Effect of Vascular Inflow Occlusion in Open Liver Resection for Hepatocellular Carcinoma

Open Liver Resection With or Without Vascular Inflow Occlusion for Hepatocellular Carcinoma: a Randomized Controlled Trial

Bleeding is a major problem during liver resection. Vascular inflow occlusion, also known as Pringle maneuver, has been commonly employed to reduce blood loss during liver surgery. However, Pringle maneuver might cause ischaemic insult to the remnant liver and lead to post-operative liver dysfunction.

The investigators hypothesize that liver resection without the use of vascular inflow occlusion (Pringle maneuver) is associated with lower postoperative complications rate.

The aim of this study is to evaluate whether elective open liver resection without vascular inflow occlusion (Pringle Maneuvre) would lead to a reduction of post-operative surgical complications in patient with hepatocellular carcinoma.

Eligible patients undergoing liver resection in the Prince of Wales Hospital will be recruited and randomized into 2 study arms comparing the effect of Pringle maneuver.

Inclusion Criteria:

• Age >18
• Child's A or B cirrhosis

Exclusion Criteria:

• Informed consent not available
• Presence of portal vein thrombosis, portal vein tumor thrombus, or previous portal vein embolisation
• Presence of hepatic artery thrombosis, previous transarterial therapy like TACE, lipiodol-ethanol mixture injection or transarterial internal radiation
• Anticipation of portal vein resection
• Emergency hepatectomy
• Ruptured HCC
• Adhesion or anatomical variation that preclude safe and successful application of Pringle maneuver
• Anticipation of concomitant bowel or bile duct resection