Safety comparison of laparoscopic hepatic blood flow occlusion for hepatectomy in HCC patients with cirrhosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YE Junshan ^1,2 ,  WEI Yonggang ¹ , LAN Xiang ¹ , LIU Fei ¹ , LI Bo ¹ , ZHANG Hua ¹ , XU Hongwei ¹ , HE Zhongping ¹ , ZHAO Rongce ¹ , WANG Linyuan ¹

1. Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
2. Department of General Surgery, People’s Hospital of Tibet Autonomous Region, Lhasa 850000, P. R. China;

Corresponding author：

WEI Yonggang, Email: yourwyg@163.com

Keywords：

hepatocellular carcinoma; liver cirrhosis; intermittent Pringle maneuver; continuous hemi-hepatic vascular inflow occlusion; laparoscopic liver resection; propensity score matching

DOI：

10.7507/1007-9424.201811084

Video：

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Objective To investigate the effect of intermittent Pringle (IP) and continuous hemi-hepatic vascular inflow occlusion (CHVIO) on the prognosis of patients with hepatocellular carcinoma (HCC) complicated with cirrhosis in laparoscopic liver resection (LLR).Methods Retrospective analysis of consecutive 107 LLR patients with HCC complicated with liver cirrhosis at West China Hospital of Sichuan University between January 2015 and December 2017 was performed. Patients were divided into an IP group and a CHVIO group according to the method of hepatic vascular occlusion, intraoperative and postoperative outcome indicators and short-term prognosis were compared between the two groups.Results Patients in the IP group had shorter operative time [(237+90) min vs (285+118) min, P=0.041] and less blood loss [(279+24) mL vs (396+35) mL, P=0.012], without a significant increase in postoperative liver function [including ALT, AST, TBIL, and ALB], postoperative complications, induced flow, 1-year disease-free survival, and1-year survival (P>0.05).Conclusions IP can reduce the operative time and blood loss in patients with HCC complicated with cirrhosis in LLR, and will not lead to deterioration of liver function, it is a recommended hepatic inflowocclusion method.

Citation： YE Junshan, WEI Yonggang, LAN Xiang, LIU Fei, LI Bo, ZHANG Hua, XU Hongwei, HE Zhongping, ZHAO Rongce, WANG Linyuan. Safety comparison of laparoscopic hepatic blood flow occlusion for hepatectomy in HCC patients with cirrhosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(2): 141-147. doi: 10.7507/1007-9424.201811084 Copy

