Περίληψη:
Aim: We hereby present and evaluate a technique for hepatic parenchymal
transection based on the application of Metzenbaum scissors and clips
during liver ischemia. Methods: Our technique was retrospectively
evaluated in 32 noncirrhotic, noncholestatic patients with intrahepatic
cholangiocarcinoma and 32 patients with hepatocellular carcinoma (23 of
whom cirrhotic, 71.9%). Patient data were retrieved from our
Hepatobiliary Surgery Database. Type and duration of vascular clamping,
blood transfusion requirements, marginal status and immediate
postoperative complications were analyzed. Results: Twenty-seven
extended (>4 liver segments; 42.2%) and 37 nonextended (<= 4 liver
segments; 57.8%) liver resections were analyzed. Warm liver ischemia
duration was 14 (interquartile range: 11-17.8) min. Thirty-three
patients (51.6%) were transfused with a median of 2 (1.5-3) units of
packed red blood cells. Tumor-free margins were achieved in 90.6% of
cases (n = 58). The overall morbidity rate was 18.8% with a 4.7%
mortality rate. Our technique allowed for excellent identification and
safe dissection and preservation, or ligation of major liver vessels.
Conclusions: The proposed technique is simple, fast, safe and with low
cost. It is associated with limited postoperative complications while
from an oncologic standpoint it enables the surgeon to achieve a high
percentage of tumor-free margins while protecting major vascular
structures. (C) 2014 S. Karger AG, Basel
Συγγραφείς:
Schwartz, Myron E.
Miller, Charles M.
Roayaie, Sasan and
Gomatos, Ilias P.
Konstadoulakis, Manousos M.
