Ligating the Corresponding Inflow and Outflow Vessels during Hepatectomy: A Prospective Randomized Controlled Trial and Animal Study

Abstract

Background: We have devised a simple bleeding control technique ligating the corresponding inflow and outflow vessels without hilus dissection before the parenchyma transection during hepatectomy. The main objective of this study is to investigate the role of this simple technique on postoperative metastasis and survival. Methods: During the past 10 years, 330 patients with primary HCC were performed hepatectomy with the new hemorrhage control technique, and prospective randomized controlled trial was applied. Circulating tumor cells (CTC) were detected in 24 hours postoperatively. We further applied a mice model ligating the pedicle of the lesion-located hepatic lobe before hepatectomy to imitate the clinic practice, and evaluated the role of the new technique on postoperative metastasis and survival. Results: The new technique prolonged postoperative overall and disease-free survival for patients with primary HCC, and reduced the number of circulatin CTC postoperatively, when compared with the conventional hepatectomy. In the animal model, hepatectomy with the new technique showed lower metastasis, and longer survival when compared with conventional surgery. Human specific-AFP expressed at a high level in the serum of the metastasis bearing mice, but not expressed in metastasis-free mice. Conclusion: Ligating the inflow and outflow vessels of the lesion-located hepatic lobe before hepatectomy reduces postoperative metastasis and prolongs survival of primary HCC. These results also indicate a potential mechanism that the new technique prevents hematogenous metastasis owing to its coincidence to principles of oncological surgery to avoid the intraoperative spread of tumour cells during hepatectomy.