In situ hypothermic perfusion of the liver versus standard total vascular exclusion for complex liver resection / "Perfusão hipotérmica in situ versus exclusão vascular total do fígado para ressecções hepáticas complexas"

AUTOR(ES)
DATA DE PUBLICAÇÃO

2005

RESUMO

OBJECTIVE. To compare the results of liver resection performed under in situ hypothermic perfusion vs standard total vascular exclusion (TVE) of the liver <60 minutes and ≥ 60 minutes in terms of liver tolerance, liver and renal functions, postoperative morbidity and mortality. SUMMARY BACGROUND DATA. The safe duration of TVE is still debated. Promising results have been reported following TVE associated with hypothermic perfusion of the liver with durations of up to several hours. The two techniques have not been compared so far. PATIENTS AND METHODS.The study population includes 81 consecutive liver resections under TVE <60 minutes (group TVE <60’ , 34 patients), ≥ 60 minutes (group TVE ≥ 60’, 19 patients) and in situ hypothermic perfusion (group TVEHYPOTH , 28 patients). Liver tolerance (peaks of transaminases), liver and kidney function (peak of bilirubin, minimum prothrombin time and peak of creatinine), morbidity and inhospital mortality were compared within the 3 groups. RESULTS. The postoperative peaks of ASAT and ALAT were significantly lower (p <0.05) in group TVE HYPOTH (535 + 361 U/L and 436 + 427 U/L) compared to the groups TVE<60’ (988 + 798 U/L; 844 + 733 U/L) and TVE≥60’ (1583 + 984 U/L; 1082 + 842 U/L). In the group TVE HYPOTH , the peaks of bilirubin (6,5 + 2,5 mg/dl), creatinine (1,2 + 0,7 mg/dl), and the number of complications per patient (1,2 + 1) were comparable to those of the group TVE<60’ (5,5 + 7,8; 1,3 + 1; e 0,7 + 1 respectively) and significantly lower to those of the group TVE≥60’ (12,8 + 11,8; 2,3 + 2,3, e 2,3 + 1,2). In hospital mortality rates were 1/34, 2/19 and 2/28 for the groups TVE <60’ , TVE ≥ 60’ , and TVEHYPOTH respectively and were comparable. On multivariate analysis, the size of the tumor, portal vein embolization and a planned vascular reconstruction werem significantly predictive of TVE ≥ 60 minutes. CONCLUSIONS. Compared to standard TVE of any duration, hypothermic perfusion of the liver is associated with a better tolerance to ischemia. In addition, compared to TVE ≥ 60 minutes, it is associated with better postoperative liver and renal functions, and a lower morbidity. Predictive factors for TVE ≥ 60 minutes may help to indicate hypothermic perfusion of the liver.

ASSUNTO(S)

hypothermia surgical hemostasis/methods soluÇÕes para preservaÇÃo de ÓrgÃos hemostasia cirurgica/métodos hepatectomy/methods liver/surgery organ preservation solutions hepatectomia/métodos cryopreservation fÍgado/cirurgia morbidade hipotermia morbidity criopreservaÇÃo

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