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Wan Yee Lau - One of the best experts on this subject based on the ideXlab platform.

  • a prospective randomized controlled trial to compare Pringle Manoeuvre with hemi hepatic vascular inflow occlusion in liver resection for hepatocellular carcinoma with cirrhosis
    Journal of Gastrointestinal Surgery, 2013
    Co-Authors: Wan Yee Lau, Zeya Pan, Yuan Yang, Zhenguang Wang, Hui Liu, Weiping Zhou
    Abstract:

    The duration of hepatic vascular inflow occlusion and the amount of intraoperative blood loss have significant negative impacts on postoperative morbidity, mortality and long-term survival outcomes of patients who receive partial hepatectomy for hepatocellular carcinoma (HCC) with cirrhosis. This study aimed to compare the perioperative outcomes of partial hepatectomy for HCC superimposed on hepatitis B-related cirrhosis using two different occlusion techniques. A randomized controlled trial was carried out to evaluate the impact of two different vascular inflow occlusion techniques. The postoperative short-term results were compared. During the study period, 252 patients received partial hepatectomy for HCC with cirrhosis. Of these patients, 120 were randomized equally into two groups: the Pringle Manoeuvre group (n = 60) and the hemi-hepatic vascular inflow occlusion group (n = 60). The number of patients who had poor liver function on postoperative day 5 with ISLGS grade B or worse was 24 and 13, respectively (P = 0.030). The postoperative complication rate was significantly higher in the Pringle Manoeuvre group (40 versus 22 %, P = 0.030). However, the Pringle Manoeuvre group had significantly shorter operating time (116 versus 136 min, P = 0.012) although there was no significant difference in intraoperative blood loss between the two groups [200 ml (range 10–5,000 ml) versus 300 ml (range 100–1,000 ml); P = 0.511]. There was no perioperative mortality. The results indicated that for patients with HCC with cirrhosis, hemi-hepatic vascular inflow occlusion was a better inflow occlusion method than Pringle Manoeuvre.

  • selective hepatic vascular exclusion versus Pringle Manoeuvre in liver resection for tumours encroaching on major hepatic veins
    British Journal of Surgery, 2012
    Co-Authors: J Zhang, Eric C H Lai, W P Zhou, Zeya Pan, Yefa Yang, Wan Yee Lau
    Abstract:

    Background: Control of bleeding is crucial during liver resection, and several techniques have been developed to achieve this. This study compared the safety and efficacy of selective hepatic vascular exclusion (SHVE) and Pringle Manoeuvre in partial hepatectomy for liver tumours compressing or involving major hepatic veins. Methods: All patients undergoing liver resection between January 2003 and December 2010 for liver tumours compressing or involving one or more major hepatic veins were identified retrospectively from a prospective institutional database. Either SHVE or Pringle Manoeuvre was used to minimize blood loss during hepatectomy. Data on demographics and the intraoperative and postoperative course were analysed. Results: From the database of 3900 patients, 1420 were identified who underwent liver resection for tumours encroaching on major hepatic veins using either SHVE (550) or the Pringle Manoeuvre (870). Intraoperative blood loss (mean(s.d.) 480(210) versus 830(340) ml; P = 0·007) and transfusion requirements (mean(s.d.) 1·3(0·6) versus 2·9(1·4) units; P = 0·008) were significantly less in the SHVE group. In the Pringle group, hepatic vein injury resulted in major intraoperative bleeding of over 1000 ml in 65 patients (7·5 per cent) and air embolism in 14 (1·6 per cent), and three patients (0·3 per cent) died during surgery, whereas there was no major bleeding, air embolism or intraoperative death in the SHVE group. Postoperative liver failure, multiple organ failure and in-hospital death were significantly more common in the Pringle group (P = 0·019, P = 0·032 and P = 0·004 respectively). Conclusion: SHVE was more efficacious than the Pringle Manoeuvre in minimizing intraoperative bleeding and air embolism during partial hepatectomy for tumours encroaching on major hepatic veins, and decreased the postoperative liver failure rate. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  • liver resection under total vascular exclusion with or without preceding Pringle Manoeuvre
    British Journal of Surgery, 2009
    Co-Authors: Eric C H Lai, Zeya Pan, Yefa Yang, Wan Yee Lau, Yang Sun, W P Zhou
    Abstract:

