[Application of Ischemic Preconditioning Before Hepatic Vascular Exclusion for Resection of Hepatocellular Carcinoma]

Objective: To assess the value of clinical application of ischemic preconditioning (IP) before hepatic vascular exclusion for resection of hepatocellular carcinoma (HCC) accompanied by cirrhosis and explore the possible mechanism underlying the protective effect of this maneuver.

Methods: Thirty-four consecutive patients with resectable HCC were randomized into IP group to receive IP with a 5-min ischemia followed by 5-min perfusion before hepatic vascular exclusion and the control group with simply hepatic vascular exclusion. The liver function, hepatic Fas mRNA expression, caspase-3 activity, apoptosis of the hepatocytes were compared between the two groups.

Results: In the IP group, the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels on postoperative day 1, 3 and 7 were all significantly higher than those of the control group (t=6.985, P<0.01). The total bilirubin levels were also higher in the former group on postoperative day 3 and 7 (t=3.447, P<0.05). The IP group had higher albumin levels on postoperative day 1 than the control group (t=3.360, P<0.05). After 1 hour's reperfusion, the hepatic mRNA expression of Fas, caspase-3 activity and apoptotic sinusoidal endothelial cells were all significantly higher than those of the control group (t=3.771, P<0.05).

Conclusion: IP has a protective effect on liver function after hepatic resection with hepatic vascular exclusion in HCC patients, possibly due to the inhibition of hepatocyte apoptosis by down-regulating hepatic Fas mRNA expression and caspase-3 activity, and is a convenient technique applicable in such operations as hepatic transplants and hepatectomy.