Methods for Vascular Control in Liver Resections Due to Colorectal Metastases - Impact on Residual Parenchyma

Abstract

Introduction. Massive blood loss while performing resections of the liver continues to be a serious problem with potentially lethal outcome. Therefore in the last 2-3 decades there has been a significant developement of techniques for vascular control during liver resections. Methods. In the period from 01.01.2006 to 31.12.2015 in KOCPH UMBAL "Aleksnadrovska" a total of 239 patients with colorectal liver metastases underwent surgery of whom: 179 patients were radicaly operated on and 57 patients were subjected to Pringle maneuver. Using the statistical software SPSS-19 we analyzed various factors that may affect the early postoperative results. Results. In resections of colorectal liver metastases there was a significant difference in the postoperative functional parameters (AST, ALT), which correlated with the degree of liver damage, in patients with Pringle and without Pringle maneuver 265.32 vs. 448 (p=0.001), and 300.53 vs. 481.91 (p=0.002),-respectively. There was no significant difference in the postoperative results in comparisson of resections <15 minutes, performed without Pringle and with Pringle maneuver. The blood loss is another factor that affects the postoperative complications (p = 0.048), and it was lowest in the Pringle group <15 min. Conclusion. Pringle maneuver is a simple and effecttive method for vascular control. As a result of its use we can observe the damage of the residual liver volume from the continuous ischemia to the reperfusion period. Thus, in liver resections, due to colorectal metastasis, vascular control strategy should be individual and corresponding to the extent of the procedure and associated diseases of the liver-fatty liver, cirrhosis, chronic hepatitis and others.