The Application of Selective Hepatic Inflow Vascular Occlusion with Anterior Approach in Liver Resection: Effectiveness in Managing Major Complications and Long-Term Survival

Abstract

Background. Hepatectomy is always a challenge to surgeons and requires an appropriate approach for specific tumors to achieve effective complication management. Selective hepatic pedicle clamping is more considerable strategy when comparing with total hepatic pedicle clamping in the balance between reducing blood loss and transfusion with causing the hepatic parenchyma damages (two main complications affecting liver resection result). Objectives. In this study, we aim to describe the application of selective hepatic inflow vascular occlusion (SHIVO) and anatomical anterior approach in liver resection and evaluate the results, focusing on intraoperative and postoperative complications. Methods. We enrolled 72 patients who underwent liver resection with SHIVO at Viet Duc University Hospital in 4-year period (2011-2014) and then followed up all of them until June 2020 (in $52.6\pm 33$ months; range, 2-105 months) or up to the time of death. All the patients were diagnosed with primary or secondary liver cancer, and their future remnant liver volume measured on 64-slice CT scan (dm3) to $\text{body}\text{weight}\left(\text{kg}\right)>0.8$ % (for right hepatectomy). Perioperative parameters were collected and analyzed. Results. The average operation time was $196.2\pm 62.2$ minutes, and blood loss was $261.4\pm 202.9$  ml; total blood transfusion proportion during and after surgery was 16.7%. Complications accounted for 44.5% of patients in which pleural effusion was the most common one (41.7%). There were no liver failure and biliary fistula after surgery. No deaths were recorded during 30 days postoperatively. Average hospital stay was $11.4\pm 3.7$ days. Blood transfusions during the operation and major liver resection were the factors significantly affecting the percentage of complications after liver surgery in our study. In the last follow-up evaluation, 44 patients were dead and 28 patients were alive, in which 7 with recurrence and 21 without recurrence. The overall survival rate was 38.9%. Conclusion. SHIVO in anatomical liver resection is a safe and feasible approach to help resect precisely targeted tumors and manage several complications in liver resection.