Skip to main content
SpringerLink
Log in

Vascular Control in Major Hepatic Resections

  • Chapter
  • First Online:
Extreme Hepatic Surgery and Other Strategies

  • 1371 Accesses

Abstract

Liver surgery for metastatic colorectal cancer has become one of the most sophisticated and specialized areas in modern visceral surgery. Exact knowledge of the normal liver anatomy and its variants is necessary in order to carefully plan one- or two-staged liver resections and to perform the correct techniques of parenchymal transections and vascular control for each individual case. Although vascular control and/or vascular reconstruction is not required for every liver resection, a profound knowledge of vascular control is required for the modern liver surgeon. Intraoperative blood loss remains one of the major risk factors for postoperative morbidity and mortality, and therefore vascular control plays a major role in performing safe liver resection for colorectal liver metastases.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Langenbuch C. Ein Fall von Resecktion eines linksseitigen Schnurlappens der Leber. Berl Klin Wochenschr. 1888;25:37.

    Google Scholar 

  2. Wendel W. Beiträge zur Chirurgie der Leber. Arch Klin Chir. 1911;95:887–94.

    Google Scholar 

  3. Pringle JH. V. notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg. 1908;48(4):541–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236(4):397–406; discussion 406–7.

    Google Scholar 

  5. Couinaud C. Le foie; études anatomiques et chirurgicales. Paris: Masson; 1957.

    Google Scholar 

  6. Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg. 1982;6(1):3–9.

    Article  CAS  PubMed  Google Scholar 

  7. Majno P, Mentha G, Toso C, Morel P, Peitgen HO, Fasel JHD. Anatomy of the liver: an outline with three levels of complexity—a further step towards tailored territorial liver resections. J Hepatol. 2014;60(3):654–62.

    Article  PubMed  Google Scholar 

  8. Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149(5):713–24.

    Article  PubMed  Google Scholar 

  9. Rahbari NN, Reissfelder C, Koch M, Elbers H, Striebel F, Büchler MW, et al. The predictive value of postoperative clinical risk scores for outcome after hepatic resection: a validation analysis in 807 patients. Ann Surg Oncol. 2011;18(13):3640–9.

    Article  PubMed  Google Scholar 

  10. de Santibañes E, Clavien P-A. Playing Play-Doh to prevent postoperative liver failure: the “ALPPS” approach. Ann Surg. 2012;255(3):415–7.

    Article  PubMed  Google Scholar 

  11. Morris-Stiff G, Tan Y-M, Vauthey JN. Hepatic complications following preoperative chemotherapy with oxaliplatin or irinotecan for hepatic colorectal metastases. Eur J Surg Oncol. 2008;34(6):609–14.

    Article  CAS  PubMed  Google Scholar 

  12. Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H. Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg. 2000;232(6):777–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Reissfelder C, Rahbari NN, Bejarano LU, Schmidt T, Kortes N, Kauczor H-U, et al. Comparison of various surgical approaches for extensive bilateral colorectal liver metastases. Langenbeck’s Arch Surg. 2014;399(4):481–91.

    Article  Google Scholar 

  14. Reissfelder C, Brand K, Sobiegalla J, Rahbari NN, Bork U, Schirmacher P, et al. Chemotherapy-associated liver injury and its influence on outcome after resection of colorectal liver metastases. Surgery. 2014;155(2):245–54.

    Article  PubMed  Google Scholar 

  15. Mehrabi A, Fonouni H, Golriz M, Hofer S, Hafezi M, Rahbari NN, et al. Hypothermic ante situm resection in tumors of the hepatocaval confluence. Dig Surg. 2011;28(2):100–8.

    Article  PubMed  Google Scholar 

  16. Bismuth H, Majno PE. Biliary strictures: classification based on the principles of surgical treatment. World J Surg. 2001;25(10):1241–4.

    Article  CAS  PubMed  Google Scholar 

  17. Majno PE, Mentha G, Morel P, Segalin A, Azoulay D, Oberholzer J, et al. Arantius’ ligament approach to the left hepatic vein and to the common trunk. J Am Coll Surg. 2002;195(5):737–9.

    Article  PubMed  Google Scholar 

  18. Rahbari NN, Koch M, Schmidt T, Motschall E, Bruckner T, Weidmann K, et al. Meta-analysis of the clamp-crushing technique for transection of the parenchyma in elective hepatic resection: back to where we started? Ann Surg Oncol. 2009;16(3):630–9.

