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Liver Extracts

patients subjected to major hepatectomy with vascular control of blood inflow and outflow of the whole liver

patients subjected to major hepatectomy by selectively clamping the portal and hepatic vessels only of the lobe harboring the tumor

major hepatectomy with vascular control of blood inflow and outflow of the whole liver

selective hepatic vascular exclusion

major liver resection by selectively clamping the portal and hepatic vessels only of the lobe harboring the tumor

semielective hepatic vascular exclusion

Kassiani Theodoraki, PhD

Severe ischemic changes of the liver remnant after hepatectomy could expedite tumor recurrence on the residual liver. Our study aimed at assessing the effect of warm ischemic/reperfusion (I/R) injuries on surgery-to-local recurrence interval and patient overall survival, during major hepatectomies under inflow and outflow vascular control.

One hundred and eighteen patients were subjected to liver resection under total inflow and outflow vascular clamping and were assigned as study group. These individuals were retrospectively matched to 112 counterparts, who underwent liver surgery applying inflow and outflow vascular clamping only of the segment harboring the tumor, sparing the liver remnant from any I/R injury (control group). The two cohorts were compared regarding recurrence-free survival and overall survival.

Recurrence of Liver Malignancy After Ischemia/Reperfusion Injury

Does Vascular Occlusion in Liver Resections Predispose to Recurrence of Malignancy in the Liver Remnant Due to Ischemia/Reperfusion Injury?

Aretaieion University Hospital

Associate Professor of Anesthesiology

Carcinoma

Carcinoma, Hepatocellular

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Adenocarcinoma

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Liver Diseases

Patients with HCC received Selective Hepatic Vascular Exclusion in hepatectomy.

Patients with HCC received Pringle's Maneuver in hepatectomy.

Inflow occlusion with extraparenchymal control of major hepatic veins results in total liver isolation from the systemic circulation but without interruption of caval flow.

Selective Hepatic Vascular Exclusion

Hepatic pedical clamping is performed by encircling the hepatoduodenal ligament with a tape and then applying a tourniquet or a vascular clamp until the pulse in the hepatic artery disappears distally.

Pringle's Maneuver

Feng Shen, M.D.

To confirm that SHVE is a safe and effective procedure and it can prevent bleeding of the hepatic vein. To evaluate the recurrence and metastasis in HCC patients undergoing hepatectomy by SHVE.To evaluate that SHVE can improve survival in HCC patients or not.

Hepatocellular carcinoma (HCC), a serious disease with high incidence at home and abroad still shows a rising trend. In recent decade, the overall survival rate of the disease has entered a platform stage with little advance despite diversified methods of treatment. The prognosis of HCC is not so satisfying.

Intraoperative bleeding remains a major concern during liver resection. Blood loss usually occurs during parenchymal transection and reperfusion after Pringle's maneuver. The amount of blood loss and the need for blood transfusion have a detrimental effect on the short- and long-term prognosis.

Portal triad clamping is sufficient in most situations to control bleeding during hepatectomy. However, it does not prevent backflow bleeding from hepatic veins, which may become troublesome or even hazardous. This is particularly true in tumors that are large or that have invaded into the branches of the major hepatic veins.

SHVE completely isolates the liver from the systemic circulation with the advantage of preventing backflow hemorrhage or air embolism without having to resort to caval blood flow interruption of THVE.

The purpose of the study is to assess the risk factors for the recurrence and metastasis in HCC patients undergoing hepatectomy by SHVE and to evaluate that SHVE can improve survival in HCC patients or not.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Recurrence of Liver Malignancy After Ischemia/Reperfusion Injury	NCT04257240	Ischemic Reperf... Liver Injury Cancer Recurren... Malignancy Liver Cancer	selective hepat... semielective he...	18 Years - 90 Years	Aretaieion University Hospital
Pringle's Maneuver Versus Selective Hepatic Vascular Exclusion in Hepatectomy	NCT00820339	Hepatocellular ...	Selective Hepat... Pringle's Maneu...	18 Years - 70 Years	Eastern Hepatobiliary Surgery Hospital
Recurrence of Liver Malignancy After Ischemia/Reperfusion Injury	NCT04257240	Ischemic Reperf... Liver Injury Cancer Recurren... Malignancy Liver Cancer	selective hepat... semielective he...	18 Years - 90 Years	Aretaieion University Hospital
Pringle's Maneuver Versus Selective Hepatic Vascular Exclusion in Hepatectomy	NCT00820339	Hepatocellular ...	Selective Hepat... Pringle's Maneu...	18 Years - 70 Years	Eastern Hepatobiliary Surgery Hospital

Spots Global Cancer Trial Database for selective hepatic vascular exclusion