Journal of Gastrointestinal Surgery

, Volume 17, Issue 8, pp 1414–1421

A Prospective Randomized Controlled Trial to Compare Pringle Manoeuvre with Hemi-hepatic Vascular Inflow Occlusion in Liver Resection for Hepatocellular Carcinoma with Cirrhosis

  • Jun-sheng Ni
  • Wan Yee Lau
  • Yuan Yang
  • Ze-Ya Pan
  • Zhen-guang Wang
  • Hui Liu
  • Meng-chao Wu
  • Wei-ping Zhou
Original Article

Abstract

Background

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.

Aim

This study aimed to compare the perioperative outcomes of partial hepatectomy for HCC superimposed on hepatitis B-related cirrhosis using two different occlusion techniques.

Methods

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.

Results

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.

Conclusions

The results indicated that for patients with HCC with cirrhosis, hemi-hepatic vascular inflow occlusion was a better inflow occlusion method than Pringle manoeuvre.

Keywords

Liver neoplasm Hepatocellular carcinoma Cirrhosis Pringle manoeuvre Hemi-hepatic vascular inflow occlusion 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Jun-sheng Ni
    • 1
  • Wan Yee Lau
    • 2
  • Yuan Yang
    • 1
  • Ze-Ya Pan
    • 1
  • Zhen-guang Wang
    • 1
  • Hui Liu
    • 1
  • Meng-chao Wu
    • 1
  • Wei-ping Zhou
    • 1
  1. 1.The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery HospitalSecond Military Medical UniversityShanghaiChina
  2. 2.Faculty of Medicine, Prince of Wales HospitalThe Chinese University of Hong KongHong KongPeople’s Republic of China

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