This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (49)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Selective Use, Extensive Use, or Abuse?

Gian Luca Grazi, MD; Alighieri Mazziotti, MD; Elio Jovine, MD; Filippo Pierangeli, MD; Giorgio Ercolani, MD; Antonio Gallucci, MD; Antonino Cavallari, MD

Arch Surg. 1997;132(10):1104-1109.

Abstract
Objectives
To review our experience with total vascular exclusion of the liver and to assess its role in hepatic resections.

Design
Retrospective survey.

Setting
University hospital, a tertiary referring center for surgical liver diseases.

Patients
A total of 722 patients who underwent liver resections from November 1, 1981, to March 31, 1996, of whom 19 (2.6%) required total vascular exclusion because of hepatic lesions closely adherent to or infiltrating the retrohepatic vena cava or centrally located in the liver, strictly in contact with the hepatic vein convergence.

Main Outcome Measure
² Test for qualitative data and Student t test for categorical data.

Results
Of the 19 resections carried out under total vascular exclusion, 6 had tumoral infiltration of the retrohepatic vena cava: in 4 cases the venous wall was partially resected, while in the remaining 2 it was completely removed and replaced with a prosthetic graft. There were no operative deaths. Of the 722 resections, 227 were major hepatectomies: 74 (32.6%) were performed after ligation of the glissonian elements for the hemiliver to be removed, without clamping of the hepatic pedicle, and a further 36 (15.8%) were performed without any preliminary vascular control. A significant reduction in intraoperative blood transfusions was achieved despite the performance of more extended operations, regardless of the technique used.

Conclusions
Total vascular exclusion is a useful tool in controlling blood inflow to the liver, but true need for it during liver resection is limited. Its performance requires a well-trained team familiar with problems regarding surgical access to the inferior vena cava and prolonged occlusion of the hepatic pedicle and the inferior vena cava.

Arch Surg. 1997;132:1104-1109

Author Affiliations
From the Second Department of Surgery, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Use of Vascular Clamping in Hepatic Surgery: Lessons Learned From 1260 Liver Resections
Ercolani et al.
Arch Surg 2008;143:380-387.
ABSTRACT | FULL TEXT  

Web Relationships Between Physicians and Individuals Seeking Information on Hepatopancreatobiliary Diseases
Grazi
Arch Surg 2006;141:1176-1182.
ABSTRACT | FULL TEXT  

Liver Resection for Multiple Colorectal Metastases: Influence of Parenchymal Involvement and Total Tumor Volume, vs Number or Location, on Long-term Survival
Ercolani et al.
Arch Surg 2002;137:1187-1192.
ABSTRACT | FULL TEXT  

Effects of Preoperative Steroid Administration on Surgical Stress in Hepatic Resection: Prospective Randomized Trial
Yamashita et al.
Arch Surg 2001;136:328-333.
ABSTRACT | FULL TEXT