In Situ Hypothermic Perfusion of the Liver Versus Standard Total Vascular Exclusion for Complex Liver Resection

Total vascular exclusion of the liver (TVE), including the clamping of the portal triad, the vena cava above and below the liver, is indicated for tumors involving or adjacent to the vena cava and/or to the confluence of the hepatic veins into the latter. Whereas the safe time limit of the liver tolerance to TVE is still debated, 60 minutes seems a reasonable one. The adjunction of hypothermic perfusion of the liver has been reported to prolong safely the vascular exclusion up to several hours. The benefit of resection under hypothermic perfusion of the liver over standard TVE remains to be shown. The aim of the present study was to compare the results of TVE with in situ hypothermic perfusion of the liver to those of TVE <60 minutes and TVE ≥60 minutes in terms of postoperative liver tolerance, liver function, kidney function, in-hospital mortality, and morbidity. In a second step, the predictive factors for TVE ≥60 minutes were evaluated by univariate and multivariate analysis.