    Background: Adequate control of bleeding is crucial during liver resection. This study analysed the safety and efficacy of hepatectomy under total hepatic vascular exclusion (THVE) in patients with tumours encroaching or infiltrating the hepatic veins and/or the inferior vena cava (IVC). Methods: All patients undergoing liver resection with THVE between January 2000 and July 2006 were identified from a prospectively collected database containing 2400 patients. Data on patient demographics, surgical procedure and outcome were collected. Results: A total of 87 patients scheduled for liver resection under THVE were identified, 77 with malignant tumours and ten with benign disease. THVE could not be used in two patients (2 per cent) owing to haemodynamic intolerance during trial clamping. Seventeen patients received simultaneous clamping of the portal triad and vena cava, and 68 had portal triad clamping followed by concomitant portal and vena cava clamping. The mean(s.d.) duration of THVE was 28·3(7·5) and 18·7(5·2) min respectively. Overall postoperative complication and operative mortality rates were 53 and 2 per cent respectively. Mean(s.d.) hospital stay was 16·8(4·7) days. Conclusion: Major hepatic resection for tumours encroaching on the hepatic veins or IVC can be carried out under THVE with reasonable morbidity and mortality. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Zeya Pan - One of the best experts on this subject based on the ideXlab platform.

  • a prospective randomized controlled trial to compare Pringle Manoeuvre with hemi hepatic vascular inflow occlusion in liver resection for hepatocellular carcinoma with cirrhosis
    Journal of Gastrointestinal Surgery, 2013
    Co-Authors: Wan Yee Lau, Zeya Pan, Yuan Yang, Zhenguang Wang, Hui Liu, Weiping Zhou
    Abstract:

    The duration of hepatic vascular inflow occlusion and the amount of intraoperative blood loss have significant negative impacts on postoperative morbidity, mortality and long-term survival outcomes of patients who receive partial hepatectomy for hepatocellular carcinoma (HCC) with cirrhosis. This study aimed to compare the perioperative outcomes of partial hepatectomy for HCC superimposed on hepatitis B-related cirrhosis using two different occlusion techniques. A randomized controlled trial was carried out to evaluate the impact of two different vascular inflow occlusion techniques. The postoperative short-term results were compared. During the study period, 252 patients received partial hepatectomy for HCC with cirrhosis. Of these patients, 120 were randomized equally into two groups: the Pringle Manoeuvre group (n = 60) and the hemi-hepatic vascular inflow occlusion group (n = 60). The number of patients who had poor liver function on postoperative day 5 with ISLGS grade B or worse was 24 and 13, respectively (P = 0.030). The postoperative complication rate was significantly higher in the Pringle Manoeuvre group (40 versus 22 %, P = 0.030). However, the Pringle Manoeuvre group had significantly shorter operating time (116 versus 136 min, P = 0.012) although there was no significant difference in intraoperative blood loss between the two groups [200 ml (range 10–5,000 ml) versus 300 ml (range 100–1,000 ml); P = 0.511]. There was no perioperative mortality. The results indicated that for patients with HCC with cirrhosis, hemi-hepatic vascular inflow occlusion was a better inflow occlusion method than Pringle Manoeuvre.

