Randomized clinical trial of liver resection with and without hepatic pedicle clamping

Background: The purpose of this study was to compare the perioperative outcome of liver resection with and without intermittent hepatic pedicle clamping. Methods: Between June 2002 and June 2004, 126 consecutive patients with resectable liver tumours were randomized to undergo resection with (63 patients) or without (63 patients) intermittent hepatic pedicle clamping. Results: The transection time was significantly higher in the group without hepatic pedicle clamping. The blood loss per cm2 was similar in the two groups: 2·7 ml/cm2 in the group with versus 3·2 ml/cm2 in group without hepatic pedicle clamping (P = 0·425). In the subset of patients with an abnormal liver, there were no differences in blood loss per transection surface: 3·1 ml/cm2 in the group with versus 2·9 ml/cm2 in the group without clamping (P = 0·829). The rate of blood transfusions was not higher in the non‐clamping group. No differences were observed in the postoperative liver enzyme serum levels, the in‐hospital mortality (one patient in each group) or the number of complications. Conclusion: This study showed clearly that liver resection without hepatic pedicle clamping is safe, even in patients with a diseased liver. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Not clamping is safe when blood loss is small