Hepatic resection under liver surface or perfusion cooling together with hepatoprotective agents of PGE1 and urinastatin

: The techniques and results of nine patients who underwent hepatic resections with surface and/or in situ perfusion cooling with hepatoprotective agents of PGE1 and Ulinastatin are described. Eight hepatocellular carcinomas associating chronic liver disease and one hemangioma are included in this report. Complete vascular exclusion technique with the centrifugal blood pump driven veno-venous bypass was employed on the three patients with giant liver tumors. The bypass technique with liver cooling made it possible to carry out otherwise impossible and risky resections, particularly in case with neoplastic involvement of the inferior vena cava. The other patients were subjected to segmentectomy of the right lobe under hemihepatic surface cooling or in situ hypothermic perfusion by chilled Lactate Ringer for vascular arrested right lobe. Liver tissue temperature dropped down to 19 degrees C to 26 degrees C during cooling. Postoperative physiologic changes were minimal irrespective of prolonged continuous vascular interruption of the cirrhotic liver for up to 60 min. There was no mortality and major morbidity in the present series. Liver cooling can be an useful hepatoprotective method for the cirrhotic liver in the hepatic resection with vascular occlusion.