  • selective hepatic vascular exclusion versus Pringle Manoeuvre in liver resection for tumours encroaching on major hepatic veins
    British Journal of Surgery, 2012
    Co-Authors: J Zhang, Eric C H Lai, W P Zhou, Zeya Pan, Yefa Yang, Wan Yee Lau
    Abstract:

    Background: Control of bleeding is crucial during liver resection, and several techniques have been developed to achieve this. This study compared the safety and efficacy of selective hepatic vascular exclusion (SHVE) and Pringle Manoeuvre in partial hepatectomy for liver tumours compressing or involving major hepatic veins. Methods: All patients undergoing liver resection between January 2003 and December 2010 for liver tumours compressing or involving one or more major hepatic veins were identified retrospectively from a prospective institutional database. Either SHVE or Pringle Manoeuvre was used to minimize blood loss during hepatectomy. Data on demographics and the intraoperative and postoperative course were analysed. Results: From the database of 3900 patients, 1420 were identified who underwent liver resection for tumours encroaching on major hepatic veins using either SHVE (550) or the Pringle Manoeuvre (870). Intraoperative blood loss (mean(s.d.) 480(210) versus 830(340) ml; P = 0·007) and transfusion requirements (mean(s.d.) 1·3(0·6) versus 2·9(1·4) units; P = 0·008) were significantly less in the SHVE group. In the Pringle group, hepatic vein injury resulted in major intraoperative bleeding of over 1000 ml in 65 patients (7·5 per cent) and air embolism in 14 (1·6 per cent), and three patients (0·3 per cent) died during surgery, whereas there was no major bleeding, air embolism or intraoperative death in the SHVE group. Postoperative liver failure, multiple organ failure and in-hospital death were significantly more common in the Pringle group (P = 0·019, P = 0·032 and P = 0·004 respectively). Conclusion: SHVE was more efficacious than the Pringle Manoeuvre in minimizing intraoperative bleeding and air embolism during partial hepatectomy for tumours encroaching on major hepatic veins, and decreased the postoperative liver failure rate. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  • liver resection under total vascular exclusion with or without preceding Pringle Manoeuvre
    British Journal of Surgery, 2009
    Co-Authors: Eric C H Lai, Zeya Pan, Yefa Yang, Wan Yee Lau, Yang Sun, W P Zhou
    Abstract:

    Background: Adequate control of bleeding is crucial during liver resection. This study analysed the safety and efficacy of hepatectomy under total hepatic vascular exclusion (THVE) in patients with tumours encroaching or infiltrating the hepatic veins and/or the inferior vena cava (IVC). Methods: All patients undergoing liver resection with THVE between January 2000 and July 2006 were identified from a prospectively collected database containing 2400 patients. Data on patient demographics, surgical procedure and outcome were collected. Results: A total of 87 patients scheduled for liver resection under THVE were identified, 77 with malignant tumours and ten with benign disease. THVE could not be used in two patients (2 per cent) owing to haemodynamic intolerance during trial clamping. Seventeen patients received simultaneous clamping of the portal triad and vena cava, and 68 had portal triad clamping followed by concomitant portal and vena cava clamping. The mean(s.d.) duration of THVE was 28·3(7·5) and 18·7(5·2) min respectively. Overall postoperative complication and operative mortality rates were 53 and 2 per cent respectively. Mean(s.d.) hospital stay was 16·8(4·7) days. Conclusion: Major hepatic resection for tumours encroaching on the hepatic veins or IVC can be carried out under THVE with reasonable morbidity and mortality. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

W P Zhou - One of the best experts on this subject based on the ideXlab platform.

  • selective hepatic vascular exclusion versus Pringle Manoeuvre in liver resection for tumours encroaching on major hepatic veins
    British Journal of Surgery, 2012
    Co-Authors: J Zhang, Eric C H Lai, W P Zhou, Zeya Pan, Yefa Yang, Wan Yee Lau
    Abstract:

