TY - JOUR
T1 - Liver Resection Without Pedicle Clamping
T2 - Feasibility and Need for "Salvage Clamping". Looking for the Right Clamping Policy. Analysis of 512 Consecutive Resections
AU - Viganò, Luca
AU - Jaffary, Syed A A
AU - Ferrero, Alessandro
AU - Russolillo, Nadia
AU - Langella, Serena
AU - Capussotti, Lorenzo
PY - 2011/10
Y1 - 2011/10
N2 - Background: Pedicle clamping during liver resection (LR) is debated. The purpose of this study is to validate non-clamping policy across a large series of LR and to evaluate the need for salvage clamping (SC) and its outcomes. Methods: Five hundred twelve consecutive LR without initial pedicle clamping performed between 2004 and 2009 were analyzed. Results: Among 512 LR (171 major hepatectomies), 90. 2% were completed without clampage. Fifty (9. 8%) required SC. Blood loss were higher in SC group (555 vs. 175 mL, p <0. 0001), while transfusion rate was not. No differences were observed in terms of mortality (0%/1. 3%), morbidity (38%/38. 3%), liver dysfunction (4%/3. 7%), and renal dysfunction (0%/1. 3%). Bile leak rate was increased in the SC group (20%/10. 2%, p = 0. 036). At multivariate analysis, three predictive factors of SC were identified: arterial hypertension (p = 0. 007, SC rate = 13%), cirrhosis (p = 0. 003, SC rate = 26%), and LR conducted along the right portal scissure (p = 0. 010, SC rate = 32%). One protective factor was identified: LR confined to antero-lateral segments (Sg2-6, p = 0. 001, SC rate = 2%). Extension of LR had no impact on need for SC. Conclusions: The majority of LR can be safely performed without clamping with excellent outcomes. SC is a safe procedure and does not worsen postoperative outcomes, except for bile leak rate. Clamping policy should be tailored to the type of LR and presence of cirrhosis.
AB - Background: Pedicle clamping during liver resection (LR) is debated. The purpose of this study is to validate non-clamping policy across a large series of LR and to evaluate the need for salvage clamping (SC) and its outcomes. Methods: Five hundred twelve consecutive LR without initial pedicle clamping performed between 2004 and 2009 were analyzed. Results: Among 512 LR (171 major hepatectomies), 90. 2% were completed without clampage. Fifty (9. 8%) required SC. Blood loss were higher in SC group (555 vs. 175 mL, p <0. 0001), while transfusion rate was not. No differences were observed in terms of mortality (0%/1. 3%), morbidity (38%/38. 3%), liver dysfunction (4%/3. 7%), and renal dysfunction (0%/1. 3%). Bile leak rate was increased in the SC group (20%/10. 2%, p = 0. 036). At multivariate analysis, three predictive factors of SC were identified: arterial hypertension (p = 0. 007, SC rate = 13%), cirrhosis (p = 0. 003, SC rate = 26%), and LR conducted along the right portal scissure (p = 0. 010, SC rate = 32%). One protective factor was identified: LR confined to antero-lateral segments (Sg2-6, p = 0. 001, SC rate = 2%). Extension of LR had no impact on need for SC. Conclusions: The majority of LR can be safely performed without clamping with excellent outcomes. SC is a safe procedure and does not worsen postoperative outcomes, except for bile leak rate. Clamping policy should be tailored to the type of LR and presence of cirrhosis.
KW - Blood transfusion
KW - Cirrhosis
KW - Liver dysfunction
KW - Liver resection
KW - Liver surgery
KW - Pedicle clamping
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U2 - 10.1007/s11605-011-1625-4
DO - 10.1007/s11605-011-1625-4
M3 - Article
C2 - 21809167
AN - SCOPUS:80053120532
VL - 15
SP - 1820
EP - 1828
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
IS - 10
ER -