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Prolonged Portal Triad Clamping Increases Postoperative Sepsis after Major Hepatectomy in Patients with Sinusoidal Obstruction Syndrome and/or Steatohepatitis

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Abstract

Background

Portal triad clamping (PTC) has been widely adopted in an attempt to decrease bleeding during liver parenchymal transection. As a larger proportion of patients are treated with chemotherapy prior to liver resection, the safety of PTC in patients with chemotherapy-associated liver injury remains poorly investigated. This study aims to evaluate the influence of PTC on early postoperative outcomes in patients with chemotherapy-associated liver injury undergoing major hepatectomy for colorectal liver metastases (CLM).

Patients and methods

From January 2000 to October 2010, 53 patients with histologically proven chemotherapy-associated liver injuries [sinusoidal obstruction syndrome (SOS; n = 41), steatohepatitis (n = 5), and both SOS and steatohepatitis (n = 7)] who underwent major hepatectomy for CLM were divided into two groups; patients undergoing intermittent TPC (n = 20) and those who did not undergo TPC (n = 33). Perioperative clinicobiological factors, morbidity including septic complications, and mortality were analyzed and compared between the two groups.

Results

Intraoperative blood transfusions and postoperative liver function were comparable between the two groups. Sepsis and biloma occurred more often in patients undergoing PTC longer than 30 min than in those undergoing PTC ≤30 min (66.7 % versus 17.1 %, p = 0.002, and 33.3 versus 0 %, p = 0.002, respectively). A multiple logistic regression analysis showed that prolonged PTC (>30 min) and the ratio of future liver remnant volume to total liver volume ≤43 % were independent factors for predicting postoperative sepsis [odds ratio (OR): 32.68; 95 % confidence interval (95 % CI): 2.86–372.82; p = 0.005—and odds ratio: 9.70; 95 % CI: 1.04–90.86; p = 0.047, respectively].

Conclusions

Portal triad clamping can be safely used in patients with chemotherapy-associated liver injury who require major liver resection. Prolonged PTC can increase the occurrence of postoperative biliary and septic complications.

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Authors and Affiliations

  1. Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Avenue Molière, 67098, Strasbourg Cedex, France

    Masato Narita, Elie Oussoultzoglou, Edoardo Rosso, Daniel Jaeck & Philippe Bachellier

  2. Service d’Anatomie Pathologique, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Avenue Molière, 67098, Strasbourg Cedex, France

    Marie-Pierre Chenard

  3. Department of Surgery, The Permanente Medical Group, 1425 South Main, Walnut Creek, CA, 95667, USA

    Pascal Fuchshuber

  4. Department of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital, Kyoto, Japan

    Keiichi Yamamoto

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  1. Masato Narita
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  2. Elie Oussoultzoglou
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  3. Pascal Fuchshuber
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  4. Marie-Pierre Chenard
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  5. Edoardo Rosso
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  6. Keiichi Yamamoto
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  7. Daniel Jaeck
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  8. Philippe Bachellier
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Correspondence to Philippe Bachellier.

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Narita, M., Oussoultzoglou, E., Fuchshuber, P. et al. Prolonged Portal Triad Clamping Increases Postoperative Sepsis after Major Hepatectomy in Patients with Sinusoidal Obstruction Syndrome and/or Steatohepatitis. World J Surg 36, 1848–1857 (2012). https://doi.org/10.1007/s00268-012-1565-5

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  • DOI: https://doi.org/10.1007/s00268-012-1565-5

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