1.	Abu Hilal M, van der Poel MJ, Samim M, et al. Laparoscopic liver resection for lesions adjacent to major vasculature: feasibility, safety and oncological efficiency. J Gastrointest Surg, 2015, 19(4): 692-698.
2.	Jackson NR, Hauch A, Hu T, et al. The safety and efficacy of approaches to liver resection: a meta-analysis. JSLS, 2015, 19(1): e2014.
3.	Zheng B, Zhao R, Li X, et al. Comparison of laparoscopic liver resection for lesions located in anterolateral and posterosuperior segments: a meta-analysis. Surg Endosc, 2017, 31(11): 4641-4648.
4.	Cai LX, Tong YF, Yu H, et al. Is laparoscopic hepatectomy a safe, feasible procedure in patients with a previous upper abdominal surgery? Chin Med J (Engl), 2016, 129(4): 399-404.
5.	Araki K, Fuks D, Nomi T, et al. Feasibility of laparoscopic liver resection for caudate lobe: technical strategy and comparative analysis with anteroinferior and posterosuperior segments. Surg Endosc, 2016, 30(10): 4300-4306.
6.	Tranchart H, O’Rourke N, Van Dam R, et al. Bleeding control during laparoscopic liver resection: a review of literature. J Hepatobiliary Pancreat Sci, 2015, 22(5): 371-378.
7.	Kawaguchi Y, Nomi T, Fuks D, et al. Hemorrhage control for laparoscopic hepatectomy: technical details and predictive factors for intraoperative blood loss. Surg Endosc, 2016, 30(6): 2543-2551.
8.	Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1, 803 consecutive cases over the past decade. Ann Surg, 2002, 236(4): 397-406.
9.	Katz SC, Shia J, Liau KH, et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg, 2009, 249(4): 617-623.
10.	Mizuguchi T, Kawamoto M, Nakamura Y, et al. New technique of extracorporeal hepatic inflow control for pure laparoscopic liver resection. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): e16-e20.
11.	Lee N, Cho CW, Kim JM, et al. Application of temporary inflow control of the Glissonean pedicle method provides a safe and easy technique for totally laparoscopic hemihepatectomy by Glissonean approach. Ann Surg Treat Res, 2017, 92(5): 383-386.
12.	Ni JS, Lau WY, Yang Y, et al. A prospective randomized controlled trial to compare pringle manoeuvre with hemi-hepatic vascular inflow occlusion in liver resection for hepatocellular carcinoma with cirrhosis. J Gastrointest Surg, 2013, 17(8): 1414-1421.
13.	Fu SY, Lau WY, Li GG, et al. A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy. Am J Surg, 2011, 201(1): 62-69.
14.	Hoekstra LT, van Trigt JD, Reiniers MJ, et al. Vascular occlusion or not during liver resection: the continuing story. Dig Surg, 2012, 29(1): 35-42.
15.	Torzilli G, Procopio F, Donadon M, et al. Safety of intermittent Pringle maneuver cumulative time exceeding 120 minutes in liver resection: a further step in favor of the " radical but conservative” policy. Ann Surg, 2012, 255(2): 270-280.
16.	Chen YJ, Zhen ZJ, Chen HW, et al. Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach. Hepatobiliary Pancreat Dis Int, 2014, 13(5): 508-512.
17.	Rotellar F, Pardo F, Benito A, et al. A novel extra-glissonian approach for totally laparoscopic left hepatectomy. Surg Endosc, 2012, 26(9): 2617-2622.
18.	Herman P, Krüger J, Lupinacci R, et al. Laparoscopic bisegmentectomy 6 and 7 using a Glissonian approach and a half-Pringle maneuver. Surg Endosc, 2013, 27(5): 1840-1841.
19.	Zhang Y, Yang H, Deng X, et al. Intermittent Pringle maneuver versus continuous hemihepatic vascular inflow occlusion using extra-glissonian approach in laparoscopic liver resection. Surg Endosc, 2016, 30(3): 961-970.
20.	Hepp J, Couinaud C. Approach to and use of the left hepatic duct in reparation of the common bile duct. Presse Med, 1956, 64(41): 947-948.
21.	Desmet VJ, Gerber M, Hoofnagle JH, et al. Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology, 1994, 19(6): 1513-1520.
22.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
23.	Rosenbaum PR, Rubin DB. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat, 1985, 39: 33-38.
24.	Nomi T, Fuks D, Govindasamy M, et al. Risk factors for complications after laparoscopic major hepatectomy. Br J Surg, 2015, 102(3): 254-260.
25.	Costi R, Scatton O, Haddad L, et al. Lessons learned from the first 100 laparoscopic liver resections: not delaying conversion may allow reduced blood loss and operative time. J Laparoendosc Adv Surg Tech A, 2012, 22(5): 425-431.
26.	Chao YJ, Wang CJ, Shan YS. Technical notes: a self-designed, simple, secure, and safe six-loop intracorporeal Pringle’s maneuver for laparoscopic liver resection. Surg Endosc, 2012, 26(9): 2681-2686.
27.	Dixon E, Vollmer CM Jr, Bathe OF, et al. Vascular occlusion to decrease blood loss during hepatic resection. Am J Surg, 2005, 190(1): 75-86.
28.	Dua MM, Worhunsky DJ, Hwa K, et al. Extracorporeal Pringle for laparoscopic liver resection. Surg Endosc, 2015, 29(6): 1348-1355.
29.	Rotellar F, Pardo F, Bueno A, et al. Extracorporeal tourniquet method for intermittent hepatic pedicle clamping during laparoscopic liver surgery: an easy, cheap, and effective technique. Langenbecks Arch Surg, 2012, 397(3): 481-485.
30.	Xu C, Yu C, Li Y. Ischaemia-reperfusion injury in non-alcoholic steatohepatitis (NASH) liver: a tough problem to cope with. Gut, 2008, 57(11): 1631.