    Google Scholar 

  19. Rahbari NN, Elbers H, Koch M, Vogler P, Striebel F, Bruckner T, et al. Randomized clinical trial of stapler versus clamp-crushing transection in elective liver resection. Br J Surg. 2014;101(3):200–7.

    Article  CAS  PubMed  Google Scholar 

  20. Hoekstra LT, van Trigt JD, Reiniers MJ, Busch OR, Gouma DJ, van Gulik TM. Vascular occlusion or not during liver resection: the continuing story. Dig Surg. 2012;29(1):35–42.

    Article  PubMed  Google Scholar 

  21. Smyrniotis V, Farantos C, Kostopanagiotou G, Arkadopoulos N. Vascular control during hepatectomy: review of methods and results. World J Surg. 2005;29(11):1384–96.

    Article  PubMed  Google Scholar 

  22. Simillis C, Li T, Vaughan J, Becker LA, Davidson BR, Gurusamy KS. Methods to decrease blood loss during liver resection: a network meta-analysis. Cochrane Database Syst Rev. 2014;4:CD010683.

    Google Scholar 

  23. Lesurtel M, Lehmann K, de Rougemont O, Clavien P-A. Clamping techniques and protecting strategies in liver surgery. HPB (Oxford). 2009;11(4):290–5.

    Article  Google Scholar 

  24. Kim IK, Klein A. Hepatic vascular control in liver transplant and application in gastrointestinal surgery. J Gastrointest Surg. 2015;19:2074–8.

    Article  PubMed  Google Scholar 

  25. O’Neill S, Leuschner S, McNally SJ, Garden OJ, Wigmore SJ, Harrison EM. Meta-analysis of ischaemic preconditioning for liver resections. Br J Surg. 2013;100(13):1689–700.

    Article  PubMed  Google Scholar 

  26. Rahbari NN, Wente MN, Schemmer P, Diener MK, Hoffmann K, Motschall E, et al. Systematic review and meta-analysis of the effect of portal triad clamping on outcome after hepatic resection. Br J Surg. 2008;95(4):424–32.

    Article  CAS  PubMed  Google Scholar 

  27. Rahbari NN, Koch M, Mehrabi A, Weidmann K, Motschall E, Kahlert C, et al. Portal triad clamping versus vascular exclusion for vascular control during hepatic resection: a systematic review and meta-analysis. J Gastrointest Surg. 2009;13(3):558–68.

    Article  PubMed  Google Scholar 

  28. Makuuchi M, Mori T, Gunvén P, Yamazaki S, Hasegawa H. Safety of hemihepatic vascular occlusion during resection of the liver. Surg Gynecol Obstet. 1987;164(2):155–8.

    CAS  PubMed  Google Scholar 

  29. Isozaki H, Okajima K, Kobayashi M, Hara H, Akimoto H. Experimental study of liver injury after partial hepatectomy with intermittent or continuous hepatic vascular occlusion. Differences in tolerance to ischemia between normal and cirrhotic livers. Eur Surg Res. 1995;27(5):313–22.

    Article  CAS  PubMed  Google Scholar 

  30. Huguet C, Gavelli A, Bona S. Hepatic resection with ischemia of the liver exceeding one hour. J Am Coll Surg. 1994;178(5):454–8.

    CAS  PubMed  Google Scholar 

  31. Wu CC, Hwang CR, Liu TJ, P’eng FK. Effects and limitations of prolonged intermittent ischaemia for hepatic resection of the cirrhotic liver. Br J Surg. 1996;83(1):121–4.

    Article  CAS  PubMed  Google Scholar 

  32. Belghiti J, Noun R, Malafosse R, Jagot P, Sauvanet A, Pierangeli F, et al. Continuous versus intermittent portal triad clamping for liver resection: a controlled study. Ann Surg. 1999;229(3):369–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Scatton O, Zalinski S, Jegou D, Compagnon P, Lesurtel M, Belghiti J, et al. Randomized clinical trial of ischaemic preconditioning in major liver resection with intermittent Pringle manoeuvre. Br J Surg. 2011;98(9):1236–43.

    Article  CAS  PubMed  Google Scholar 

  34. Oldhafer KJ, Lang H, Malagó M, Testa G, Broelsch CE. Ex situ resection and resection of the in situ perfused liver: are there still indications? Chirurg. 2001;72(2):131–7.

    Article  CAS  PubMed  Google Scholar 

  35. Dubay D, Gallinger S, Hawryluck L, Swallow C, McCluskey S, McGilvray I. In situ hypothermic liver preservation during radical liver resection with major vascular reconstruction. Br J Surg. 2009;96(12):1429–36.

