Abstract
Background Major hepatectomy is the mainstay of the treatment for cholangiocarcinoma. Infrahepatic inferior vena cava (IVC) clamping is an effective maneuver for reducing 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. Methods Clinical and pathological data were collected retrospectively 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 adapted 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). Results The patients' backgrounds, operative parameters, and extent of hepatectomy did not differ significantly between the 2 groups, except for gender. A significantly lower blood loss (p = 0.028), blood transfusion (p = 0.011), and rate of vascular inflow occlusion requirement (p < 0.001) were observed in the C1 group. The respective blood losses in the C1 group and the C0 group were 498.9 (95% CI: 375.8-622.1) and 685.6 (95% CI: 571-800.2) millilitres. Conclusions The current study found infrahepatic IVC clamping during liver transection for cholangiocarcinoma reduces blood loss, blood transfusion, and rate of vascular inflow occlusion requirement.
Highlights
Cholangiocarcinoma (CCA) is a considerably rare primary tumor of the liver [1, 2], for which the mainstay of treatment is major surgical resection [1, 3,4,5]
Our findings are compatible with previous reports, which found that infrahepatic inferior vena cava (IVC) clamping was associated with lower blood loss and blood transfusion [17, 18]
Our study evaluated the benefit of infrahepatic IVC clamping focusing on patients with cholangiocarcinoma, which gave some unique features of hepatic resection, including (i) the requirements of anatomical major liver resection; (ii) being quite simple but having a large transection surface; (iii) being noncirrhotic but, sometimes, having a tense liver from biliary obstruction; iv) the plan: the resected lobe is usually already de-vascularized; and (v) some limiting of the exposure because the bile duct remains intact during liver transection [16]
Summary
Cholangiocarcinoma (CCA) is a considerably rare primary tumor of the liver [1, 2], for which the mainstay of treatment is major surgical resection [1, 3,4,5]. Various methods have been applied to reduce blood flow through the hepatic veins, including control of the central venous pressure (CVP) [8], exclusion of hepatic veins [9], and infrahepatic inferior vena cava (IVC) clamping [10]. Infrahepatic inferior vena cava (IVC) clamping is an effective maneuver for reducing blood loss during liver transection. The impact of this procedure on major hepatectomy for cholangiocarcinoma is unknown. A significantly lower blood loss (p = 0:028), blood transfusion (p = 0:011), and rate of vascular inflow occlusion requirement (p < 0:001) were observed in the C1 group. The current study found infrahepatic IVC clamping during liver transection for cholangiocarcinoma reduces blood loss, blood transfusion, and rate of vascular inflow occlusion requirement
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