NORMOTHERMIC HEPATIC VASCULAR EXCLUSION FOR EXTENSIVE HEPATECTOMY

Abstract

In humans, there is still considerable controversy concerning the tolerance of the liver to warm ischemia. To avoid anoxic hepatocellular damage, chilled intraportal and intra-arterial infusion has been advised as an adjunct to hepatic vascular isolation. Patients (14) with hepatic tumors underwent extensive hepatic resection, complete hepatic vascular exclusion being used but without the use of refrigeration. This procedure considerably reduced blood loss during resection of large and hypervascular hepatic tumors and increased the safety of hazardous lobectomies. Careful hemodynamic monitoring including pulmonary artery pressure was necessary. Hepatic tolerance to prolonged warm ischemia up to 65 min was surprisingly good in the absence of preoperative, extensive hepatic dysfunction. The use of this procedure was advised for resection of large hepatic tumors when the technical risks appear to be high. The classical delay of 15 to 20 min. of normothermic hepatic ischemia may be safely extended to about 1 h when necessary.