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Effectiveness of Routine Application Of Anterior Approach During Right Hepatectomy
Conditions
Liver Neoplasm
Conditions: official terms
Liver Neoplasms
Conditions: Keywords
LIVER TUMOURS
Study Type
Interventional
Study Phase
N/A
Study Design
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Intervention
Name: RIGHT HEPATECTOMY WITH CLASSIC APPROACH
Type: Procedure
Overall Status
Not yet recruiting
Summary
The aim of this study was to evaluated the advantages of routine application of the anterior approach in patients scheduled to right hepatectomy or extended right hepatectomy, without infiltration of segment 1, inferior vena cava or main bile duct.
Detailed Description
Mobilization of the liver during right hepatectomy with classic approach is performed before parenchymal transection. In this phase severe bleeding may occur due to laceration of the inferior vena cava (IVC) wall, rupture or ligation falling off the hepatic short vein (HSV) or bleeding from the right liver attachments. Besides, the twisting of the portal pedicle during mobilization can render the left hepatic lobe ischemic for transient interruption of the hepatopetal flow. These events are more frequent in case of large hepatic lesions (mainly HCC) that involves surrounding structures (such as diaphragm). Two of the most important factors that affect the postoperative course of patients undergoing liver resections are indeed intraoperative bleeding and postoperative liver dysfunction. For these reasons Lai et al proposed anterior approach as alternative to classic right hepatectomy. In this case liver mobilization is performed only at the end of parenchymal transection, when all vascular connections are already interrupted. Liu et al published the results of a retrospective study in which 54 patients with, right sided HCC greater than 5 cm underwent right hepatectomy using the anterior approach technique. The anterior approach group had significantly less intraoperative blood loss, less need of blood transfusion and a lower hospital mortality rate. The same group reported results of a prospective randomized controlled study analyzing 120 patients with large (>5 cm) right liver HCC. The overall operative blood loss, morbidity, and duration of hospital stay were comparable in both groups. However, a higher number of patients in classic approach group experienced mayor operative blood loss (> 2000 cc) and required blood transfusions (8.3% vs. 28.3%).
Criteria for eligibility
Healthy Volunteers: No
Maximum Age: 80 Years
Minimum Age: 18 Years
Gender: Both
Criteria: Inclusion Criteria:
- patients between 18 and 80 years
- patients scheduled to right hepatectomy or extended right hepatectomy
- the future remnant liver (FRL) ≥ 25% in patients with a normal liver or ≥ 30% in those with chronic liver disease
- indocyanine green retention rate (ICG) at 15 minutes ≤ 10% in cirrhotic patients
Exclusion Criteria:
- resection of S1
- resection of bile duct
- infiltration of inferior vena cava
- America Society of Anesthesiologists (ASA) grade IV
- Emergency surgery
- patients between 18 and 80 years
- patients scheduled to right hepatectomy or extended right hepatectomy
- the future remnant liver (FRL) ≥ 25% in patients with a normal liver or ≥ 30% in those with chronic liver disease
- indocyanine green retention rate (ICG) at 15 minutes ≤ 10% in cirrhotic patients
Exclusion Criteria:
- resection of S1
- resection of bile duct
- infiltration of inferior vena cava
- America Society of Anesthesiologists (ASA) grade IV
- Emergency surgery
Location
Ospedale Mauriziano di Torino
Turin, Italy
Status: Recruiting
Contact: Alessandro Ferrero, MD - 00390115082590 - aferrero@mauriziano.it
Start Date
August 2010
Completion Date
August 2011
Sponsors
Azienda Ospedaliera Ordine Mauriziano di Torino
Source
Azienda Ospedaliera Ordine Mauriziano di Torino
Record processing date
ClinicalTrials.gov processed this data on July 28, 2015
ClinicalTrials.gov page