Hepatic pedicle clamping during hepatic resection for colorectal liver metastases: No impact on survival or hepatic recurrence Journal Article
| Authors: | Weiss, M. J.; Ito, H.; Araujo, R. L. C.; Zabor, E. C.; Gonen, M.; D'Angelica, M. I.; Allen, P. J.; DeMatteo, R. P.; Fong, Y.; Blumgart, L. H.; Jarnagin, W. R. |
| Article Title: | Hepatic pedicle clamping during hepatic resection for colorectal liver metastases: No impact on survival or hepatic recurrence |
| Abstract: | Background: Hepatic pedicle clamping is often used during liver resection. While its use reduces blood loss and transfusion requirements, the long-term effect on survival and recurrence has been debated. This study evaluates the effect of hepatic pedicle clamping [i.e., Pringle maneuver (PM)] on survival and recurrence following hepatic resection for colorectal liver metastasis (CRLM). Methods: Patients who underwent R0 resection for CRLM from 1991 to 2004 were identified from a prospectively maintained database. Operative, perioperative, and clinicopathological variables were analyzed. The primary outcomes were disease-free survival (DFS) and liver recurrence (LR). Disease extent was categorized using a well-defined clinical risk score (CRS). Subgroup analysis was performed for patients given preoperative systemic chemotherapy and postoperative pump chemotherapy. Results: This study included 928 consecutive patients with median follow-up of 8.9 years. PM was utilized in 874 (94 %) patients, with median time of 35 min (range 1-181 min). On univariate analysis, only resection type (p < 0.001) and tumor number (p = 0.002) were associated with use of PM. Younger age (p = 0.006), longer operative time (p < 0.001), and multiple tumors (p = 0.006) were associated with prolonged PM (>60 min). There was no association between DFS, overall survival (OS) or LR and Pringle time. Neither the CRS nor use of neoadjuvant therapy stratified disease-related outcome with respect to use of PM. Conclusions: PM was used in most patients undergoing resection for CRLM and did not adversely influence intrahepatic recurrence, DFS, or OS. © 2012 Society of Surgical Oncology. |
| Keywords: | adult; cancer chemotherapy; cancer survival; controlled study; treatment outcome; aged; surgical technique; major clinical study; overall survival; cancer recurrence; cancer patient; disease free survival; outcome assessment; follow up; colorectal cancer; data base; risk assessment; liver metastasis; clinical evaluation; liver surgery; perioperative period; vascular pedicle; vascular surgery; colorectal liver metastasis; pringle maneuver |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 20 |
| Issue: | 1 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2013-01-01 |
| Start Page: | 285 |
| End Page: | 294 |
| Language: | English |
| DOI: | 10.1245/s10434-012-2583-0 |
| PROVIDER: | scopus |
| PUBMED: | 22868921 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 February 2013" - "CODEN: ASONF" - "Source: Scopus" |
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