A safe protocol of intermittent hilar vascular clamping for hepatic resection in cirrhosis

Background/Aims: In liver surgery, vascular clamping reduces blood loss but may induce ischemia-reperfusion injury. However, the best protocol of hepatic vascular occlusion remains controversial. Recently, we reported safe clamping associated with least ischemia-reperfusion injury as assessed by calpain-μ in a rat model. In this study, it was applied the same protocol during resection of hepatocellular carcinoma in patients with liver cirrhosis. Methododogy: Patients were divided into four groups; group 1: repeated 10-min complete clamping of the hepatic vasculature with 5-min reperfusion (n=62), group 2: similar to group 1 but complete clamping for more than 10-min (n=18), group 3: similar to group 1 but hemi-hepatic occlusion only (n=20), and Group 4: similar to group 3 but hemi-hepatic for more than 10-min (n=46). Postoperative liver function was assessed at days 1, 3 and 5. Results: There were no differences in PT and T. Bil among the groups; AST on postoperative day 5 was lower in Group 1 than in Group 2 (p<0.001). Western blot analysis and immunohistochemistry confirmed upregulation of calpain-μ induced by hepatic vascular clamping. Conclusions: Our results indicated that repeated 10-min hepatic vascular clamping interrupted by 5-min reperfusion is a safe protocol as it does not cause ischemia-reperfusion injury.