A Prospective Randomized Controlled Trial to Compare Pringle Manoeuvre with Hemi-hepatic Vascular Inflow Occlusion in Liver Resection for Hepatocellular Carcinoma with Cirrhosis
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The duration of hepatic vascular inflow occlusion and the amount of intraoperative blood loss have significant negative impacts on postoperative morbidity, mortality and long-term survival outcomes of patients who receive partial hepatectomy for hepatocellular carcinoma (HCC) with cirrhosis.
This study aimed to compare the perioperative outcomes of partial hepatectomy for HCC superimposed on hepatitis B-related cirrhosis using two different occlusion techniques.
A randomized controlled trial was carried out to evaluate the impact of two different vascular inflow occlusion techniques. The postoperative short-term results were compared.
During the study period, 252 patients received partial hepatectomy for HCC with cirrhosis. Of these patients, 120 were randomized equally into two groups: the Pringle manoeuvre group (n = 60) and the hemi-hepatic vascular inflow occlusion group (n = 60). The number of patients who had poor liver function on postoperative day 5 with ISLGS grade B or worse was 24 and 13, respectively (P = 0.030). The postoperative complication rate was significantly higher in the Pringle manoeuvre group (40 versus 22 %, P = 0.030). However, the Pringle manoeuvre group had significantly shorter operating time (116 versus 136 min, P = 0.012) although there was no significant difference in intraoperative blood loss between the two groups [200 ml (range 10–5,000 ml) versus 300 ml (range 100–1,000 ml); P = 0.511]. There was no perioperative mortality.
The results indicated that for patients with HCC with cirrhosis, hemi-hepatic vascular inflow occlusion was a better inflow occlusion method than Pringle manoeuvre.
KeywordsLiver neoplasm Hepatocellular carcinoma Cirrhosis Pringle manoeuvre Hemi-hepatic vascular inflow occlusion
- 2.European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2012 Apr;56(4):908–943.Google Scholar
- 4.Sugiyama Y, Ishizaki Y, Imamura H , Sugo H, Yoshimoto J, Kawasaki S, et al. Effects of intermittent Pringle's manoeuvre on cirrhotic compared with normal liver. Br J Surg 2010 Jul;97(7):1062–1069.Google Scholar
- 5.Merican I, Guan R, Amarapuka D , Alexander MJ, Chutaputti A, Chien RN, et al. Chronic hepatitis B virus infection in Asian countries. J Gastroenterol Hepatol 2000 Dec;15(12):1356–1361.Google Scholar
- 9.Heizmann O, Meimarakis G, Volk A, Matz D, Oertli D, Schauer RJ, et al. Ischemic preconditioning-induced hyperperfusion correlates with hepatoprotection after liver resection. World J Gastroenterol 2010 Apr 21;16(15):1871–1878.Google Scholar
- 13.Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 2011 May; 149(5): 713–724.Google Scholar
- 14.Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009 Aug;250(2):187–96.Google Scholar
- 15.Dindo D, Demartines N, Clavien PA, et al. Classification of Surgical Complications A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann Surg. 2004 Aug;240(2):205–13.Google Scholar
- 19.Blumgart LH, Hann LE. Surgical and radiologic anatomy of the liver and biliary tract. In: Surgery of the Liver and Biliary Tract. Ed. Blumgart LH, Fong Y. WB Saunders Co. Ltd., London. Third Edition, Ch 1, pp 21–22.Google Scholar
- 20.Smyrniotis V, Kostopanagiotou G, Theodoraki K, Tsantoulas D, Contis JC, et al. The role of central venous pressure and type of vascular control in blood loss during major liver resections. Am J Surg. 2004 Mar;187(3):398–402.Google Scholar
- 25.Yang Y, Lai EC, Fu SY, Gu FM, Li PP, Lau WY, Et al. A prospective randomized controlled trial to compare two methods of selective hepatic vascular exclusion in partial hepatectomy. Eur J Surg Oncol. 2012 Dec 13. pii: S0748-7983(12)01305-4.Google Scholar
- 27.Theodoraki K, Tympa A, Karmaniolou I, Tsaroucha A, Arkadopoulos N, Smyrniotis V, et al. Ischemia/reperfusion injury in liver resection: a review of preconditioning methods, Surg Today. 2011 May;41(5): 620–629.Google Scholar
- 28.Camacho VR, de Fraga RS, Cerski CT, de Oliveira JR, Álvares-da-Silva MR, et al. Relationship between ischemia/reperfusion injury and the stimulus of fibrogenesis in an experimental model: comparison among different preservation solutions. Transplant Proc. 2011 Dec;43(10):3634–3637.Google Scholar