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INDICATIONS

TVE of the liver is indicated for hepatic lesions which are closely related to, or infiltrating, the vena cava or the confluence between hepatic veins and vena cava. Cases other than liver resections in which TVE may be indicated include surgery for retroperitoneal tumors, for right renal or adrenal tumors, and for tumors of the vena cava (5-7,17). According to the majority of the Authors indications to TVE are very selective, their rate being around 10% of all liver resections in healty liver. Some surgeons, however, use this technique more extensively, in almost all major resections, also in cirrhotic liver, emphasizing the advantage of performing a safer resection in a completely bloodless operative field (23-26).
At the moment there is only one prospective controlled trial addressing this issue, comparing clamping of the hepatic pedicle to TVE in 28 patients with healthy liver, who required a major liver resection for lesions not involving the major hepatic veins or the inferior vena cava (i.e., not including patients who would have benefited clearly from a TVE). The results of this study showed that the amounts of intraoperative blood loss and of intraoperative blood transfusions were comparable in the two groups. Furthermore in the group of patients with TVE a trend toward a greater incidence of pulmonary complications and subphrenic fluid collections was observed. Finally, specific complications of TVE, such as rupture of the spleen and injury to the caudate lobe, were reported. The conclusion of this study is that, because of the need for a more demanding surgical technique and a complex anesthesiological menagement, indications to TVE must be selective.

 

 

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