Use of hepatic portal occlusion without hemihepatic artery control in liver resection for hepatocelluar carcinoma

Abstract

Objective To investigate the value of hepatic portal occlusion without hemihepatic artery control (hemihepatic occlusion) in liver resection for hepatocelluar carcinoma (HCC). Methods Clinical data of 422 patients with HCC undergoing liver resection in Department of Hepatobiliary Surgery, Nanfang Hospital of Southern Medical University from January 2007 to January 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were divided into two groups according to the different hepatic inflow occlusions: the hemihepatic occlusion group (n=140) and Pringle maneuver group (n=282). There were 114 males and 26 females in the hemihepatic occlusion group with a mean of (45±12) years old. Hemihepatic occlusion was performed in this group and the hepatic arterial branch of the healthy side was dissected up along the proper hepatic artery. The other hepatic pedicles including hepatic artery of the diseased side, hepatic portal vein and bile duct were occluded with occluding straps. There were 230 males and 52 females in the Pringle maneuver group with a mean of (47±13) years old and Pringle maneuver was performed. The differences were compared between two groups in the operation time, occlusion time, intraoperative blood loss, peak levels of blood alanine aminotransferase (ALT), total bilirubin (TB) within 5 days after operation and incidence of postoperative complications. The variation of patient quantity in the periods of 2007-2009 and 2010-2013 in two groups was observed. The data between two groups were compared by t test and the comparison of ratio was conducted by Chi-square test. Results The peak levels of blood ALT, TB within 5 days after operation were (179±53) U/L, (24±9) μmol/L in hemihepatic occlusion group and were (291±126) U/L, (30±15) μmol/L in Pringle maneuver group accordingly, where significant differences were observed (t=-12.757, -5.777; P 0.05). From the year 2007 to 2009, the patients undergoing hemihepatic occlusion accounted for 24.2% (53/219) and increased to 42.9% (87/203) during the year 2010-2013. From the year 2007 to 2009, the patients undergoing Pringle maneuver accounted for 75.8% (166/219) and decreased to 57.1% (116/203) during the year 2010-2013. Significant difference was observed in the variation of patient quantity between two groups (χ2=16.540, P<0.05). Conclusions Compared with the Pringle maneuver, the hepatic portal occlusion without hemihepatic artery control causes lighter liver damage after liver resection in patients with HCC and it has been gradually widely used in clinic in recent years. Key words: Carcinoma, hepatocelluar; Hepatectomy; Hemihepatic vascular occlusion; Hepatic artery