Adverse impact of intermittent portal clamping on long-term postoperative outcomes in hepatocellular carcinoma

Abstract

Introduction To evaluate the impact of intermittent portal clamping (IPC) on long-term postoperative outcomes in patients with hepatocellular carcinoma (HCC). Methods Clinical records of 355 patients underwent curative liver resection for HCC in January 2007 to December 2010 were retrospectively reviewed. According to how portal clamping was performed, patients were grouped as: IPC, n=113; other portal clamping (OPC), n=190; and no portal clamping (NPC), n=52. Results Median recurrence-free survival (RFS) was statistically significantly shorter in the IPC (39.4 months) than OPC (47.3 months, p=0.010) and NPC groups (51.4 months, p=0.008). Median overall survival (OS) was also significantly shorter with IPC (46.3 months), versus 52.9 months with OPC (p=0.022) and 56.2 months with NPC (p=0.015). Kaplan-Meier survival analysis revealed that 5-year cumulative RFS was much lower in the IPC (42.5%) than OPC (50.9%, p=0.014) and NPC groups (49.6%, p=0.013). Five-year cumulative OS was also much lower in the IPC (44.9%) than OPC (58.0%, p=0.020) and NPC groups (57.7%, p=0.025). On univariate analysis, tumour grade, size and number, TNM stage, blood transfusion, vascular invasion and IPC were significantly inversely correlated with RFS and OS. On multivariate analysis, tumour size and number, blood transfusion, vascular invasion and IPC remained significant. Conclusions Our study suggests that IPC is an independent risk factor for poor long-term postoperative outcomes in patients with HCC.

Does the intermittent Pringle maneuver affect the recurrence following surgical resection for hepatocellular carcinoma? A systematic review

“…After browsing titles and abstracts, 439 records were excluded, including 38 were for lack of comparison, 66 were for benign disease, 20 were for data unavailable, 66 were for palliative treatment, 168 were for not specified for HCC, 45 were for in vitro studies, 36 were for reviews. Among the remained 109 records, 103 records were excluded for comparison PM with selective PM, Finally, six researches [21,22,27,28,29,30] were included for analysis. Details were depicted specifically in Fig 1. In total, 5275 patients were enrolled in this meta-analysis, with 3290 cases in the IPM group and 1985 cases in the non-IPM group.…”

“…The scores ranged from 7 to 8, indicating that all the studies were of high quality (Table 1). Of note, five of the six included studies came from China [21,27,28,29,30].…”

“…DFS was evaluated in the same five studies [21,22,27,28,29], but no significant heterogeneity was observed among included studies (I 2 = 9%, P = 0.36). The pooled HR was determined by fixed-effect model, and results showed that there were no significant differences between IPM group and non-IPM group (HR 0.93, 95%CI 0.81~1.07, P = 0.29; Fig 2B).…”

“…The 1-, 3-, and 5-year survival rates were evaluated in six [21,22,27,28,29,30], five [21,22,27,28,29], and four [21,22,27,28] studies, respectively. A random-effect model was used, and the pooled ORs for the 1-, 3-, and 5-year survival rates of the IPM group when compared with the non-IPM group were 0.65 (95% CI 0.45~0.94, P = 0.02; Fig 3A), 0.92(95% CI 0.59~1.45, P = 0.72; Fig 3B), and 0.93 (95% CI 0.65~1.34, P = 0.69; Fig 3C), respectively.…”

“…Relevant clinical trials evaluating the impact of IPM on the long-term prognosis after curative resection have been rarely published openly in the previous decades, and the currently identified studies are almost come from eastern countries [19,20,21]. Until recently, a study from a western series reported that IPM did not increase the risk of recurrence and decrease long-term survival [22].…”