Open AccessAnterior approach combined with infrahepatic inferior vena cava clamping right hepatic resection for large hepatocellular carcinoma
Author(s) -
Yanming Zhou,
Chengjun Sui,
Xiaofeng Zhang,
Bin Li,
Jiamei Yang
Publication year - 2016
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000004159
Subject(s) - medicine , hepatocellular carcinoma , inferior vena cava , perioperative , clamping , surgery , blood loss , blood transfusion , hepatectomy , randomized controlled trial , vein , resection , carcinoma , mechanical engineering , engineering
Background: The anterior approach (AA) technique has been reported to provide better operative and survival outcomes compared with the conventional approach for large right hepatocellular carcinoma (HCC) resection. However, this technique runs the risk of massive retrograde bleeding from the right hepatic vein or middle hepatic vein at the deeper plane of parenchymal transection. This study was designed to evaluate the efficacy of AA combined with infrahepatic inferior vena cava (IVC) clamping on the perioperative outcomes in patients undergoing right hepatic resection for large HCC in randomized clinical trial settings. Methods: A total of 101 patients undergoing right hepatic resection for large HCC were randomized to receive AA combined with infrahepatic IVC clamping (group A, n = 50), or AA alone (group B, n = 51). Results: The total blood loss (423 ± 154 vs 757 ± 338 mL; P = 0.001), blood loss during liver transection (272 ± 96 vs 563 ± 144 mL; P = 0.001), and intraoperative blood transfusion requirements (12.0% vs 29.4%; P = 0.031) were significantly less in group A patients compared with group B patients. There was no IVC clamping-associated morbidity in group A. Conclusion: AA combined with infrahepatic IVC clamping for large right HCC resection is a safe, feasible, and effective technique in reducing intraoperative blood loss.