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World Journal of Surgery
Published in: World Journal of Surgery 12/2019

01-12-2019 | Liver Resection | Original Scientific Report

Impact of Intermittent Pringle Maneuver on Long-Term Survival After Hepatectomy for Hepatocellular Carcinoma: Result from Two Combined Randomized Controlled Trials

Authors: Kit Fai Lee, Charing C. N. Chong, Sunny Y. S. Cheung, John Wong, Andrew K. Y. Fung, Hon Ting Lok, Paul B. S. Lai

Published in: World Journal of Surgery | Issue 12/2019

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Abstract

Background

Hepatectomy remains an important curative treatment for hepatocellular carcinoma (HCC). Intermittent Pringle maneuver (IPM) is commonly applied during hepatectomy for control of bleeding. Whether the ischemia/reperfusion injury brought by IPM adversely affects the operative outcomes is controversial. This study aims to examine whether the application of IPM during hepatectomy affects the long-term outcomes.

Methods

Two randomized controlled trials (RCT) have been carried out previously to evaluate the short-term outcomes of IPM. The present study represented a post hoc analysis on the HCC patients from the first RCT and all patients from the second RCT, and the long-term outcomes were evaluated.

Results

There were 88 patients each in the IPM group and the no-Pringle-maneuver (NPM) group. The patient demographics, type and extent of liver resection and histopathological findings were comparable between the two groups. The 1-, 3-, 5-year overall survival in the IPM and NPM groups was 92.0%, 82.0%, 72.1% and 93.2%, 68.8%, 58.1%, respectively (P = 0.030). The 1-, 3-, 5-year disease-free survival in the IPM and NPM groups was 73.6%, 56.2%, 49.7% and 71.6%, 49.4%, 40.3%, respectively (P = 0.366). On multivariable analysis, IPM was a favorable factor for overall survival (P = 0.035). Subgroup analysis showed that a clamp time of 16–30 min (P = 0.024) and cirrhotic patients with IPM (P = 0.009) had better overall survival.

Conclusion

IPM provided a better overall survival after hepatectomy for patients with HCC. Such survival benefit was noted in cirrhotic patients, and the beneficial duration of clamp was 16–30 min.

Trial registration

NCT00730743 and NCT01759901 (http://​www.​clinicaltrials.​gov).
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Metadata
Title
Impact of Intermittent Pringle Maneuver on Long-Term Survival After Hepatectomy for Hepatocellular Carcinoma: Result from Two Combined Randomized Controlled Trials
Authors
Kit Fai Lee
Charing C. N. Chong
Sunny Y. S. Cheung
John Wong
Andrew K. Y. Fung
Hon Ting Lok
Paul B. S. Lai
Publication date
01-12-2019
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 12/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-019-05130-8

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