    Background: Control of bleeding is crucial during liver resection, and several techniques have been developed to achieve this. This study compared the safety and efficacy of selective hepatic vascular exclusion (SHVE) and Pringle Manoeuvre in partial hepatectomy for liver tumours compressing or involving major hepatic veins. Methods: All patients undergoing liver resection between January 2003 and December 2010 for liver tumours compressing or involving one or more major hepatic veins were identified retrospectively from a prospective institutional database. Either SHVE or Pringle Manoeuvre was used to minimize blood loss during hepatectomy. Data on demographics and the intraoperative and postoperative course were analysed. Results: From the database of 3900 patients, 1420 were identified who underwent liver resection for tumours encroaching on major hepatic veins using either SHVE (550) or the Pringle Manoeuvre (870). Intraoperative blood loss (mean(s.d.) 480(210) versus 830(340) ml; P = 0·007) and transfusion requirements (mean(s.d.) 1·3(0·6) versus 2·9(1·4) units; P = 0·008) were significantly less in the SHVE group. In the Pringle group, hepatic vein injury resulted in major intraoperative bleeding of over 1000 ml in 65 patients (7·5 per cent) and air embolism in 14 (1·6 per cent), and three patients (0·3 per cent) died during surgery, whereas there was no major bleeding, air embolism or intraoperative death in the SHVE group. Postoperative liver failure, multiple organ failure and in-hospital death were significantly more common in the Pringle group (P = 0·019, P = 0·032 and P = 0·004 respectively). Conclusion: SHVE was more efficacious than the Pringle Manoeuvre in minimizing intraoperative bleeding and air embolism during partial hepatectomy for tumours encroaching on major hepatic veins, and decreased the postoperative liver failure rate. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  • liver resection under total vascular exclusion with or without preceding Pringle Manoeuvre
    British Journal of Surgery, 2009
    Co-Authors: Eric C H Lai, Zeya Pan, Yefa Yang, Wan Yee Lau, Yang Sun, W P Zhou
    Abstract:

    Background: Adequate control of bleeding is crucial during liver resection. This study analysed the safety and efficacy of hepatectomy under total hepatic vascular exclusion (THVE) in patients with tumours encroaching or infiltrating the hepatic veins and/or the inferior vena cava (IVC). Methods: All patients undergoing liver resection with THVE between January 2000 and July 2006 were identified from a prospectively collected database containing 2400 patients. Data on patient demographics, surgical procedure and outcome were collected. Results: A total of 87 patients scheduled for liver resection under THVE were identified, 77 with malignant tumours and ten with benign disease. THVE could not be used in two patients (2 per cent) owing to haemodynamic intolerance during trial clamping. Seventeen patients received simultaneous clamping of the portal triad and vena cava, and 68 had portal triad clamping followed by concomitant portal and vena cava clamping. The mean(s.d.) duration of THVE was 28·3(7·5) and 18·7(5·2) min respectively. Overall postoperative complication and operative mortality rates were 53 and 2 per cent respectively. Mean(s.d.) hospital stay was 16·8(4·7) days. Conclusion: Major hepatic resection for tumours encroaching on the hepatic veins or IVC can be carried out under THVE with reasonable morbidity and mortality. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

St Fan - One of the best experts on this subject based on the ideXlab platform.

  • Delayed portal vein thrombosis after experimental radiofrequency ablation near the main portal vein
    'Wiley', 2004
    Co-Authors: Shek Twh, Wong J, Ng Kkc, Cm Lam, Poon Rtp, St Fan
    Abstract:

