Total Hemihepatic Vascular Exclusion in Hepatectomy in Hepatocellular Carcinoma Treatment
Condition: Hepatocellular Carcinoma
MeSH terms: Carcinoma; Carcinoma, Hepatocellular
Study type: Interventional

Summary: 
      Total hemihepatic vascular exclusion(THHVE),completely isolates the right or left hemiliver
      ipsilateral to the lesion that requires resection from the systemic circulation,has the
      advantage of preventing backflow hemorrhage or air embolism without having to resort to caval
      blood flow interruption of THVE.This study is to evaluate if THHVE can raduce bleeding,reduce
      the incidence of complications and improve the patient's free survival and overall survival
      compared with hemihepatic vascular clamping and Pringle maneuver.
    

Detailed description: 
      The amount of blood loss and blood transfusion in Hepatectomy have a detrimental effect on
      the prognosis for Hepatocellular carcinoma(HCC).Intraoperative bleeding remains a major
      concern during liver resection. The most often used hepatic vascular control methods at
      present are hepatic pedicle occlusion(Pringle maneuver), hemihepatic vascular
      clamping,segmental vascular clamping and total hepatic vascular exclusion (THVE).However,all
      these methods have shortcomings. Pringle maneuver cannot prevent bleeding from hepatic veins
      and leads to ischemia-reperfusion injury of the liver; Hemihepatic vascular clamping cannot
      prevent bleeding from hepatic veins as well, and from the remnant (nonoccluded) liver. THVE
      is a technically demanding technique that requires surgical and anesthetic expertise and may
      lead to hemodynamic intolerance as well as increased morbidity and hospital stay. Total
      hemihepatic vascular exclusion(THHVE),completely isolates the right or left hemiliver
      ipsilateral to the lesion that requires resection from the systemic circulation,has the
      advantage of preventing backflow hemorrhage or air embolism without having to resort to caval
      blood flow interruption of THVE.

      The purpose of this study is to evaluate if THHVE can raduce bleeding,reduce the incidence of
      complications and improve the patient's free survival and overall survival compared with
      other occlusion methods.
    

Intervention name(s): Total hemihepatic vascular exclusion; Hemihepatic vascular Clamping; Pringle's Maneuver
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): A long vascular clamp is inserted along the midline of the anterior surface of the vena cava,proceed cranially up to the space between the right and the middle hepatic vein trunks. Two tapes are seized with the clamp passing between the anterior surface of the IVC and the liver parenchyma.One tape is use to pass around the hepatic parenchyma for occlusion of the bleeding from the remnant liver;the other is used to loop the right (or left )hepatic vein trunk and short hepatic vein,as well as inferior right hepatic vein,if present. Selectively interrupts the arterial and portal inflow to the part of the liver (right or left hemiliver)ipsilateral to the lesion that requires resection.Thus total hemihepatic vascular exclusion is achieved.; Selectively interrupts the arterial and portal inflow to the part of the liver (right or left hemiliver)ipsilateral to the lesion that requires resection. Selective clamping can be achieved after carefully dissecting the right from the left hilar branches or after inserting a clamp between the right and left hilar branches without prior hilar dissection and looping the right or left portal structures with a tape.; Hepatic pedicle clamping is performed by encircling the hepatoduodenal ligament with a tape and then applying a tourniquet or a vascular clamp until the pulse in the hepatic artery disappears distally.
Other intervention name(s): THHVE group; Hemihepatic vascular Clamping group; Pringle's Maneuver group
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: hepatocellular carcinoma; Surgical resection; total hemihepatic vascular exclusion; occlusion; bleeding; overall survival