A propensity score analysis of two methods of hepatic vascular occlusion in hepatectomy.

ABSTRACT

BACKGROUND: The key points in hepatectomy are reducing blood loss and preservation of hepatic function. The aim of this study was to compare the perioperative outcomes of partial hepatectomy using two techniques of hepatic vascular inflow occlusion. MATERIALS AND METHODS: A total of 1817 patients were selected from our multi-institutional hepatectomy database in China and classified into two groups the hemihepatic inflow occlusion (HIO) group (n = 1693) and the ipsilateral portal vein branch occlusion (IPVBO) group (n = 124). Propensity score matching of patients in a ratio of 11 was conducted. The primary outcome was intraoperative blood loss. Secondary outcomes were postoperative liver function, postoperative morbidity and mortality, and duration of hospital stay after surgery. RESULTS: After propensity score matching, there were 124 patients in the IPVBO group and the HIO group, respectively. There were no significant differences between the two groups regarding intraoperative blood loss, blood transfusion requirement, operating time, postoperative morbidity and mortality, and duration of hospital stay after surgery (P > 0.05). However, The IPVBO group was associated with significantly lower peak in postoperative ALT level than the HIO group (P < 0.05). CONCLUSIONS: The results indicated that IPVBO did not lead to more intraoperative blood loss compared with HIO, and it decreased the peak of postoperative ALT level. In terms of postoperative morbidity and mortality, duration of hospital stay after surgery, IPVBO was also equal to HIO. Thus, IPVBO could be an alternative method of hepatic inflow occlusion.