Blood Loss, Surgical Approach & Incisions
Conditions
Keywords
Anterior approach, infrahepatic inferior vena cava clamping, hepatic resection
Brief summary
Anterior approach results in better operative and survival outcomes compared with the conventional approach in patients with large hepatocellular carcinoma (HCC), but anterior approach has the problem of bleeding from the hepatic vein. Our previous study showed that infrahepatic inferior vena cava (IVC) clamping can reduce blood loss during conventional hepatic resection. The investigators guess infrahepatic IVC clamping may also reduce blood loss in anterior approach right hepatic resection. So the investigators conduct this prospective, randomized, controlled trial to compare anterior approach combined with infrahepatic IVC clamping and anterior approach in major right hepatectomy for large HCC.
Detailed description
Traditionally, mobilisation of the right hemiliver followed by right hepatic vein control before parenchymal transection has been considered the standard approach to a major right hepatectomy. However, this approach is often difficult and hazardous when performing liver resection for large hepatocellular carcinoma (HCC) or for tumors with extrahepatic organ invasion in the right retrohepatic region.In setting of right hepatectomy by an anterior approach,liver mobilisation is performed only at the end of parenchymal transection, when all vascular connections have already been interrupted.The anterior approach was found to be associated with significantly less intraoperative blood loss, less blood transfusions and a lower hospital mortality rate.However,excessive bleeding can occur at the deeper plane of parenchymal transection from the right hepatic vein or middle hepatic vein. Bleeding from the hepatic veins is closely related to the CVP.Our previous retrospective analysisfound that the infrahepatic inferior vena cava (IVC) clamping is efficacious in reducing CVP without the need of systemic fluid restriction and is associated with significantly less intraoperative blood loss during complex hepatectomy. The aim of the present study was therefore to evaluate if the application of the anterior approach combined with infrahepatic IVC clamping during right hepatectomy for large HCC reduces intraoperative blood loss.
Interventions
PROCEDUREIVC clamping
in right hepatectomy,use anterior approach and infrahepatic Inferior Vena Cava clamping.
Sponsors
The First Affiliated Hospital of Xiamen University
Eastern Hepatobiliary Surgery Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Understanding and being willing to sign the informed consent form * Aged 18-75 years * Diagnosed HCC by clinical findings and radiography，tumor size ≥ 5cm and located in the right lobe, need to perform right hemihepatectomy or major right hepatic resection (three Couinaud's segments) * Without any surgery contraindication * Child-Pugh grade A
Exclusion criteria
* Refusal to take part in the study * With lymph node or extrahepatic metastases * History of previous hepatectomy or other abdominal operation * Those who can not be follow-up * Non-HCC
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| intraoperative total blood loss | participants will be followed for the duration of the entire operation,an expected average of 140 minutes |
Secondary
| Measure | Time frame |
|---|---|
| intraoperative CVP value | participants will be followed for the duration of the parenchymal transection,an expected average of 20 minutes |
| morbidity and mortality | participants will be followed for the duration of the postoperative hospital stay,an expected average of 15 days |
| postoperative hepatorenal function | postoperative day 1,3 and 7 |
| operation time | the duration of the entire operation,an expected average of 140 minutes |
| disease-free survival duration and overall survival duration | the duration from operation to recurrence or death,an expected average of 3 years |
| blood loss during parenchymal transection | the duration of the parenchymal transection,an expected average of 20 minutes |
| postoperative hospital stay | the duration of the postoperative hospital stay,an expected average of 15 days |
Outcome results
None listed