The difference in prolonged continuous and intermittent Pringle maneuver during complex hepatectomy for hepatocellular carcinoma patients with chronic liver disease: A retrospective cohort study. (18th October 2021)

• Record Type: Journal Article
• Authors: Liu, Jianwei; Wang, Wei; Shi, Chunchao; Li, Chenqi; Xue, Feng; Hu, Lei; Wang, Yi; Ge, Ruiliang
• Is Part Of: Cancer medicine. Volume 10:Number 23(2021)
• Page Start: 8507
• Page End: 8517
• Publication Date: 2021-10-18
• Subjects: bleeding -- complications -- continuous Pringle maneuver -- intermittent Pringle maneuver -- liver function; 616.994005
• DOI: 10.1002/cam4.4361
• Languages: English
• ISSNs: 2045-7634

Abstract

Abstract: Purpose: To explore the differences between prolonged continuous Pringle maneuver (CPM) and prolonged intermittent Pringle maneuver (IPM) in patients with hepatocellular carcinoma (HCC), who underwent complex hepatectomy. Methods: This retrospective cohort study performed between June 2014 and May 2016 included 142 patients who underwent complex hepatectomy for HCC and concomitant chronic liver disease but with good liver function. Patients were categorized into CPM ( n = 69) and IPM groups ( n = 73). The differences in these aspects were compared between the two groups which include operation time, intraoperative bleeding, perioperative transfusion, postoperative complications, liver function injury, postoperative overall survival (OS), and tumor recurrence. Results: The cumulative clamping time, operation time, intraoperative bleeding, and perioperative transfusion rates were 38.0, 132 min, 300 ml, and 17.4% in CPM and 40.0, 145 min, 400 ml, and 32.9% in IPM, respectively. There were significant intergroup differences in operation time ( p = 0.018), intraoperative bleeding ( p < 0.001), and perioperative transfusion rates ( p = 0.034). Besides, the postoperative complications and postoperative liver function injury of the CPM group were better than those of IPM. There was no significant intergroup difference in OS ( p = 0.908) and tumor recurrence ( p = 0.671) between two groups. Conclusion: Compared with IPM, CPM with a cumulative clamping time between 30 and 50 min can shorten operation time, reduce intraoperative bleeding and perioperative transfusion, and reduce postoperative complications and postoperative liver function injury in patients who underwent complex hepatectomy for HCC and concomitant liver disease but with good liver function. There was no significant difference in OS and tumor recurrence between two groups. Abstract : This is the first study to explore the difference in prolonged continuous Pringle maneuver (CPM) and prolonged intermittent Pringle maneuver (IPM) in HCC patients who underwent complex liver resection. The results showed that CPM whose cumulative clamping time between 30 and 50 min can shorten operation time, reduce intraoperative bleeding and proportion of transfusion, and reduce the postoperative complications and postoperative liver function injury, similar to overall survival and tumor recurrence compared with IPM. Therefore, CPM should be preferred when the estimated clamping time was between 30 and 50 min for HCC patients with chronic liver disease and well‐compensated liver function.