Objective: To evaluate the optimal method for hepatic vascular occlusion during resection of liver carcinoma.
Methods: One hundred and twenty-four patients with liver carcinoma were divided into four groups of hepatectomy with total hepatic inflow occlusion (group A, 51 cases), selective hepatic inflow occlusion (group B, 38 cases), selective exclusion of hepatic inflow and outflow (group C, 24 cases) and total hemi-hepatic vascular exclusion (group D, 11 cases). The time of operation and hepatic vascular occlusion, intraoperative blood loss and transfusion, postoperative liver function, complications and mortality were compared among the four groups.
Results: There were no significant difference among the four groups statistically in preoperative basic states (P > 0.05). The duration of operation was prolonged significantly in group C and D than that of group A, but intra-operative blood loss and transfusion requirements were decreased significantly in group C and D versus group A and B (P < 0.05). There was no significant difference among the four groups regarding ischemia time, postoperative complications and mortality (P > 0.05). The level of postoperative alanine aminotransferase was higher in group A than other three groups (P < 0.05). The postoperative total bilirubin increased significantly in group A contrast to group B (P < 0.05).
Conclusions: Each hepatic vascular occlusion technique has its place in liver resection. The size and location of tumor, preoperative liver function, underlying liver disease, cardiovascular and cerebral vessels status, and most important the experience and capability to weigh the merits and demerits of the surgeon should be taken into account to select the most appropriate occlusion method.