Infrahepatic inferior vena cava clamping during liver transection for cholangiocarcinoma: a quasi – experimental study

Abstract

Introduction: Major hepatectomy is the mainstay of treatment of cholangiocarcinoma. Infrahepatic inferior vena cava (IVC) clamping is effective maneuver for reducing central venous pressure (CVP), may lead to reducing in blood loss during liver transection. The impact of this procedure on major hepatectomy for cholangiocarcinoma is unknown. This study evaluated the effect of infrahepatic IVC clamping on blood loss during liver transection. Method: Clinical and pathological data were retrospectively collected for 116 cholangiocarcinoma patients who underwent major hepatectomy between January 2015 and December 2016, to investigate the benefit of infrahepatic IVC clamping. Two of five surgeons adopt the policy performing infrahepatic IVC clamping during liver transection in all cases. Patients, therefore, were divided into those (n = 39; 33.6%) who received infrahepatic IVC clamping during liver transection (C1) and those (n = 77; 66.4%) who did not (C0). Result: The patient backgrounds, operative parameters, and extent of hepatectomy did not significantly differ between the 2 groups except for gender of patients. A significant lower in blood loss (p=0.028), blood transfusion (p=0.011) and rate of portal clamping (p<0.001) were observed in C1 group. The respective blood loss in C1 group and C0 group was 498.9 (95%CI: 375.8- 622.1) and 685.6 (95%CI:571-800.2) milliliter. Conclusion: The current study found infrahepatic IVC clamping during liver transection reduce blood loss, blood transfusion and rate of portal clamping.