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Randomized clinical trial of ischaemic preconditioning in major liver resection with intermittent Pringle manoeuvre


Scatton, O; Zalinski, S; Jegou, D; Compagnon, P; Lesurtel, M; Belghiti, J; Boudjema, K; Lentschener, C; Soubrane, O (2011). Randomized clinical trial of ischaemic preconditioning in major liver resection with intermittent Pringle manoeuvre. British Journal of Surgery, 98(9):1236-1243.

Abstract

BACKGROUND:

Vascular inflow occlusion is effective in avoiding excessive blood loss during hepatic parenchymal transection but may cause ischaemic damage to the remnant liver. Intermittent portal triad clamping (IPTC) is superior to continuous hepatic pedicle clamping as it avoids severe ischaemia-reperfusion (IR) injury in the liver remnant. Ischaemic preconditioning (IPC) before continuous Pringle manoeuvre may protect against IR during major liver resection.
METHODS:

This RCT assessed the impact of IPC in major liver resection with intermittent vascular inflow occlusion. Patients undergoing major liver resection with intermittent vascular inflow occlusion were randomized, during surgery, to receive IPC (10 min inflow occlusion followed by 10 min reperfusion) or no IPC (control group). Data analysis was on an intention-to-treat basis. The primary endpoint was serum alanine aminotransferase (ALT) level on the day after surgery.
RESULTS:

Eighty four patients were enrolled and randomized to IPC (n = 41) and no IPC (n = 43). The groups were comparable in terms of demographic data, preoperative American Society of Anesthesiologists grade and extent of liver resection. Intraoperative morbidity and postoperative outcomes were also similar. ALT levels on the day after operation were not decreased by IPC (mean(s.d.) 537·6(358·5) versus 525·0(400·6) units/ml in IPC and control group respectively; P = 0·881). Liver biochemistry tests in the week after operation showed the same pattern in both groups.
CONCLUSION:

IPC did not reduce liver damage in patients undergoing major liver resection with IPTC. Registration number: NCT00908245 (http://www.clinicaltrials.gov).

Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

BACKGROUND:

Vascular inflow occlusion is effective in avoiding excessive blood loss during hepatic parenchymal transection but may cause ischaemic damage to the remnant liver. Intermittent portal triad clamping (IPTC) is superior to continuous hepatic pedicle clamping as it avoids severe ischaemia-reperfusion (IR) injury in the liver remnant. Ischaemic preconditioning (IPC) before continuous Pringle manoeuvre may protect against IR during major liver resection.
METHODS:

This RCT assessed the impact of IPC in major liver resection with intermittent vascular inflow occlusion. Patients undergoing major liver resection with intermittent vascular inflow occlusion were randomized, during surgery, to receive IPC (10 min inflow occlusion followed by 10 min reperfusion) or no IPC (control group). Data analysis was on an intention-to-treat basis. The primary endpoint was serum alanine aminotransferase (ALT) level on the day after surgery.
RESULTS:

Eighty four patients were enrolled and randomized to IPC (n = 41) and no IPC (n = 43). The groups were comparable in terms of demographic data, preoperative American Society of Anesthesiologists grade and extent of liver resection. Intraoperative morbidity and postoperative outcomes were also similar. ALT levels on the day after operation were not decreased by IPC (mean(s.d.) 537·6(358·5) versus 525·0(400·6) units/ml in IPC and control group respectively; P = 0·881). Liver biochemistry tests in the week after operation showed the same pattern in both groups.
CONCLUSION:

IPC did not reduce liver damage in patients undergoing major liver resection with IPTC. Registration number: NCT00908245 (http://www.clinicaltrials.gov).

Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Citations

22 citations in Web of Science®
26 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Visceral and Transplantation Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2011
Deposited On:04 Mar 2012 17:50
Last Modified:05 Apr 2016 15:28
Publisher:Wiley-Blackwell
ISSN:0007-1323
Additional Information:Comment in: Br J Surg. 2011 Sep;98(9):1243-1244.
Publisher DOI:https://doi.org/10.1002/bjs.7626
PubMed ID:21809337

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