    Article  CAS  PubMed  Google Scholar 

  36. Belghiti J, Noun R, Zante E, Ballet T, Sauvanet A. Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study. Ann Surg. 1996;224(2):155–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Hemming AW, Reed AI, Langham MR, Fujita S, Howard RJ. Combined resection of the liver and inferior vena cava for hepatic malignancy. Ann Surg. 2004;239(5):712–9; discussion 719–21.

    Google Scholar 

  38. Emond JC, Kelley SD, Heffron TG, Nakagawa T, Roberts JP, Lim RC. Surgical and anesthetic management of patients undergoing major hepatectomy using total vascular exclusion. Liver Transpl Surg. 1996;2(2):91–8.

    Article  CAS  PubMed  Google Scholar 

  39. Jeon J, Watkins A, Wagener G, Samstein B, Guarrera J, Goldstein M, et al. Complex hepatectomy under total vascular exclusion of the liver: impact of ischemic preconditioning on clinical outcomes. World J Surg. 2013;37(4):838–46.

    Article  PubMed  Google Scholar 

  40. Miyazaki M, Ito H, Nakagawa K, Ambiru S, Shimizu H, Okuno A, et al. Aggressive surgical resection for hepatic metastases involving the inferior vena cava. Am J Surg. 1999;177(4):294–8.

    Article  CAS  PubMed  Google Scholar 

  41. Rahbari NN, Koch M, Zimmermann JB, Elbers H, Bruckner T, Contin P, et al. Infrahepatic inferior vena cava clamping for reduction of central venous pressure and blood loss during hepatic resection: a randomized controlled trial. Ann Surg. 2011;253(6):1102–10.

    Google Scholar 

  42. Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection. Br J Surg. 1998;85(8):1058–60.

    Article  CAS  PubMed  Google Scholar 

  43. Abu-Amara M, Gurusamy KS, Glantzounis G, Fuller B, Davidson BR. Pharmacological interventions for ischaemia reperfusion injury in liver resection surgery performed under vascular control. Cochrane Database Syst Rev. 2009;(4):CD008154.

    Google Scholar 

  44. Gurusamy KS, Li J, Vaughan J, Sharma D, Davidson BR. Cardiopulmonary interventions to decrease blood loss and blood transfusion requirements for liver resection. Cochrane Database Syst Rev. 2012;(5):CD007338.

    Google Scholar 

  45. Pathak S, Hakeem A, Pike T, Toogood GJ, Simpson M, Prasad KR, et al. Anaesthetic and pharmacological techniques to decrease blood loss in liver surgery: a systematic review. ANZ J Surg. 2015;85:923–30.

    Article  PubMed  Google Scholar 

  46. Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. 2013;100(1):75–82.

    Article  CAS  PubMed  Google Scholar 

  47. Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL. Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg. 2012;255(6):1048–59.

    Article  PubMed  Google Scholar 

  48. Tjandra JJ, Chan MKY. Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Color Dis. 2006;8(5):375–88.

    Article  CAS  Google Scholar 

  49. Shabanzadeh DM, Sørensen LT. Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients: a systematic review and meta-analysis. Ann Surg. 2012;256(6):934–45.

    Article  PubMed  Google Scholar 

  50. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg. 2015;261(4):619–29.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastrointestinal-, Thoracic- and Vascular Surgery, University Hospital Carl-Gustav-Carus Dresden, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Ulrich Bork, Nuh N. Rahbari, Christoph Reissfelder, Sören Torge Mees & Jürgen Weitz MSc

Authors
  1. Ulrich Bork
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nuh N. Rahbari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christoph Reissfelder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sören Torge Mees
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jürgen Weitz MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jürgen Weitz MSc .

Editor information

Editors and Affiliations

  1. General Surgery Department HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Eduardo de Santibañes

  2. General Surgery Department HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Victoria Ardiles

  3. General Surgery Department HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Fernando A. Alvarez

  4. General Surgery Department HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Virginia Cano Busnelli

  5. General Surgery Department HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Martin de Santibañes

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Bork, U., Rahbari, N.N., Reissfelder, C., Mees, S.T., Weitz, J. (2017). Vascular Control in Major Hepatic Resections. In: de Santibañes, E., Ardiles, V., Alvarez, F., Busnelli, V., de Santibañes, M. (eds) Extreme Hepatic Surgery and Other Strategies. Springer, Cham. https://doi.org/10.1007/978-3-319-13896-1_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-13896-1_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13895-4

  • Online ISBN: 978-3-319-13896-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation