Total vascular exclusion in pediatric hepatectomy: reducing hemorrhage without added morbidity

IF 3.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2026-09-01 Epub Date: 2026-06-19 DOI:10.1016/j.hpb.2026.06.007

Juri Fuchs, Lucas Rabaux-Eygasier, Geraldine Hery, Virginie Fouquet, Catherine Baujard, Florent Guerin, Sophie Branchereau

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引用次数: 0

Abstract

Background

Major hepatectomy in children carries distinct risks and challenges, with intraoperative hemorrhage being a critical determinant of morbidity and survival. Total vascular exclusion (TVE) provides complete vascular control, but its use in adults is associated with high morbidity. Evidence for pediatric hepatectomy is lacking.

Methods

A single-center study of all children (<18 years) undergoing major hepatectomy between 2013 and 2023 was performed. Patients were grouped by TVE use. Primary outcomes were major complications (Clavien–Madadi ≥ III) and posthepatectomy liver dysfunction. Secondary outcomes included CCI, blood loss, transfusion, renal function, hospital stay, and oncologic outcomes.

Results

A total of 125 patients were included (68% with hepatoblastoma). TVE was applied in 67 children (53.6%) with a median duration of 18 min. No episodes of hemodynamic instability occurred during TVE. Outcomes including major complications (6.0% TVE vs. 6.9% non-TVE, p = 1.000), as well as intraoperative blood loss and transfusion, did not differ significantly between the groups. No patient developed clinically relevant posthepatectomy liver failure or renal dysfunction.

Conclusions

This is the largest series of children undergoing hepatectomy using TVE. In contrast to adult liver surgery, where adverse physiological effects constrain its use, TVE can be safely performed in children, without increasing perioperative morbidity.

查看原文本刊更多论文

全血管排除在小儿肝切除术：减少出血而不增加发病率。

背景：儿童大肝切除术具有明显的风险和挑战，术中出血是发病率和生存率的关键决定因素。全血管排除术（TVE）提供了完全的血管控制，但其在成人中的应用与高发病率相关。儿童肝切除术缺乏证据。方法：对所有儿童进行单中心研究(结果：共纳入125例患者（68%为肝母细胞瘤）。TVE应用于67例儿童（53.6%），中位持续时间为18分钟。TVE期间未发生血流动力学不稳定。结果包括主要并发症（6.0% TVE vs. 6.9%非TVE， p = 1.000），以及术中出血量和输血，组间无显著差异。无患者出现与临床相关的肝切除术后肝功能衰竭或肾功能不全。结论：这是使用TVE进行肝切除术的最大的儿童系列。成人肝脏手术的不良生理效应限制了其使用，与之相反，TVE可以安全地在儿童中进行，而不会增加围手术期的发病率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).