Monitoring hepatic venous hemoglobin oxygen saturation during Appleby operation for pancreatic cancer

Background/Aims: When an Appleby operation is performed for pancreatic body and tail carcinoma, it is necessary for prevention of hepatic ischemia to estimate accurately the hepatic circulation after resection of the celiac artery, the common hepatic artery and the portal vein. We studied the hepatic circulation by monitoring the ShvO₂ (hepatic venous hemoglobin oxygen saturation) during an Appleby operation. Methodology: We performed an Appleby operation on 8 patients with pancreatic cancer. In 6 of 8 patients, a 7-Fr fiberoptic flow direct catheter was inserted in the right hepatic vein. The ShvO₂ values were monitored continuously during surgery. Results: The ShvO₂ value was 76±3.5% just after laparotomy, and reduced to 61±13.2% after clamping the common hepatic artery. The values of the ShvO₂ returned to 70.8±10.9% one hour after clamping. But, one patient underwent reconstruction of the common hepatic artery, because the ShvO₂ value still stood at 50%. Combined resection of the portal vein was performed in 5 out of 8 patients. Two patients underwent resection of the portal vein without reconstruction due to the development of the colateral vein, one patient; resection of the portal vein with reconstruction, and two patients; wedge resection. In all 5 patients, the ShvO₂ was stable during resection of the portal vein. Conclusions: Monitoring the ShvO₂ is a useful method to evaluate at real time the hepatic circulation during the Appleby operation, and to decide if reconstruction of the common hepatic artery or the portal vein is needed or not.