Impact of intermittent portal clamping on the early recurrence of hepatocellular carcinoma after surgery

Abstract

IPC is an independent risk factor for the early recurrence of HCC after surgery.

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

“…OS and DFS are reported to be irrelevant with IPM for colorectal liver metastasis [33,34], but it has yet to be known for HCC. In this study, six studies [21,22,27,28,29,30] were eligible for this metaanalysis, including the latest report from the western series [22]. Resulted showed that longterm outcomes were comparable between groups of IPM and non-IPM, which was in line with the most of the eastern series and the newly-published western series.…”

“…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].…”

“…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.…”

“…Intermittent Pringle maneuver for hepatocellular carcinoma duration was reported to be well tolerated for up to 2 hours [41], but the longer ischemia, the more severe reperfusion injury. Occlusion time and courses are typically correlated with the incidence of intraoperative blood loss, the rate of liver dysfunction of HCC [19,22,28,30], but it remains controversial whether they affect the long-term outcomes. Liu et al found that longer occlusion time increased the risk of early recurrence or shortened overall survival time, while a shorter duration decreased the risk of recurrence.…”