Portal flow modulation by splenic artery ligation to prevent posthepatectomy liver failure: A randomized controlled trial.

Summary

In hepatectomy patients with portal venous pressure >15 mm Hg, splenic artery ligation lowered portal pressures and reduced clinically significant posthepatectomy liver failure (16.7% vs 66.7%), ascites burden, and comprehensive complication index in a randomized trial halted early for benefit.

Key Findings

• Among patients with portal venous pressure >15 mm Hg, splenic artery ligation reduced PHLF grades B/C from 66.7% to 16.7% (P = .006).
• Significant reductions in portal venous pressure and PVP–CVP gradient compared with control and pre-ligation values.
• Lower comprehensive complication index (8.70 vs 20.90) and reduced ascites volume with ligation.

Clinical Implications

In patients with elevated intraoperative portal venous pressure, splenic artery ligation can be considered to modulate portal inflow and reduce PHLF; requires team protocols for pressure monitoring and selection.

Limitations

• Single-center trial with early termination and small randomized sample, which may overestimate effect sizes.
• Generalizability limited to patients with measured elevated portal venous pressure undergoing open hepatectomy.

Future Directions

Multicenter RCTs with standardized portal pressure monitoring, assessment of long-term outcomes, and integration with other inflow modulation strategies.