Segmental and subsegmental resections of the cirrhotic liver under hepatic inflow and outflow occlusion

Segmental and subsegmental resections of the cirrhotic liver were carried out on 44 patients with hepatocellular carcinoma (HCC) and three cases with regenerating liver nodules. Seventeen patients underwent hepatectomies without hepatic vascular arrest (Group 1). In Group 2 (19 occasions), the Pringle manoeuvre was used for 8-46 min during parenchymal dissection. Hepatic resections were performed during simultaneous occlusion of hepatic inflow and outflow for 20-47 min in 11 patients (Group 3). The estimated blood loss during surgery was 2924 ml in Group 1, 1239 in Group 2, and 765 in Group 3 (Group 1 versus Group 2; P less than 0.02, Group 1 versus Group 3; P less than 0.02). Haemorrhagic shock occurred in three patients of Group 1, one of Group 2, and none of Group 3. Life-threatening postoperative complications occurred in four patients in Group 1, two in Group 2, and none in Group 3. Hospital death rate was 23.5 per cent in Group 1, 10.5 per cent in Group 2, and nil in Group 3. The present results may indicate that in performing nonanatomical resection of cirrhotic livers temporary occlusion of both hepatic inflow and outflow can be achieved for at least 30 min and is useful in reducing postoperative morbidity and mortality.