Application Of Liver Double-hanging Maneuver And Clamping Of The Infrahepatic Inferior Vena Cava During Hepatectomy

Objective:To evaluate whether major right hepatectomy by an anterior approach using the liver double-hanging maneuver (LDHM) results in better operative and long-term survival outcomes when compared with the conventional approach technique.Methods:A prospective randomized controlled study was performed on124patients who had large right liver HCC and underwent curative major right hepatic resection from October2009to October2014. The patients were randomized to undergo resection of the tumor by an anterior approach using the liver double-hanging maneuver (LDHM)(LDHM group, n=60, hepatocellular carcinoma (HCC) in39, colorectal liver metastasis (CLM) in10, intrahepatic cholangiocarcinoma (ICC) in11or in conventional approach (non-LDHM group, n=64, hepatocellular carcinoma (HCC) in42, colorectal liver metastasis (CLM) in12, intrahepatic cholangiocarcinoma (ICC) in10. the key to the liver double-hanging maneuver is to develop the re-trohepatic tunnel between right adrenal gland and hepatic parenchyma and place two tapes. The anterior approach technique involved initial vascular inflow control, complete venous outflow control and completion of pare-nchymal transaction before the right liver was mobilized. Operative and long-term survival outcomes of the two groups were analyzed.Results:There were no postoperative deaths in two groups.In HCC patients, blood loss, number of patients requiring blood transfusion, transection time in the LDHM group were significantly lower than those in the non-LDHM group (p<0.05). There was no difference between two grops in cancer-positive margin rate, The percentage of hepatic insufficience and pleural effusion is lower in the LDHM group than the non-LDHM group, but the difference is not significant. In CLM, transection time in the LDHM group was significantly lower than that in the non-LDHM group (p<0.05). however, this difference of cancer-positive margin rate, blood loss, number of patients requiring blood transfusion and morbidity was not observed in both group. Significant differences of cancer-positive margin rate, blood loss, number of patients requiring blood transfusion and morbidity were not observed in ICC. In HCC patients, disease-free survival was not different between the LHM group and the non-LDHM group (p>0.05). Overall survival was significantly better in the LDHM group than in the non-LDHM group (p<0.05). However, significant differences of disease-free and overall survivals were not observed in CLM and ICC patients.Conclusion:The anterior approach using the liver double-hanging maneuver (LDHM) results in better operative and survival outcomes compared with the conventional approach. It is the preferred technique for major right hepatectomy for large HCC. Background and aims:Intraoperative hemorrhage control during liver transection has been one of the most important issues in hepatic surgery. Pringle maneuver and other inflow occlusive methods could minimize hepatic arterial and portal blood flow to the liver, but these techniques could not avoid the blood loss from hepatic venous system. Bleeding from the hepatic venous system is related to central venous pressure closely. To evaluate the effect of total and half clamping of inferior vena cava to decrease CVP during hepatic transectionMethods:A retrospective study was performed on52patients undergoing hepatectomy with the IVC clamping from September2012to September2014(Total clamping group R=28,Half-clamping group R=24), Comparing with48patients undergoing hepatectomy without IVC clamping between July2009and January2012.Amount of blood loss during the hapetectomy, volume of blood transfsion and complications were compared between the two groups.Results:The total blood loss in IVC total clamping group, half clamping group and IVC non-clamping group was387.67±182.54ml,406.32±178.45ml,796.72±337.38ml respectively. Patients in the clamping group experienced more blood loss than the non-clamping group of patients (p<0.05). The CVP was no significant between total clamping group and half clamping group, which was lower than non-clamping group. There were no complications of hemodynamic and electrolytic parameter.Conclusions:Using the complete clamping or half clamping technique of the IVC can decrease CVP and reduce the bleeding from hepatic veins. IVC clamping can decrease CVP when the CVP is elevated without any side effects. Besides, half clamping technique is more better in hemodynamic.