A Trial of Complete Versus Selective HepaticVascular Clamping in Hepatectomy
Condition: Hepatocellular Carcinoma
MeSH terms: Carcinoma, Hepatocellular
Study type: Interventional

Summary: 
      Intraoperative bleeding remains a major concern during liver resection. Pringle maneuver is
      the most frequently used method to occlude inflow blood of the liver.However, experimental
      and clinical studies have shown than even short periods of clamping produce some degree of
      ischemia-reperfusion injury that can result in hepatocellular damage,this damage being
      especially important in patients with abnormal liver parenchyma such as steatosis and
      cirrhosis. The aim of this study was to evaluate whether the use of selective vascular
      clamping should be generalized to HCC patients and help to reduce the ischemia-reperfusion
      injury.
    

Detailed description: 
      From recent animal studies, it can be easily concluded that I/R injury of the liver may be a
      significant factor, which can promote the primary liver tumor recurrence and metastasis. If
      it is a truth in human, there must be a big challenge to the Pringle maneuver which was
      adopted routinely in hepatectomy in the past years. Pringle maneuver during hepatic resection
      may do harm to the liver function, make the tumor cell more aggressive and tend to
      recurrence. It is suggested that further strategies may be needed for the prevention and
      treatment of I/R injury ,early and late recurrences.Selective hepatic vascular clamping
      (SVC)such as hemihepatic vascular occlusion have been used to minimize ischemic injury during
      liver surgery, especially in patients with abnormal liver parenchyma. However,these procedure
      used is likely to depend on the surgeon's training or preference rather than on objective
      data, there is not any further reported data or RCT studies conducted about the postoperative
      outcome ,especially liver function.To address these issues,we designed a prospective
      randomized controlled trial comparing the complete hepatic vascular clamping (Pringle
      maneuver) and selective hepatic vascular clamping ( portal vein or hemi-hepatic occlusion) in
      patients undergoing hepatectomy. The main objective was to compare the liver I/R injury of
      two procedures to the postoperative liver function. The secondary objective was to evaluate
      the feasibility, safety, efficacy, amount of hemorrhage,postoperative complications
      ,disease-free and overall survival rate of the 2 procedures.
    

Intervention name(s): Pringle's Maneuver; Hemihepatic vascular Clamping; Portal vein occlusion
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): The entire hilar pedicle was encircled with a rubber tape to perform a Pringle maneuver with a tourniquet.; The portal vein,hepatic artery ,and biliary duct were dissected in the hilum by opening the peritoneal fascia. Either the right or left portal pedicle was isolated and encircled with a tourniquet or clamped with Shatinsky clamp. Separate clamping of accessory left hepatic artery was performed when present in controlling the left hemihepatic portal traid.; The proper hepatic artery was dissected first from the duodenohepatic ligament, portal pedicle was blocked with a rubber encircled through the posterior wall of proper hepatic artery and the bottom of duodenohepatic ligament.When aberrant hepatic arteries emerging from the superior mesenteric artery are found in duodenohepatic ligament ,they should be dissected and kept unobstructed.
Other intervention name(s): Pringle's Maneuver group; Hemihepatic vascular Clamping group; Portal vein occlusion group
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: hepatectomy; Selective HepaticVascular Clamping