Clinical effect of ischemic preconditioning prior to hepatectomy

Objective: This study evaluated the effect and clinical value of hepatic ischemic preconditioning (IP) prior to hepatectomy. Methods: 458 patients who underwent liver resection from 2001 to 2014 at Xijing Hospital were retrospectively analyzed. The patients were divided into two groups. From 2001 to 2005, the Pringle maneuver was primarily used for hepatic inflow occlusion, and 223 patients were assigned to the Pringle group, which served as the Control Group. From 2006 to 2014, IP was performed instead of the Pringle maneuver, and 235 patients were assigned to the IP Group. The liver function, duration of hepatic inflow occlusion, blood loss and transfusion volume during the operation; the duration of hospital stay; and complications were compared. Results: At postoperative days 1, 3, 5, and 7, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and total bilirubin (TBIL) were significantly lower in the IP Group compared with the Control Group (P<0.05). The albumin (ALB) in the IP Group was also higher, but there was a significant difference only at the 1st and 7th days. Additionally, a shorter inflow occlusion time and hospital stay duration, less bleeding, and fewer transfusions were observed in the IP Group. No significant differences in complications were observed between the groups. Conclusions: Performing hepatic inflow occlusion prior to hepatectomy could significantly extend the duration of hepatic ischemic tolerance. The procedure could also maintain the consistency of the surgery, reduce blood loss, alleviate reperfusion injury, and promote liver function recovery.