[Value of selective clamping in major hepatectomies]

Charts of 100 consecutive patients who had undergone liver resection, performed by a single surgeon, during the 10 year period from 1983 to 1993 were reviewed. Liver trauma was excluded. The age of the patients ranged from 14 to 78 years, with a mean age of 52 +/- 12.3. Indications for liver resection were malignant tumors in 73 patients and benign disease in another 27 patients. The remnant liver was pathologic in 24 cases (21 cirrhosis, 3 chronic hepatitis). The extent of liver resection was major (> 3 segments) in 51 cases, and minor in 45 cases. Postoperative complications, including death, occurred in 24% of cases. Five complications required reoperation. Hospital mortality was 4%. Multivariate analysis demonstrated two major risk factors of morbidity: intraoperative blood transfusion, and cirrhosis. Age of patients was the only risk factor of mortality. In major resection, four categories of patients were established according to the type of hepatic inflow occlusion. Each group was comparable. Selective vascular clamping (selective control of the hilar vessels to the liver and selective hepatic vein occlusion) decreased the morbidity and post operative liver failure rate (p < 0.05). On the other hand, no correlation was observed between the type of hepatic inflow occlusion and the hospital mortality.