Intermittent portal triad clamping in resection of liver tumors involving the hepatocaval confluence

Objective: To review our experience in and the re-sults of resecting liver tumors involving the hepatoca-val confluence under intermittent portal triad clam-ping (PTC).Methods: Sixty-eight consecutive patients with livertumors involving the hepatocaval confluence under-went hepatectomies with liver parenchymal transec-tions under intermittent PTC.Results: All the tumors were successfully resected un-der PTC, except for one in which the infrahepatic in-ferior vena cava was concomitantly occluded in addi-tion to PTC. There was neither operative death noruncontrollable massive bleeding or air embolism oc-curred in our patients. The bleedings from the mainand short hepatic veins and right adrenal veins wereproperly managed during the operation, with a meanintraoperative blood loss of 1400 ml. Of the 68tumors resected, 65 were hepatocellular carcinomas(HCC). Their 1-, 2-, 3- and 4-year suvival rateswere 64.11%, 52. 82%, 44.90% and 36.98%, re-spectively, and the patients with HCC with capsulessurvived significantly longer than those with HCCwithout capsules.Conclusions: The liver tumors involving the hepato-caval confluence could be safely resected simply un-der PTC, without routine use of total hepatic vascu-lar exclusion. As for HCCs in this area, the tumorwith capsule is a better indicator for surgical resec-tion than that without capsule.