Pringle maneuver & prognosis

Continuous Pringle maneuver does not affect outcomes
of patients with hepatocellular carcinoma after curative
resection

Asia-Pacific Journal of Clinical Oncology 2017; 13: e321–e330

Aim: To investigate whether the use of continuous Pringle maneuver (PM) adversely impacts the outcome of patients with hepatocellular carcinoma (HCC).北京协和医院肝脏外科毛一雷
Methods: From January 1989 to January 2011, 586 HCC patients who underwent curative resection in Peking Union Medical College Hospital were identified from the database. Continuous PM was performed in 290 patients (PM group), including 163 patients with a hepatic inflow occlusion time of<15 min (PM-1 group) and 127 with 15–30 min (PM-2 group). An additional 296 patients underwent partial hepatectomy without inflow occlusion (occlusion-free, OF group).
Results: The PMgroup showed less estimated blood loss during hepatectomy than the OF group (P = 0.005)and the two groups experienced similar incidence of perioperative complications. There were no significant differences in either overall survival or disease-free survival (DFS) between the PMand OF groups (P = 0.117 and 0.291, respectively), and between the PM-1 and PM-2 groups (P=0.344 and 0.103, respectively).Hepatic inflow occlusion and occlusion time were not independent risk factors for OS or DFS.
Conclusions: Continuous PM effectively reduces intraoperative bleeding and does not adversely impact the outcomes of HCC patients. It remains a valuable tool in hepatic resection, even difficult, complicated resections requiring prolonged clamping times.