Does topical cooling alleviate ischemia/reperfusion injury during inflow occlusion in hepatectomy? Results of an experimental and clinical study

This study was une whether topical cooling can alleviate ischemia/reperfusi on injury, after continuous inflow occlusion during hepatectomy. Using a ca nine model of 70% partial liver ischemia (60 min), alteration in the subcel lular (cytoplasm, mitochondria, nucleus) elements calcium, sodium, potassiu m, and chloride, and liver functions following reperfusion were compared be tween control livers and livers subjected to topical cooling down to 23 deg rees +/- 4.9 degrees C by seeding ice slush over the ischemic lobe. The ele ments were determined by X-ray microanalysis using liver biopsy specimens. A similar clinical study was undertaken examining ten patients with hepatoc ellular carcinoma and chronic liver disease who underwent right-sided segme ntectomy under continuous right inflow occlusion, five of whom were given t opical cooling and five of whom were not. In the experimental study, postre perfusion worsening of liver function tests was significantly suppressed in the cooling group, which was associated with the suppression of subcellula r Ca, Na, and Cl increases and K decreases after reperfusion. In the clinic al study, the occlusion time was significantly longer in the hypothermic pa tients than in the normothermic patients, but no significant differences in postoperative liver function or postischemic increases in Ca, Na, or Cl an d decreases in K were observed. These experimental and clinical findings su ggest that topical cooling alleviates ischemic insult and enhances safe pro longed inflow occlusion.