Major hepatic resection under total vascular exclusion.

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Vascular Surgery

Background:

• Major liver resections are complex procedures often requiring control of major vascular inflow and outflow.
• Centrally located liver tumors and hepatocellular carcinoma present significant surgical challenges.
• Total vascular exclusion (TVE) offers a method to achieve avascularity during extensive liver resections.

Purpose of the Study:

• To evaluate the safety and efficacy of total vascular exclusion (TVE) in major hepatic resections.
• To identify indications and outcomes associated with TVE during liver surgery.
• To analyze correlations between operative parameters and postoperative outcomes.

Main Methods:

• A retrospective review of 51 major hepatic resections performed using TVE over a 9-year period.
• TVE involved supra- and infrahepatic caval and portal vein clamping.
• Indications included liver metastases and hepatocellular carcinoma; resections encompassed extended hepatectomies and segmentectomies.

Main Results:

• Successful major resection with TVE in 51 cases.
• Mean vascular exclusion time was 46.5 minutes with a mean transfusion requirement of 1.4 units.
• Significant correlations found between factor II levels and segments removed, and ALT levels and exclusion duration.
• Mortality was 2% (1 patient), with nonfatal complications in 14% of patients (respiratory infection, biliary fistula, collections).

Conclusions:

• Total vascular exclusion is a safe and effective technique for major liver resections, particularly for lesions involving hepatic veins.
• The procedure is associated with manageable morbidity and mortality.
• TVE facilitates complex liver tumor resections with acceptable blood loss and operative times.