    Background: Portal venous blood flow may protect adjacent tumour cells from thermal destruction with radiofrequency ablation (RFA). This study aimed to investigate the local effect of RFA on the main portal vein branch, and the completeness of cellular ablation in its vicinity, with or without a Pringle Manoeuvre using a porcine model. Methods: This was an in vivo study on 23 domestic pigs. RFA using a cooled-tip electrode was performed 5 mm from the left main portal vein branch under ultrasonographic guidance for 12 min with (n = 10) or without (n = 10) a Pringle Manoeuvre. Ten pigs were killed 4 h after the procedure to study the early effects of RFA and ten others were killed 1 week later to determine any delayed effect. As a control, sham operations with a Pringle Manoeuvre for 12 min were performed on three pigs. The flow velocity changes of portal vein and hepatic artery were measured using Doppler ultrasonography, and the completeness of cellular ablation around the portal vein was assessed qualitatively by histochemical staining and quantitatively by measuring intracellular levels of adenosine 5′-triphosphate (ATP). Results: In the absence of the Pringle Manoeuvre, there was no significant change in mean(s.d.) portal vein flow velocity before RFA (20.0(3.5) cm/s) and at 4 h (18.5(2.5) cm/s) (P = 0.210) and 1 week (19.5(2.2) cm/s) (P = 0.500) after the procedure. Gross and histological examination of the portal vein branches showed no damage without the Pringle Manoeuvre. In all pigs that underwent RFA with a Pringle Manoeuvre, the portal vein was occluded 1 week after the operation; histological examination of the affected portal vein showed severe thermal injury and associated venous thrombosis. The local effect of RFA on the hepatic artery was similar. With intact portal blood flow during RFA, complete ablation of liver tissue around the pedicle was demonstrated by histochemical staining and measurement of the intracellular ATP concentration. Conclusion: RFA was safe when applied close to the main portal vein branch without a Pringle Manoeuvre, with complete cellular destruction. Use of the Pringle Manoeuvre resulted in delayed portal vein and hepatic artery thrombosis and injury to the hepatic artery and bile duct.link_to_subscribed_fulltex

  • effects of the intermittent Pringle Manoeuvre on hepatic gene expression and ultrastructure in a randomized clinical study
    British Journal of Surgery, 2003
    Co-Authors: Kwan Man, St Fan, Chileung Liu, Zw Zhang, T K Lee, John Wong
    Abstract:

    Background: The intermittent Pringle Manoeuvre during hepatectomy results in a better clinical outcome when the accumulated ischaemia time is less than 120 min. The aim of this study was to investigate hepatic gene expression related to microcirculatory modulation and ultrastructural changes in patients having the intermittent Pringle Manoeuvre. Methods: Forty patients who underwent hepatectomy for liver tumours were randomly assigned to liver transection with intermittent Pringle Manoeuvre (Pringle group, n = 20) or without the Manoeuvre (control group, n = 20). The clinical data and hepatic expression of endothelin (ET) 1 and endothelial nitric oxide synthase (eNOS) combined with liver ultrastructure were compared. Results: The Pringle Manoeuvre resulted in less blood loss (8·9 versus 12·4 ml/cm2; P = 0·034), a shorter transection time (2·7 versus 4·1 min/cm2; P = 0·015) and a lower serum bilirubin level on postoperative day 2 (26 versus 35 µm/l; P = 0·04). The hepatic messenger RNA content of ET-1 decreased by 38 per cent of the basal level in the Pringle group, whereas it increased by 28 per cent in the control group (P = 0·026). More patients in the control group showed swelling of mitochondria in hepatocytes and disruption of sinusoidal lining cells (12 of 20 patients versus three of 20 in the Pringle group; P = 0·008). Conclusion: The intermittent Pringle Manoeuvre results in less disturbance of the hepatic microcirculation and better preservation of liver sinusoids after hepatectomy. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  • Effects of the intermittent Pringle Manoeuvre on hepatic gene expression and ultrastructure in a randomized clinical study
    'Wiley', 2003
    Co-Authors: Cl Liu, Man K, Ng Iol, Zw Zhang, Wong J, Lee Tkw, St Fan
    Abstract:

    Background: The intermittent Pringle Manoeuvre during hepatectomy results in a better clinical outcome when the accumulated ischaemia time is less than 120 min. The aim of this study was to investigate hepatic gene expression related to microcirculatory modulation and ultrastructural changes in patients having the intermittent Pringle Manoeuvre. Methods: Forty patients who underwent hepatectomy for liver tumours were randomly assigned to liver transection with intermittent Pringle Manoeuvre (Pringle group, n = 20) or without the Manoeuvre (control group, n = 20). The clinical data and hepatic expression of endothelin (ET) 1 and endothelial nitric oxide synthase (eNOS) combined with liver ultrastructure were compared. Results: The Pringle Manoeuvre resulted in less blood loss (8.9 versus 12.4 ml/cm2; P = 0.034), a shorter transection time (2.7 versus 4.1 min/cm2; P = 0.015) and a lower serum bilirubin level on postoperative day 2 (26 versus 35 μm/l; P = 0.04). The hepatic messenger RNA content of ET-1 decreased by 38 per cent of the basal level in the Pringle group, whereas it increased by 28 per cent in the control group (P = 0.026). More patients in the control group showed swelling of mitochondria in hepatocytes and disruption of sinusoidal lining cells (12 of 20 patients versus three of 20 in the Pringle group; P = 0.008). Conclusion: The intermittent Pringle Manoeuvre results in less disturbance of the hepatic microcirculation and better preservation of liver sinusoids after hepatectomy.link_to_subscribed_fulltex

  • Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma
    'Wiley', 2003
    Co-Authors: Ac Wei, Poon Rtp, Wong J, St Fan
    Abstract:

    Background: Extended hepatectomy with resection of more than four segments is a high-risk operation, especially in patients with hepatocellular carcinoma (HCC) associated with chronic liver disease. This study evaluated the risk factors for morbidity and mortality following extended hepatectomy for HCC. Methods: Preoperative and intraoperative variables of 155 patients who underwent extended hepatectomy for HCC were analysed to identify risk factors for postoperative morbidity and mortality. Results: The overall morbidity rate was 55.5 per cent (n = 86). Most morbidity was due to ascites or pleural effusion. Significant life-threatening complications occurred in 20.0 per cent (n = 31). The perioperative mortality rate was 8.4 per cent (n = 13). Multivariate analysis found that portal clamping (P = 0.023) and perioperative blood transfusion (P < 0.001) were risk factors for morbidity, whereas perioperative blood transfusion (P < 0.001) was the only risk factor for significant morbidity. Co-morbid illness (P = 0.019) and perioperative blood transfusion (P = 0.004) were risk factors for perioperative mortality. Conclusion: Meticulous operative techniques to minimize blood loss and transfusion, while avoiding a prolonged Pringle Manoeuvre, may help reduce postoperative morbidity. Avoidance of perioperative blood transfusion and careful preoperative selection of patients in terms of overall physiological status are important measures to reduce the postoperative mortality rate.link_to_OA_fulltex

  • Hepatic stress gene expression and ultrastructural features under intermittent Pringle Manoeuvre
    'Science China Press. Co. Ltd.', 2002
    Co-Authors: Cl Liu, Man K, St Fan, Ng Iol, Tb Liang
    Abstract:

    Background: Intermittent Pringle Manoeuvre resulted in less blood loss and better preservation of liver function when it was applied for fewer than 120 minutes. The mechanism of better preservation of liver function under intermittent Pringle Manoeuvre at molecular level remains unclear. Furthermore, the ultrastructural features in the liver with chronic diseases under intermittent Pringle Manoeuvre have not been studied. The aim of the study is to investigate the expression of stress genes and ultrastructural change of the liver under intermittent Pringle Manoeuvre. Methods: From July 1995 to February 1998, 131 patients underwent hepatectomy for liver tumours (61 patients without Pringle Manoeuvre and 70 patients with intermittent Pringle Manoeuvre). Twenty-five patients (15 with Pringle Manoeuvre and 10 without Pringle Manoeuvre) were included in the study of hepatic stress gene expression during hepatectomy. Twenty-two patients (18 patients with intermittent Pringle Manoeuvre and four patients without Pringle Manoeuvre) were randomly assigned for electron microscopic examination. Results: For the expression of stress genes, both the heat shock genes (HSP 70A and HSC 70) and acute phase genes (TNF-α and interleukin-6) were detected simultaneously in the patients with or without intermittent Pringle Manoeuvre. The patients under intermittent Pringle Manoeuvre had relatively higher mRNA levels of heat shock gene 70 family, which is related to intracellular repair and protection. Induction of TNF-α and interleukin-6 genes, which contributed to ischaemia-reperfusion injury and postoperative complication, was not found in the patients under intermittent Pringle Manoeuvre. Under the electron microscopy, the hepatic ultrastructure was well maintained under intermittent Pringle Manoeuvre whatever the liver status, even when the accumulated ischaemic duration was extended to 120 min. Conclusion: Intermittent Pringle Manoeuvre induced relatively higher expression of heat shock genes, which are related to intracellular homeostasis, and is consistent with the well maintenance of liver ultrastructure.link_to_subscribed_fulltex

Eric C H Lai - One of the best experts on this subject based on the ideXlab platform.

