Application of hepatectomy without hepatic blood flow occlusion in treatment of primary liver cancer

Objective To investigate the effects of hepatectomy without hepatic blood flow occlusion ( HBFO) on the liver function and postoperative recovery in patients with primary liver cancer. Methods Eighty patients with primary liver cancer who underwent hepatectomy in our hospital from June 2010 to June 2013 were divided into three groups: first porta hepatis control ( Pringle) group ( n = 24) , hemihepatic vascular control ( HVC) group ( n = 24) , and non-HBFO group ( n = 32) . The operation time, intraoperative blood loss, postoperative liver function, surgical complications, and postoperative length of hospital stay were compared between the three groups. Categorical data were analyzed by chi-square test, and continuous data were analyzed using ANOVA followed by Dunnett-t for multiple comparisons. Results There were no significant differences in the operation time and intraoperative blood loss between the three groups ( F = 2. 45 and 0. 34, P > 0. 05 for both) . The recovery of serum total bilirubin ( TBil) and alanine aminotransferase ( ALT) at 1 and 7 d after operation was significantly better in the non-HBFO group ( 1 d, TBil: 22. 4 ± 9. 4 μmol /L, ALT: 287. 4 ± 165. 7 U /L; 7 d, TBil: 17. 1 ± 6. 6 μmol /L, ALT: 86. 2 ± 54. 5 U /L) than in the Pringle group ( 1 d, TBil: 33. 5 ± 11. 9 μmol /L, ALT: 429. 5 ± 137. 8 U /L; 7 d, TBil: 24. 5 ± 7. 0 μmol /L, ALT: 145. 5 ± 43. 6 U /L) and HVC group ( 1d, TBil: 29. 1 ± 8. 3 μmol /L, ALT: 390. 2 ± 176. 6 U /L; 7d, TBil: 21. 5 ± 7. 5 μmol /L, ALT: 121. 5 ± 56. 8 U /L) ( P<0. 05 for all) . The recovery of serum albumin ( Alb) at 1 d after operation was significantly better in the non-HBFO group ( 29. 3 ± 2. 8 g /L) than in the Pringle group ( 27. 3 ± 3. 3 g /L) ( P < 0. 05) , but it showed no significant difference between the non-HBFO group and HVC group ( 29. 3 ± 2. 8 g /L vs 27. 8 ± 2. 5 g /L, P >0. 05) ; there were no significant differences in the recovery of serum Alb at 7 d after operation between the three groups ( P > 0. 05) . The postoperative length of hospital stay was significantly shorter in the non-HBFO group ( 10. 3 ± 2. 1d) than in the Pringle group ( 12. 7 ± 2. 6 d) and HVC group ( 12. 0 ± 2. 2 d) ( P < 0. 05) . Conclusion Compared with Pringle maneuver and HVC, non-HBFO would not increase the intraoperative blood loss and operation time and leads to milder liver function damage and more rapid postoperative recovery in patients with primary liver cancer undergoing hepatectomy.