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Hepatic Pedicle Clamping During Hepatic Resection for Colorectal Liver Metastases: No Impact on Survival or Hepatic Recurrence

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Matthew J. Weiss MD, Hiromichi Ito MD, Raphael L. C. Araujo MD, Michael I. D’Angelica MD, Peter J. Allen MD, Ronald P. DeMatteo MD, Yuman Fong MD, Leslie H. Blumgart MD & William R. Jarnagin MD

  2. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Emily C. Zabor MS & Mithat Gonen PhD

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  1. Matthew J. Weiss MD
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  2. Hiromichi Ito MD
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  3. Raphael L. C. Araujo MD
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  6. Michael I. D’Angelica MD
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  11. William R. Jarnagin MD
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Correspondence to William R. Jarnagin MD.

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Weiss, M.J., Ito, H., Araujo, R.L.C. et al. Hepatic Pedicle Clamping During Hepatic Resection for Colorectal Liver Metastases: No Impact on Survival or Hepatic Recurrence. Ann Surg Oncol 20, 285–294 (2013). https://doi.org/10.1245/s10434-012-2583-0

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  • DOI: https://doi.org/10.1245/s10434-012-2583-0

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