Comparison of Early Clinical Outcomes between
Intermittent Vascular Inflow Occlusion versus
Intermittent Selective Hepatic Vascular Exclusion in
Hepatic Resections for Cholangiocarcinoma Patients:
A Prospective Randomized Controlled Trial Study
Tongsiri N, MD¹, Siripornadulsilp S, MD², Impool T, MD³
Affiliation : ¹ Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, Sakon Nakhon Hospital, Sakon Nakhon, Thailand ² Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, Khon Kaen Hospital, Khon Kaen, Thailand ³ Trauma Unit, Department of Surgery, Khon Kaen Hospital, Khon Kaen, Thailand
Background: There were reported benefits of selective hepatic vascular exclusion (SHVE) in reducing intraoperative blood loss
(IBL), intraoperative packed red cell (PRC) transfusion, and perioperative complications over intermittent Pringle maneuver
(IPM) in hepatectomies. However, there was lack of data regarding the use of SHVE in comparison with IPM in hepatectomies
for cholangiocarcinoma (CCA) patients.
Objective: To compare IBL, intraoperative PRC transfusion, total operative time (TOT), and perioperative complications between SHVE and IPM.
Materials and Methods: Between October 2018 and September 2019, forty eligible CCA patients participated in the study. They were randomly allocated to the SHVE group (n=20) or the IPM group (n=20). Data regarding patient demographics, tumor characteristics, and the objectives of the study were gathered and analyzed with intention-to-treat principle.
Results: The median IBL (range) 923.5 (101 to 4,979) versus 1,109 (413 to 5,305) ml; p=0.2, median intraoperative PRC transfusion (range) 112.5 (0 to 1,745) versus 296 (0 to 1,500) ml; p=0.22, and median TOT (range) 390 minute (220 to 915) versus 320 (240 to 930) minutes; p=0.55 between SHVE and IPM were not significantly different. There was no statistical difference in perioperative complications between SHVE and IPM.
Conclusion: Routine use of SHVE during hepatectomies in CCA patients showed no significant difference in outcomes regarding the objectives of the study.
Received 24 Jan 2020 | Revised 27 Apr 2020 | Accepted 28 Apr 2020
doi.org/10.35755/jmedassocthai.2020.06.11023
Keywords : Selective hepatic vascular exclusion (SHVE), Hepatic vascular exclusion with preservation of caval flow (HVEPV),
Hepatic resection, Cholangiocarcinoma, Intraoperative blood loss, Perioperative complications
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