Initial comparison of regional ischemic preconditioning and hemi-hepatic vascular inflow occlusion in resection of hepatocellular carcinoma

Abstract

To evaluate preliminarily the clinical efficacy of two types of hepatic inflow occlusion in hepatectomy for hepatocellular carcinoma (HCC). A total of 54 patients with HCC who underwent hepatectomy were divided into two groups: RIP group (regional ischemic preconditioning with continuous clamping, n=15) and HHV group (hemi-hepatic vascular inflow occlusion, n=39). HHV was performed by placing a clamp on the right hepatic artery and right portal vein, and was maintained until the liver resection was completed. In the RIP group, HHV was preceded by a 5-min period of ischemia followed by 5 min of reperfusion. The clinical indicators of the two groups were compared. The volume of intraoperative blood loss had significant difference between the two groups (P=0.039). One case (6.7%) in the RIP group and 17 cases (43.6%) in the HHV group received postoperative blood transfusion, showing a significant difference (P=0.010). No postoperative 30-day mortality happened in all patients. No significant differences were found between the two groups in hospital stay or postoperative morbidity, including hepatic insufficiency, infection, ascites, pleural effusion, cardiopulmonary complications and intestinal ventilation time (P>0.05 for all).The RIP group had a significantly higher PTA level at postoperative days 3 and 5 (P<0.001). Although no significant differences were found between the two groups regarding total bilirubin, albumin, prealbumin and aminotransferase (P>0.05) during any postoperative stage, the ALT recovered to normal level in 5 patients (33.3%) of the RIP group and only in one case (2.7%) of the HHV group, with a significant difference between the two groups (P=0.006). The results of this study indicate that regional ischemic preconditioning may have better hemostatic effect on hepatectomy, can reduce postoperative blood transfusion and promote early recovery of liver function than hemi-hepatic vascular inflow occlusion.