Hepatic Resection Using in-situ Cold Perfusion Under Total Vascular Exclusion

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The hepatic tumors localized close to the IVC or main hepatic veins had been considered to be in-operable, as the tear of these veins produce uncontrollable bleeding unless total vascular occlusion is applied. In this study, the cold perfusion in-situ was performed in dogs experimentally and the results revealed the superiority of UW solution as a perfusate evaluated by Arterial Ketone Body Ratio (AKBR). In a patient with a huge tumor in the right lobe close to the IVC, we applied this method. From the left branch of the portal vein the cold lactate Ringer solution was perfused with a hole in the IVC as a outlet after the total vascular occlusion. Liver resection with a knife and reconstruction of the IVC and the hepatic veins were completed without blood loss. The recovery rate of AKBR after recirculation to the liver was prompt and enough. Using this method the resectability of the liver tumor will increase in future.