Hilar lobar vascular occlusion for hepatic resection

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Limited liver resection is a viable option for patients with cirrhosis and compromised hepatic function.
• Hepatocellular carcinoma (HCC) resection in cirrhotic patients requires careful management of blood flow to the liver.

Purpose of the Study:

• To compare the efficacy and safety of two hilar vascular clamping methods (selective vs. lobar) against the traditional Pringle method during liver resection for HCC in cirrhotic patients.

Main Methods:

• Retrospective comparison of three vascular clamping techniques: hilar selective clamping (n=13), hilar lobar clamping (n=8), and the Pringle method (n=19).
• Evaluation parameters included cardiovascular stability, intraoperative blood loss, operative time, and postoperative recovery.

Main Results:

• Hilar lobar clamping demonstrated significantly shorter operative times (209 min) and less blood loss (920 ml) compared to selective clamping (259 min, 1640 ml).
• The Pringle method showed a more profound decrease in blood pressure during clamping.
• Postoperative liver function markers did not significantly differ between groups, though trends suggested higher levels in the Pringle group.

Conclusions:

• The hilar lobar clamping method is recommended for controlling afferent blood flow during liver resection in cirrhotic patients.
• This method offers a simple, safe, and effective approach to minimize bleeding and preserve cardiovascular stability.