INTRODUCTION: Resection of the superior mesenteric-portal vein (SMPV)performed at the time of pancreaticoduodenectomy (PD) induces a period of warm hepatic ischemia (WHI). The effects upon hepatic function post operatively have not been well studied, and have implications for post-operative recovery. We analyze the impact of WHI on post-operative liver function, and the impact of the use ischemic preconditioning (IPC)in patients undergoing revascularization of the SMPV axis for locally advanced pancreatic adenocarcinoma. METHODS: Between January 2001 and October 2005, 178 patients underwent PD for periamampullary disease, 42 of whom required resection of the SMPV axis. 18 patients were selected to undergo ischemic preconditioning (IPC), depending upon technical complexity of vascular reconstruction. Perioperative data were prospectively recorded, including warm ischemia time and post-operative liver function, as well as length of stay in the intensive care unit. Data were compared with students pared t-test. P < 0.05 were considered statistically significant. RESULTS: The age, operative time, hepatic warm ischemia time, blood loss, and length of stay (LOS) in the intensive care unit were statistically similar between patients undergoing IPC and those with no IPC. IPC induced a statistically significant reduction in prothrombin time (and international normalized ratio INR -data not shown) and ALT values, when compared to patients who did not undergo IPC, on the first postoperative day. This effect was abrogated by postoperative day 5. CONCLUSIONS: IPC appears to protect the liver from ischemia-reperfusion injury during resection of the SMPV axis, for pancreatic adenocarcinoma. This is the first report of warm ischemia-mediated hepatic dysfunction following resection of the SMPV performed at the time of P.D. and the protective effects of I.P.C.. Methods of hepatic protection may prevent ischemia-reperfusion mediated liver injury during operations, which require hepatic inflow occlusion.
Ischemic Preconditioning and liver function, following resection of the superior mesenteric-portal vein for pancreatic adenocarcinoma.

ALT (alanine aminotransferase), PT (prothrombin time [seconds]) * ± standard error (S.E.)