A propensity score analysis of two methods of hepatic vascular occlusion in hepatectomy

• Published in: The Journal of surgical research 2017-06, Vol.213, p.184-190
• Main Authors: Luo, Xin, M.D, Chen, Lin, M.D, Liu, Wenhua, B.S, Dong, Shuilin, M.D, Luo, Hongping, R.N, Zhang, Bixiang, M.D, Chen, Xiaoping, M.D., FACS
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood Loss, Surgical - prevention & control; Databases, Factual; Female; Hemihepatic inflow occlusion; Hemostasis, Surgical - methods; Hepatectomy; Hepatectomy - methods; Hepatic vascular occlusion; Humans; Ipsilateral portal vein branch occlusion; Male; Middle Aged; Portal Vein; Propensity Score; Retrospective Studies; Surgery; Treatment Outcome
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2017.02.033

Abstract Background The key points in hepatectomy are reducing blood loss and preservation of hepatic function. The aim of this study was to compare the perioperative outcomes of partial hepatectomy using two techniques of hepatic vascular inflow occlusion. Materials and Methods A total of 1817 patients were selected from our multi-institutional hepatectomy database in China and classified into 2 groups: the hemihepatic inflow occlusion (HIO) group (n = 1693), and the ipsilateral portal vein branch occlusion (IPVBO) group(n=124). Propensity score matching of patients in a ratio of 1:1 was conducted. The primary outcome was intraoperative blood loss. Secondary outcomes were postoperative liver function, postoperative morbidity and mortality, and duration of hospital stay after surgery. Results After propensity score matching, there were 124 patients in the IPVBO group and the HIO group respectively. There were no significant differences between the 2 groups regarding intraoperative blood loss, blood transfusion requirement, operating time, postoperative morbidity and mortality, duration of hospital stay after surgery ( P > 0.05 ). However, The IPVBO group was associated with significantly lower peak in postoperative ALT level than the HIO group ( P < 0.05 ). Conclusions The results indicated that IPVBO did not lead to more intraoperative blood loss compared with HIO, and it decreased peak of postoperative ALT level. In terms of postoperative morbidity and mortality, duration of hospital stay after surgery, IPVBO was also equal to HIO. Thus IPVBO could be an alternative method of hepatic inflow occlusion.