Does Intermittent Pringle Maneuver Increase Postoperative Complications After Hepatectomy for Hepatocellular Carcinoma? A Randomized Controlled Trial

Lee, Kit Fai; Wong, John; Cheung, Siu Wun; Chong, Charing Ching‐Ning; Hui, J.Y.; Leung, Vivian; Yu, Simon C.H.; Lai, Paul Bo San

doi:10.1007/s00268-018-4637-3

Cited by 27 publications

(45 citation statements)

References 33 publications

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“…After browsing titles and abstracts, 439 records were excluded, including 38 were for lack of comparison, 66 were for benign disease, 20 were for data unavailable, 66 were for palliative treatment, 168 were for not specified for HCC, 45 were for in vitro studies, 36 were for reviews. Among the remained 109 records, 103 records were excluded for comparison PM with selective PM, Finally, six researches [21,22,27,28,29,30] were included for analysis. Details were depicted specifically in Fig 1. In total, 5275 patients were enrolled in this meta-analysis, with 3290 cases in the IPM group and 1985 cases in the non-IPM group.…”

Section: Base Characteristic Of the Included Studiesmentioning

confidence: 99%

“…The characteristic and quality of the included trials were shown in Table 1. However, only one RCT [29] was eligible. The scores ranged from 7 to 8, indicating that all the studies were of high quality (Table 1).…”

Section: Base Characteristic Of the Included Studiesmentioning

confidence: 99%

“…The scores ranged from 7 to 8, indicating that all the studies were of high quality (Table 1). Of note, five of the six included studies came from China [21,27,28,29,30].…”

Section: Base Characteristic Of the Included Studiesmentioning

confidence: 99%

“…DFS was evaluated in the same five studies [21,22,27,28,29], but no significant heterogeneity was observed among included studies (I 2 = 9%, P = 0.36). The pooled HR was determined by fixed-effect model, and results showed that there were no significant differences between IPM group and non-IPM group (HR 0.93, 95%CI 0.81~1.07, P = 0.29; Fig 2B).…”

Section: Primary Endpointsmentioning

confidence: 99%

“…The 1-, 3-, and 5-year survival rates were evaluated in six [21,22,27,28,29,30], five [21,22,27,28,29], and four [21,22,27,28] studies, respectively. A random-effect model was used, and the pooled ORs for the 1-, 3-, and 5-year survival rates of the IPM group when compared with the non-IPM group were 0.65 (95% CI 0.45~0.94, P = 0.02; Fig 3A), 0.92(95% CI 0.59~1.45, P = 0.72; Fig 3B), and 0.93 (95% CI 0.65~1.34, P = 0.69; Fig 3C), respectively.…”

Section: Subgroup Analysismentioning

confidence: 99%

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Does the intermittent Pringle maneuver affect the recurrence following surgical resection for hepatocellular carcinoma? A systematic review

Lin

et al. 2020

PLoS ONE

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Background and aimTo evaluate the effect of intermittent pringle maneuver (IPM) on the long-term prognosis and recurrence of hepatocellular carcinoma (HCC). MethodsEligible studies were identified by PubMed and other databases from Jan 1st 1990 to Mar 31st 2019. Hazard ratios (HR) with 95% confidence interval (CI) were calculated to evaluate the effects of IPM on the long-term prognosis and recurrence of patients with HCC. ResultsSix studies were enrolled in this meta-analysis. Results showed that there were no differences between IPM group and non-IPM group in the pooled HRs for the overall survival (OS) and disease-free survival (DFS) (HR 1.04, 95%CI 0.84~1.28, P = 0.74; HR 0.93, 95% CI 0.81~1.07, P = 0.29; respectively). However, subgroup analysis showed that the pooled Odd ratios (OR) for the 1-year OS and DFS rates of the IPM group when compared with the non-IPM group were 0.65 (95% CI 0.45~0.94, P = 0.02), 0.38 (95% CI 0.20~0.72, P = 0.003), respectively. In addition, there were no significant differences in the proportions of liver cirrhosis, HBsAg (+), Child-Pugh A class, multiple tumor, vascular invasion, and major hepatectomy between groups of IPM and non-IPM. PLOS ONE PLOS ONE | https://doi.org/10.et al. (2020) Does the intermittent Pringle maneuver affect the recurrence following surgical resection for hepatocellular carcinoma? A systematic review. PLoS ONE 15(3): e0229870.

