Hepatic pedicle clamping during hepatic resection for colorectal liver metastases: No impact on survival or hepatic recurrence

Matthew J. Weiss, Hiromichi Ito, Raphael L.C. Araujo, Emily C. Zabor, Mithat Gonen, Michael I. D'Angelica, Peter J. Allen, Ronald P. Dematteo, Yuman Fong, Leslie H. Blumgart, William R. Jarnagin

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)285-294
Number of pages10
JournalAnnals of surgical oncology
Volume20
Issue number1
DOIs
StatePublished - Jan 2013

ASJC Scopus subject areas

  • Surgery
  • Oncology

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