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The purpose of the study is to evaluate the protective effects of Verapamil on hepatic ischemia–reperfusion injury in cirrhotic patients with HCC. A controlled study was performed on 86 consecutive patients with cirrhosis who underwent liver resection for suffering HCC. Thirty-nine patients were injected with Verapamil through the mesenteric vein before Pringle's maneuver to alleviate hepatic ischemia–reperfusion injury, while 47 patients were not. The serum AST, ALT, and total bilirubin on days 1 and 3 were markedly lower in the Verapamil group than that in the control group postoperatively (AST, P < 0.001 and P < 0.001; ALT, P < 0.001 and P = 0.042; TB, P = 0.037 and 0.049; respectively). The serum hyluronic acid on day 1 was also significantly lower in Verapamil group than that in the control group ( P < 0.01), but no marked difference on days 3 and 7. Meanwhile, the levels of IL6 on days 1 and 3 were markedly lower in the Verapamil group than that in control group ( P < 0.05 and P < 0.01, respectively. The new Clavien's classification of surgical complications showed marked severity in the control group than that in the Verapamil group ( P = 0.021), especially in the grade I level ( P = 0.045). Verapamil may serve as protective agent for hepatic ischemia–reperfusion injury in cirrhotic patients with HCC. Therefore, Verapamil can be used for treatment of patients who are to undergo hepatectomy with occlusion of hepatic blood flow. [ABSTRACT FROM AUTHOR]

Background: In patients with cirrhosis excessive hemorrhage and the need for blood transfusion are associated with increased postoperative morbidity and mortality as well as a poor long-term outcome. Saline-linked radiofrequency dissecting sealer (TissueLink) is a recent advance in technology that improves hemostasis during difficult liver resections. Preliminary studies have shown that this technique reduces blood loss without inflow occlusion. Patients and methods: A controlled study was performed on 122 consecutive patients with cirrhosis who underwent liver resection for hepatocytotic carcinoma. The outcomes of liver transection with clamp crushing and TissueLink were compared to evaluate which strategy is most beneficial to the patients. Results: Both intraoperative blood loss and blood transfusion requirements were significantly higher in the crushing clamp group than in the TissueLink group (P = 0.047 and P = 0.031, respectively). In addition, a significantly higher number of patients required a blood transfusion in the crushing clamp group (P < 0.001). However, the transection time was significantly faster in the crushing clamp group than in the TissueLink group (P < 0.001). The number of patients that required Pringle''s maneuver was markedly higher in the crushing clamp group (P < 0.001). In addition, the hemostasis time was significantly longer in the crushing clamp group (P < 0.001). The serum aspartate aminotransferase levels 3 and 7 days after surgery were significantly higher in the crushing clamp group than in the TissueLink group (P = 0.035 and P = 0.003, respectively). Serum total bilirubin levels were markedly increased 3 days after surgery in the crushing clamp group than in the TissueLink group (P = 0.011). Biliary leakage occurred in a higher number of crushing clamp patients (six) than TissueLink patients (three), although this difference was not significant. The operative morbidity not including biliary leakage was higher in the crushing clamp group than the TissueLink group (nine patients versus five patients, respectively). Conclusion: This study reveals that the TissueLink procedure has beneficial effects during liver transection under cirrhotic conditions in terms of blood loss and reperfusion-related liver injury. However, this procedure requires a significantly longer transection time of the parenchyma. [Copyright &y& Elsevier]

Background and aims: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has high morbidity and mortality. In this study, the safety and efficacy of a modification of ALPPS (radiofrequency-assisted ALPPS, RALPPS) were assessed in patients with hepatocellular carcinoma (HCC). Materials and methods: Patients who were diagnosed with HCC and were considered to have an insufficient future liver remnant (FLR) were enrolled. In stage I, a radiofrequency ablation (RFA) device was used to cauterise along the planned transection plane to form a coagulum avascular area. When the FLR reached above 40%, hepatectomy was performed in stage II along the coagulum area established previously. After two stages, operative morbidity, mortality, per cent increase in FLR, operative time and blood loss were evaluated. Results: Between July 2014 and September 2015, 10 patients with HCC (9 with hepatitis-related cirrhosis) were treated with the RALPPS procedure. The incidence of severe complications (Clavien- Dindo≥IIIb) was 20% (2/10). One patient died. No biliary leakage, intraperitoneal infection or post-hepatectomy liver failure (PHLF) occurred after both stages. The median FLR before stage I was 31% (364 ml). This increased to 47% (632 ml) before stage II after a median interval of 28 days. The median percentage increase in FLR was 53% (210 ml). Additionally, the median operative time during the first and second stages was 214 and 281 min, respectively. The corresponding median blood loss was 200 and 550 ml, respectively. Conclusions: RALPPS has a potential advantage in eliminating serious complications of biliary leakage and PHLF associated with classic ALPPS. On the basis of rigorous patient selection criteria, RALPPS may achieve the same effect of promoting significant growth of the FLR in patients with cirrhosis-related HCC and insufficient FLR volume, albeit at the cost of a longer interval time. [ABSTRACT FROM AUTHOR]