. Are the results of surgical treatment of hepatocellular carcinoma poor if the tumor has spontaneously ruptured? Scand J Gastroenterol. 2004;39:567–70.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

We are grateful to Miss Zhongfang Jie, a research assistant, for her help with data collection and statistical analyses. This work was supported by the National S&T Major Project (NO. 2008ZX10002-026).

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Authors and Affiliations

  1. Institute of Hepatobiliary Surgery, Southwest Hospital, Southwest Cancer Center, Third Military Medical University, Chongqing, China

    Feng Xia MD, PhD, Wan-Yee Lau MD, FRCS, FACS, FRACS(Hon), Kuansheng Ma MD, PhD, Xiaowu Li MD, PhD & Ping Bie MD, PhD

  2. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China

    Wan-Yee Lau MD, FRCS, FACS, FRACS(Hon)

  3. Department of Pathology, Southwest Cancer Center, Third Military Medical University, Chongqing, China

    Cheng Qian MD, PhD

Authors
  1. Feng Xia MD, PhD
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  2. Wan-Yee Lau MD, FRCS, FACS, FRACS(Hon)
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  3. Cheng Qian MD, PhD
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  4. Kuansheng Ma MD, PhD
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  5. Xiaowu Li MD, PhD
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  6. Ping Bie MD, PhD
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Corresponding author

Correspondence to Ping Bie MD, PhD.

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Xia, F., Lau, WY., Qian, C. et al. Continuous Occlusion of Hepatic Artery Proper for Prevention of Blood Loss in Partial Hepatectomy for Ruptured Hepatocellular Carcinoma: A Case-Matched Comparative Study. Ann Surg Oncol 18, 1638–1643 (2011). https://doi.org/10.1245/s10434-010-1484-3

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  • DOI: https://doi.org/10.1245/s10434-010-1484-3

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