Total vascular exclusion for hepatic resection in cirrhotic patients. Application of venovenous bypass
Y. Yamaoka, K. Ozawa, K. Kumada, Y. Shimahara, K. Tanaka, K. Mori, T. Takayasu, R. Okamoto, N. Kobayashi, Y. Konishi and al. et
Second Department of Surgery, Kyoto University of Medicine, Japan.
Hepatic vascular exclusion with double venovenous bypass using a
centrifugal force pump was used in major hepatic resections in eight
patients with hepatocellular carcinoma combined with cirrhosis, and results
were compared with those in four patients with hepatocellular carcinoma
without cirrhosis and eight with metastatic tumors without cirrhosis among
521 patients undergoing liver resection. Concomitant resection of the
retrohepatic inferior vena cava was performed in three of eight patients
with cirrhosis and five of 12 patients without cirrhosis. All patients,
except one with cirrhosis, tolerated major resection without any
hemodynamic impairment, which is often observed in hepatic vascular
exclusion without venovenous bypass. One patient, whose complete inflow
occlusion period was 70 minutes, died of liver failure. In this patient,
the recovery of the arterial ketone body ratio above 1.0 was delayed until
3 days after recirculation, whereas the ratio in the others recovered
promptly. Postoperative complications such as increased bilirubin level,
pleural effusion, and gastrointestinal tract bleeding were observed in
seven of eight patients with cirrhosis compared with six of 12 without
cirrhosis. Hepatic vascular exclusion is feasible even in cirrhotics as
long as it is applied with venovenous bypass and is kept within the time
limit of 60 minutes.
