Comparison of different hepatic inflow occlusion methods in hepatectomy for large liver cancer

Objective: To compare the clinical efficacies of three hepatic inl ow occlusion methods in hepatectomy for large hepatocellular carcinoma.Methods: The clinical data of 218 patients undergoing hepatectomy for large hepatocellular carcinoma(5 cm) from January 2011 to March 2013 were retrospectively analyzed. During surgery, 88 cases were subjected to intermittent hepatic inflow occlusion with Pringle maneuver(portal occlusion group), 51 cases underwent selective hemihepatic blood flow occlusion(hemihepatic occlusion group), and 79 cases received infrahepatic inferior vena cava(IVC) clamping plus Pringle maneuver(combination occlusion group). The relevant clinical variables among the three groups of patients were compared.Results: There were no significant differences in preoperative conditions, operative time, inflow occlusion time and liver resection volume among the three groups(all P0.05). In either hemihepatic occlusion group or combination occlusion group, the intraoperative blood loss, blood transfusion volume and blood transfusion rate were all significantly lower than those in portal occlusion group, and the blood transfusion volume and blood transfusion rate in combination occlusion group were also significantly lower than those in hemihepatic occlusion group(all P0.05). All liver function parameters showed no significant difference among the three groups on postoperative day(POD) one, but the transaminase and total bilirubin levels in both hemihepatic occlusion group and combination group were significantly decreased compared with portal occlusion group on POD 3 and 7(all P0.05). No signii cant dif erence was noted in incidence of postoperative complications among the three groups(P0.05).Conclusion: In large liver cancer resection, hepatic inl ow control with combination of infrahepatic IVC clamping and Pringle maneuver can not only effectively reduce intraoperative blood loss, but also be advantageous for recovery of postoperative liver function.