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

Hiroaki Nagano, Shinichi Kishimoto, Shogo Kobayashi, Shigeru Marubashi, Hidetoshi Eguchi, Yutaka Takeda, Masahiro Tanemura, Yoshito Tomimaru, Takehiro Noda, Koji Umeshita, Masato Sakon, Yuichiro Doki, Masaki Mori, Morito Monden

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1439-1444
Number of pages6
Issue number94-95
Publication statusPublished - 2009
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology


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