Complex liver resection under total vascular exclusion and hypothermic perfusion with versus without venous bypass

Abstract

Background: While hypothermic perfusion of the liver has been shown to improve parenchymal tolerance to complex resections in patients requiring prolonged hepatic vascular exclusion (HVE), the benefit of associated veno-venous bypass (VVB) in this setting remains poorly evaluated. Methods: All patients undergoing liver resection requiring HVE for at least 60 minutes were retrospectively reviewed. Perioperative outcomes were compared between patients with (VVB+) or without VVB (VVB-). Results: Twenty-seven patients had liver resection with HVE and hypothermic perfusion of the liver between 2006 and 2017, including 13 (48%) VVB+ and 14 (52%) VVB- patients. Demographic characteristics and indications for liver resection were similar between the two groups. Median HVE exclusion durations were similar in (96 vs. 75 min, p=0.72) VVB+ and VVB- patients. VVB+ patients had increased operative time (460 vs. 375 min, p=0.05) but decreased amount of transfusion (p=0.05). . Five (19%) patients died postoperatively from liver failure (n=4) or sepsis (n=1), without significant difference between VVB+ and VVB- patients (p=0.56). Postoperative major morbidity rate (Dindo-Clavien 3-4, 30% vs. 50%) was not different between the two groups. The rates of liver failure, haemorrhage, renal insufficiency, and sepsis were not different between the two groups but VVB- patients experienced increased rates of respiratory complications than VVB+ patients (64% vs. 15%, respectively, p=0.01). Conclusion: During liver resection under HVE and hypothermic perfusion of the liver, the use of VVB allows reducing red blood cells transfusions and postoperative respiratory complications. VVB should be recommended in case of liver resection with prolonged HVE.