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Section: Base Characteristic Of the Included Studiesmentioning

confidence: 99%

Section: Base Characteristic Of the Included Studiesmentioning

confidence: 99%

“…The scores ranged from 7 to 8, indicating that all the studies were of high quality (Table 1). Of note, five of the six included studies came from China [21,27,28,29,30].…”

Section: Base Characteristic Of the Included Studiesmentioning

confidence: 99%

Section: Primary Endpointsmentioning

confidence: 99%

Section: Subgroup Analysismentioning

confidence: 99%

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Does the intermittent Pringle maneuver affect the recurrence following surgical resection for hepatocellular carcinoma? A systematic review

Lin

et al. 2020

PLoS ONE

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Impact of Intermittent Pringle Maneuver on Long‐Term Survival After Hepatectomy for Hepatocellular Carcinoma: Result from Two Combined Randomized Controlled Trials

et al. 2019

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Background Hepatectomy remains an important curative treatment for hepatocellular carcinoma (HCC). Intermittent Pringle maneuver (IPM) is commonly applied during hepatectomy for control of bleeding. Whether the ischemia/ reperfusion injury brought by IPM adversely affects the operative outcomes is controversial. This study aims to examine whether the application of IPM during hepatectomy affects the long-term outcomes. Methods Two randomized controlled trials (RCT) have been carried out previously to evaluate the short-term outcomes of IPM. The present study represented a post hoc analysis on the HCC patients from the first RCT and all patients from the second RCT, and the long-term outcomes were evaluated. Results There were 88 patients each in the IPM group and the no-Pringle-maneuver (NPM) group. The patient demographics, type and extent of liver resection and histopathological findings were comparable between the two groups. The 1-, 3-, 5-year overall survival in the IPM and NPM groups was 92.0%, 82.0%, 72.1% and 93.2%, 68.8%, 58.1%, respectively (P = 0.030). The 1-, 3-, 5-year disease-free survival in the IPM and NPM groups was 73.6%, 56.2%, 49.7% and 71.6%, 49.4%, 40.3%, respectively (P = 0.366). On multivariable analysis, IPM was a favorable factor for overall survival (P = 0.035). Subgroup analysis showed that a clamp time of 16-30 min (P = 0.024) and cirrhotic patients with IPM (P = 0.009) had better overall survival. Conclusion IPM provided a better overall survival after hepatectomy for patients with HCC. Such survival benefit was noted in cirrhotic patients, and the beneficial duration of clamp was 16-30 min. Trial registration NCT00730743 and NCT01759901 (http://www.clinicaltrials.gov).

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Safety of intermittent Pringle maneuver during minimally invasive liver resection in patients with hepatocellular carcinoma with and without cirrhosis

Galindo

Haber

Benzing

et al. 2021

Langenbecks Arch Surg

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Purpose The aim of this study was to analyze the impact of minimally invasive intermittent Pringle maneuver (IPM) on postoperative outcomes in patients with hepatocellular carcinoma (HCC) and liver cirrhosis. Methods In this retrospective cohort study, we evaluated the safety of IPM in patients with HCC who underwent minimally invasive liver resection during five years at our center. Factors influencing the use of IPM were examined in univariate and multivariate regression analysis. Cases with use of IPM (IPM) and those without use of IPM (no IPM) were then compared regarding intraoperative and postoperative outcomes after propensity score matching (PSM) for surgical difficulty. Results One hundred fifty-one patients underwent liver resection for HCC at our center and met inclusion criteria. Of these, 73 patients (48%) received IPM with a median duration of 18 min (5–78). One hundred patients (66%) had confirmed liver cirrhosis. In multivariate analysis, patients with large tumors (≥ 3 cm) and difficult tumor locations (segments VII or VIII) were more likely to undergo IPM (OR 1.176, p = 0.043, and OR 3.243, p = 0.001, respectively). After PSM, there were no differences in intraoperative blood transfusion or postoperative complication rates between the IPM and no IPM groups. Neither did we observe any differences in the subgroup analysis for cirrhotic patients. Postoperative serum liver function tests were not affected by the use of IPM. Conclusions Based on our findings, we conclude that the use of IPM in minimally invasive liver resection is safe and feasible for patients with HCC, including those with compensated liver cirrhosis.

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Does Intermittent Pringle Maneuver Increase Postoperative Complications After Hepatectomy for Hepatocellular Carcinoma? A Randomized Controlled Trial

Abstract: ClinicalTrials.gov NCT01759901.

Cited by 27 publications

References 33 publications

Does the intermittent Pringle maneuver affect the recurrence following surgical resection for hepatocellular carcinoma? A systematic review

Does the intermittent Pringle maneuver affect the recurrence following surgical resection for hepatocellular carcinoma? A systematic review

Impact of Intermittent Pringle Maneuver on Long‐Term Survival After Hepatectomy for Hepatocellular Carcinoma: Result from Two Combined Randomized Controlled Trials

Safety of intermittent Pringle maneuver during minimally invasive liver resection in patients with hepatocellular carcinoma with and without cirrhosis

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