Is any method of vascular control superior in hepatic resection of metastatic cancers? Longmire clamping, pringle maneuver, and total vascular isolation

Archives of Surgery
J F BuellJ M Millis

Abstract

Although control of the hepatic vascular pedicle is commonly used during hepatic resection, the optimal method of vascular control continues to be debated. The utility of total or selective vascular isolation, pedicle inflow occlusion, or the absence of vascular isolation during minor and major hepatectomy needs to be examined. Retrospective review of hepatic resections performed for either isolated colorectal or noncolorectal hepatic metastases. The University of Chicago Hospitals, Chicago, Ill, a tertiary-care referral center. One hundred forty-one patients who underwent hepatic resection for isolated metastatic liver disease were identified through The University of Chicago Hospitals Tumor Registry. Intraoperative parameters, perioperative morbidity and mortality, and tumor recurrence. Four groups were compared with alternative methods of vascular management, including total vascular isolation, Longmire clamping, Pringle maneuver, or no vascular control. Tumor number and size were not significantly different between groups. Blood loss and transfusion requirements tended to be higher in the total vascular isolation group and were significantly higher compared with the Pringle group (P =.06) and the no vascular control group (...Continue Reading

Citations

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