  • selective hepatic vascular exclusion versus Pringle Manoeuvre in liver resection for tumours encroaching on major hepatic veins
    British Journal of Surgery, 2012
    Co-Authors: J Zhang, Eric C H Lai, W P Zhou, Zeya Pan, Yefa Yang, Wan Yee Lau
    Abstract:

    Background: Control of bleeding is crucial during liver resection, and several techniques have been developed to achieve this. This study compared the safety and efficacy of selective hepatic vascular exclusion (SHVE) and Pringle Manoeuvre in partial hepatectomy for liver tumours compressing or involving major hepatic veins. Methods: All patients undergoing liver resection between January 2003 and December 2010 for liver tumours compressing or involving one or more major hepatic veins were identified retrospectively from a prospective institutional database. Either SHVE or Pringle Manoeuvre was used to minimize blood loss during hepatectomy. Data on demographics and the intraoperative and postoperative course were analysed. Results: From the database of 3900 patients, 1420 were identified who underwent liver resection for tumours encroaching on major hepatic veins using either SHVE (550) or the Pringle Manoeuvre (870). Intraoperative blood loss (mean(s.d.) 480(210) versus 830(340) ml; P = 0·007) and transfusion requirements (mean(s.d.) 1·3(0·6) versus 2·9(1·4) units; P = 0·008) were significantly less in the SHVE group. In the Pringle group, hepatic vein injury resulted in major intraoperative bleeding of over 1000 ml in 65 patients (7·5 per cent) and air embolism in 14 (1·6 per cent), and three patients (0·3 per cent) died during surgery, whereas there was no major bleeding, air embolism or intraoperative death in the SHVE group. Postoperative liver failure, multiple organ failure and in-hospital death were significantly more common in the Pringle group (P = 0·019, P = 0·032 and P = 0·004 respectively). Conclusion: SHVE was more efficacious than the Pringle Manoeuvre in minimizing intraoperative bleeding and air embolism during partial hepatectomy for tumours encroaching on major hepatic veins, and decreased the postoperative liver failure rate. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  • liver resection under total vascular exclusion with or without preceding Pringle Manoeuvre
    British Journal of Surgery, 2009
    Co-Authors: Eric C H Lai, Zeya Pan, Yefa Yang, Wan Yee Lau, Yang Sun, W P Zhou
    Abstract:

    Background: Adequate control of bleeding is crucial during liver resection. This study analysed the safety and efficacy of hepatectomy under total hepatic vascular exclusion (THVE) in patients with tumours encroaching or infiltrating the hepatic veins and/or the inferior vena cava (IVC). Methods: All patients undergoing liver resection with THVE between January 2000 and July 2006 were identified from a prospectively collected database containing 2400 patients. Data on patient demographics, surgical procedure and outcome were collected. Results: A total of 87 patients scheduled for liver resection under THVE were identified, 77 with malignant tumours and ten with benign disease. THVE could not be used in two patients (2 per cent) owing to haemodynamic intolerance during trial clamping. Seventeen patients received simultaneous clamping of the portal triad and vena cava, and 68 had portal triad clamping followed by concomitant portal and vena cava clamping. The mean(s.d.) duration of THVE was 28·3(7·5) and 18·7(5·2) min respectively. Overall postoperative complication and operative mortality rates were 53 and 2 per cent respectively. Mean(s.d.) hospital stay was 16·8(4·7) days. Conclusion: Major hepatic resection for tumours encroaching on the hepatic veins or IVC can be carried out under THVE with reasonable morbidity and mortality. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.