Document Detail


In situ hypothermic perfusion of the liver versus standard total vascular exclusion for complex liver resection.
MedLine Citation:
PMID:  15650638     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
SUMMARY BACKGROUND DATA: We compare the results of liver resection performed under in situ hypothermic perfusion versus standard total vascular exclusion (TVE) of the liver <60 minutes and > or =60 minutes in terms of liver tolerance, liver and renal functions, postoperative morbidity, and mortality. The safe duration of TVE is still debated. Promising results have been reported following TVE associated with hypothermic perfusion of the liver with durations of up to several hours. The 2 techniques have not been compared so far.
METHODS: The study population includes 69 consecutive liver resections under TVE <60 minutes (group TVE<60', 33 patients), > or =60 minutes (group TVE> or =60', 16 patients), and in situ hypothermic perfusion (group TVEHYOPOTH, 20 patients). Liver tolerance (peaks of transaminases), liver and kidney function (peak of bilirubin, minimum prothrombin time, and peak of creatinine), morbidity, and in-hospital mortality were compared within the 3 groups.
RESULTS: The postoperative peaks of aspartate aminotransferase (IU/L) and alanine aminotransferase (IU/L) were significantly lower (P[r] < 0.05) in group TVE HYPOTH (450 +/- 298 IU/L and 390 +/- 391 IU/L) compared with the groups TVE<60' (1000 +/- 808; 853 +/- 743) and TVE> or =60' (1519 +/- 962; 1033 +/- 861). In the group TVEHYPOTH, the peaks of bilirubin (micromol/L) (84 +/- 31), creatinine (micromol/L) (75 +/- 22), and the number of complications per patient (1.2 +/- 0.9) were comparable to those of the group TVE<60' (80 +/- 111; 109 +/- 77; and 0.8 +/- 1.1 respectively) and significantly lower to those of the group TVE> or =60' (196 +/- 173; 176 +/- 176, and 2.6 +/- 1.8). In-hospital mortality rates were 1 in 33, 2 in 16, and 0 in 20 for the groups TVE<60', TVE> or =60', and TVEHYOPOTH, respectively, and were comparable. On multivariate analysis, the size of the tumor, portal vein embolization, and a planned vascular reconstruction were significantly predictive of TVE > or =60 minutes.
CONCLUSIONS: Compared with standard TVE of any duration, hypothermic perfusion of the liver is associated with a better tolerance to ischemia. In addition, compared with TVE > or =60 minutes, it is associated with better postoperative liver and renal functions and a lower morbidity. Predictive factors for TVE > or =60 minutes may help to indicate hypothermic perfusion of the liver.
Authors:
Daniel Azoulay; Rony Eshkenazy; Paola Andreani; Denis Castaing; René Adam; Philippe Ichai; Salima Naili; Eric Vinet; Faouzi Saliba; Antoinette Lemoine; Marie-Christine Gillon; Henri Bismuth
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  241     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-01-14     Completed Date:  2005-02-22     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  277-85     Citation Subset:  AIM; IM    
Affiliation:
Centre Hépato-Biliaire, Département de Chirurgie Hépato-Biliaire, IFR 89.9, Hôpital Paul Brousse, Villejuif, France. daniel.azoulay@pbr.ap-hop-paris.fr
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MeSH Terms
Descriptor/Qualifier:
Alanine Transaminase / blood
Aspartate Aminotransferases / blood
Blood Loss, Surgical / prevention & control
Embolization, Therapeutic
Female
Hemostasis, Surgical / methods
Hepatectomy / methods*
Hospital Mortality
Humans
Hypothermia, Induced
Intraoperative Complications
Kidney Function Tests
Liver Function Tests
Male
Middle Aged
Morbidity
Multivariate Analysis
Perfusion
Chemical
Reg. No./Substance:
EC 2.6.1.1/Aspartate Aminotransferases; EC 2.6.1.2/Alanine Transaminase
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