Anatomical Resection of the Liver for Hepatocellular Carcinoma: a New Ultrasound Guided Approach

Completed

• Conditions: Hepatocellular Carcinoma
• Interventions: Procedure: IOUS-GUIDED INTRAHEPATIC VESSEL COMPRESSION

• Registration Number: NCT00829335
• Lead Sponsor: University of Milan

Brief Summary

Anatomical resection is the gold standard approach for liver resection in patients with HCC. A new method for that by means of IOUS-guided finger compression has been devised.

Detailed Description

We herein describe a novel technique for the demarcation of the resection area by means of IOUS-guided finger compression to systematically accomplish anatomical segmental and subsegmental resections.

Using the IOUS, the tumor and the level targeted for compression are identified. Than, under the IOUS guidance, the surgeon compresses bilaterally the liver at the targeted position resulting in the compression of the portal pedicle feeding the tumor previously identified. This maneuver is constantly monitored in real-time just using the same microconvex probe, and it is maintained until the surface of the targeted liver area begins to discolor, at that time the first assistant marks the discolored area with the electrocautery, and the compression is released. Once the area is demarcated, liver dissection is started under intermittent Pringle's maneuver.

Study Timeline

• Study Start: 2007-01
• Status Verified: 2009-01
• Primary Completion: 2009-01
• Study Completion: 2009-01
• Study First Submitted: 2009-01-26
• Study First Submitted QC: 2009-01-26
• Last Update Submitted: 2009-01-26
• Study First Posted: 2009-01-27
• Last Update Posted: 2009-01-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 30

Inclusion Criteria

• Patients suitable for surgical approach carries of HCC
• Serum bilirubin level lower than 1.5 mg/dl

Exclusion Criteria

• Presence of ascites
• Serum bilirubin level equal or higher than 1.6 mg/dl
• Conditions (size, vascular relation, or infiltration) demanding resection larger than a segmental area
• Tumor thrombus in portal or hepatic veins

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
HCC patients	IOUS-GUIDED INTRAHEPATIC VESSEL COMPRESSION	According with the investigators previously reported selection flow-chart , patients suitable for surgical approach were those with HCC without ascites, without or with esophageal varices for which preoperative endoscopic eradication could be carried out successfully, and with serum bilirubin level lower than 1.5 mg/dl. Potential candidates to systematic segmental or subsegmental resection by IOUS-guided finger compression were considered patients with single HCC located in one or 2 adjacent segments without portal thrombosis, and anyway not demanding for its complete removal a sectional resection or wider.

Primary Outcome Measures

Name	Time	Method
Technical feasibility

Secondary Outcome Measures

Name	Time	Method
Morbidity and mortality	30 and 90 days

Trial Locations

Locations (1)

Istituto Clinico Humanitas Irccs; 🇮🇹 Rozzano, Milano, Italy