Ischemic preconditioning versus intermittent vascular occlusion in liver resections performed under selective vascular exclusion: a prospective randomized study

BackgroundThe aim of this study was to compare ischemic preconditioning with the intermittent vascular occlusion technique in liver resections performed under inflow and outflow occlusion.MethodsFifty-four patients with resectable liver tumors assigned were randomly to undergo surgery with either ischemic preconditioning (IP group, n = 27) or with intermittent vascular occlusion (IVO group, n = 27). Both groups were compared regarding surgical parameters, aspartate transaminase levels, and apoptosis.ResultsFor warm ischemic time less than 40 minutes, no significant difference was noticed between the 2 groups apart from caspase-3 activity, which was higher in the IVO group than in the IP group (17.2 ± 3.4 vs. 10.3 ± 5.2, P < .05). When warm ischemia exceeded 40 minutes, the IP group showed higher levels in blood aspartate transaminase levels on day 3 (442 ± 178 IU/L vs. 305 ± 104 IU/L, P < .05) and higher caspase-3 levels (26.5 ± 5.7 count/high-power field [hpf] vs. 20.7 ± 3.6 count/hpf, P < .05) and apoptotic activity (28.5 ± 7.5 count/hpf vs. 20.2 ± 4.1 count/hpf, P < .05), as compared with the IVO group.ConclusionsAlthough both techniques showed comparable efficacy for short ischemic times, intermittent vascular occlusion provided better cytoprotection when ischemia exceeded 40 minutes.