1. Abu Hilal M, van der Poel MJ, Samim M, et al. Laparoscopic liver resection for lesions adjacent to major vasculature: feasibility, safety and oncological efficiency. J Gastrointest Surg, 2015, 19(4): 692-698.
2. Jackson NR, Hauch A, Hu T, et al. The safety and efficacy of approaches to liver resection: a meta-analysis. JSLS, 2015, 19(1): e2014.
3. Zheng B, Zhao R, Li X, et al. Comparison of laparoscopic liver resection for lesions located in anterolateral and posterosuperior segments: a meta-analysis. Surg Endosc, 2017, 31(11): 4641-4648.
4. Cai LX, Tong YF, Yu H, et al. Is laparoscopic hepatectomy a safe, feasible procedure in patients with a previous upper abdominal surgery? Chin Med J (Engl), 2016, 129(4): 399-404.
5. Araki K, Fuks D, Nomi T, et al. Feasibility of laparoscopic liver resection for caudate lobe: technical strategy and comparative analysis with anteroinferior and posterosuperior segments. Surg Endosc, 2016, 30(10): 4300-4306.
6. Tranchart H, O’Rourke N, Van Dam R, et al. Bleeding control during laparoscopic liver resection: a review of literature. J Hepatobiliary Pancreat Sci, 2015, 22(5): 371-378.
7. Kawaguchi Y, Nomi T, Fuks D, et al. Hemorrhage control for laparoscopic hepatectomy: technical details and predictive factors for intraoperative blood loss. Surg Endosc, 2016, 30(6): 2543-2551.
8. Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1, 803 consecutive cases over the past decade. Ann Surg, 2002, 236(4): 397-406.
9. Katz SC, Shia J, Liau KH, et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg, 2009, 249(4): 617-623.
10. Mizuguchi T, Kawamoto M, Nakamura Y, et al. New technique of extracorporeal hepatic inflow control for pure laparoscopic liver resection. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): e16-e20.
11. Lee N, Cho CW, Kim JM, et al. Application of temporary inflow control of the Glissonean pedicle method provides a safe and easy technique for totally laparoscopic hemihepatectomy by Glissonean approach. Ann Surg Treat Res, 2017, 92(5): 383-386.
12. Ni JS, Lau WY, Yang Y, et al. A prospective randomized controlled trial to compare pringle manoeuvre with hemi-hepatic vascular inflow occlusion in liver resection for hepatocellular carcinoma with cirrhosis. J Gastrointest Surg, 2013, 17(8): 1414-1421.
13. Fu SY, Lau WY, Li GG, et al. A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy. Am J Surg, 2011, 201(1): 62-69.
14. Hoekstra LT, van Trigt JD, Reiniers MJ, et al. Vascular occlusion or not during liver resection: the continuing story. Dig Surg, 2012, 29(1): 35-42.
15. Torzilli G, Procopio F, Donadon M, et al. Safety of intermittent Pringle maneuver cumulative time exceeding 120 minutes in liver resection: a further step in favor of the " radical but conservative” policy. Ann Surg, 2012, 255(2): 270-280.
16. Chen YJ, Zhen ZJ, Chen HW, et al. Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach. Hepatobiliary Pancreat Dis Int, 2014, 13(5): 508-512.
17. Rotellar F, Pardo F, Benito A, et al. A novel extra-glissonian approach for totally laparoscopic left hepatectomy. Surg Endosc, 2012, 26(9): 2617-2622.
18. Herman P, Krüger J, Lupinacci R, et al. Laparoscopic bisegmentectomy 6 and 7 using a Glissonian approach and a half-Pringle maneuver. Surg Endosc, 2013, 27(5): 1840-1841.
19. Zhang Y, Yang H, Deng X, et al. Intermittent Pringle maneuver versus continuous hemihepatic vascular inflow occlusion using extra-glissonian approach in laparoscopic liver resection. Surg Endosc, 2016, 30(3): 961-970.
20. Hepp J, Couinaud C. Approach to and use of the left hepatic duct in reparation of the common bile duct. Presse Med, 1956, 64(41): 947-948.
21. Desmet VJ, Gerber M, Hoofnagle JH, et al. Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology, 1994, 19(6): 1513-1520.
22. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
23. Rosenbaum PR, Rubin DB. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat, 1985, 39: 33-38.
24. Nomi T, Fuks D, Govindasamy M, et al. Risk factors for complications after laparoscopic major hepatectomy. Br J Surg, 2015, 102(3): 254-260.
25. Costi R, Scatton O, Haddad L, et al. Lessons learned from the first 100 laparoscopic liver resections: not delaying conversion may allow reduced blood loss and operative time. J Laparoendosc Adv Surg Tech A, 2012, 22(5): 425-431.
26. Chao YJ, Wang CJ, Shan YS. Technical notes: a self-designed, simple, secure, and safe six-loop intracorporeal Pringle’s maneuver for laparoscopic liver resection. Surg Endosc, 2012, 26(9): 2681-2686.
27. Dixon E, Vollmer CM Jr, Bathe OF, et al. Vascular occlusion to decrease blood loss during hepatic resection. Am J Surg, 2005, 190(1): 75-86.
28. Dua MM, Worhunsky DJ, Hwa K, et al. Extracorporeal Pringle for laparoscopic liver resection. Surg Endosc, 2015, 29(6): 1348-1355.
29. Rotellar F, Pardo F, Bueno A, et al. Extracorporeal tourniquet method for intermittent hepatic pedicle clamping during laparoscopic liver surgery: an easy, cheap, and effective technique. Langenbecks Arch Surg, 2012, 397(3): 481-485.
30. Xu C, Yu C, Li Y. Ischaemia-reperfusion injury in non-alcoholic steatohepatitis (NASH) liver: a tough problem to cope with. Gut, 2008, 57(11): 1631.

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Safety comparison of laparoscopic hepatic blood flow occlusion for hepatectomy in HCC patients with cirrhosis

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