Abstracts
1999 Digestive Disease Week

# 2122 HEPATIC RESECTION USING VASCULAR INFLOW CONTROL AND LOW CENTRAL VENOUS PRESSURE IMPROVES MORBIDITY AND MORTALITY
H Chen, N B Merchant, Johns Hopkins Med Inst, Baltimore, MD; Mukund S Didolkar, Sinai Hosp of Baltimore, Baltimore, MD

Hepatic resection results in significant morbidity and mortality primarily related to intraoperative blood loss. Improved understanding of hepatic physiology and segmental anatomy of the liver has led to advances in surgical and anesthetic technique for hepatic resection. Vascular inflow control (VC) and maintenance of a low central venous pressure (CVP) during hepatectomy have been used to reduce blood loss. However, their effect on morbidity and mortality have not been clearly demonstrated. In order to determine the benefit of VC and low CVP, we reviewed the outcomes of 168 consecutive patients who underwent liver resection between 1979 to 1998. The mean age was 60±1 years and 52% were female. The most recent 78 consecutive patients had hepatic resection using VC and low CVP (post-VC/CVP). Their results were compared to the previous 90 patients who had hepatectomy without VC and low CVP (pre-VC/CVP). Hepatectomies were performed for metastatic disease (65%), hepatoma (20%), and benign disease (15%). Resections included 18 trisegmentectomies (TRI), 67 lobectomies (LOB), and 83 segmental resections (SEG). Patients in the two groups were similar with regard to age, gender, and extent of resection. However, post-VC/CVP patients had a significantly lower median estimated blood loss (EBL), less morbidity, lower mortality, fewer ICU days, and shorter overall length of stay (LOS) compared to pre-VC/CVP patients. In conclusion, these data suggest that VC and low CVP during liver resection improve patient outcomes. Beneficial effects include a reduction in blood loss, morbidity, mortality, ICU stay, and overall LOS. Therefore, these results support the routine use of VC and low CVP during hepatic resection.

	N	resections TRI LOB SEG	median EBL (cc)	morbidity*	mortality	ICU tay (days)†	LOS (days)†
pre-VC/CVP	90	11% 49% 40%	2300	22.2%	10.0%	5.6%±1.2	15.0±1.6
post-VC/CVP	78	10% 30% 60%	725	10.3%	2.6%	1.6±0.2	8.0±0.5
p value	--	NS	<0.001	0.038	0.050	0.003	0.001

†mean±SEM; NS = not significant; *bleeding, infectious, pulmonary, and renal complications statistics performed by log rank, ANOVA and chi-square analysis where appropriate

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