Does Pringle Maneuver Affect Survival in Patients with Colorectal Liver Metastases?
Corresponding Author
Alessandro Ferrero
Department of Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati, 62-10128 Turin, Italy
[email protected]Search for more papers by this authorNadia Russolillo
Department of Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati, 62-10128 Turin, Italy
Search for more papers by this authorLuca Viganò
Department of Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati, 62-10128 Turin, Italy
Search for more papers by this authorRoberto Lo Tesoriere
Department of Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati, 62-10128 Turin, Italy
Search for more papers by this authorAndrea Muratore
Department of Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati, 62-10128 Turin, Italy
Search for more papers by this authorLorenzo Capussotti
Department of Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati, 62-10128 Turin, Italy
Search for more papers by this authorCorresponding Author
Alessandro Ferrero
Department of Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati, 62-10128 Turin, Italy
[email protected]Search for more papers by this authorNadia Russolillo
Department of Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati, 62-10128 Turin, Italy
Search for more papers by this authorLuca Viganò
Department of Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati, 62-10128 Turin, Italy
Search for more papers by this authorRoberto Lo Tesoriere
Department of Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati, 62-10128 Turin, Italy
Search for more papers by this authorAndrea Muratore
Department of Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati, 62-10128 Turin, Italy
Search for more papers by this authorLorenzo Capussotti
Department of Surgery, Ospedale Mauriziano “Umberto I”, Largo Turati, 62-10128 Turin, Italy
Search for more papers by this authorAbstract
Background
The purpose of this original article was to evaluate the impact of the Pringle maneuver on the survival of patients with colorectal liver metastases.
Methods
Eighty patients with colorectal liver metastases were randomized to undergo hepatectomy with (39 patients, HPC group) or without (41 patients, NHPC group) pedicle clamping.
Results
The two groups were homogeneous. Mortality and morbidity rates were similar. Blood transfusions rates were higher in HPC group (p = 0.010). Median follow-up was 67.1 ± 20 months in the HPC group and 77.5 ± 16.6 months in the other group (p = 0.07). Overall survival at 1, 3, and 5 years was 100%, 86.1%, and 49.4% in HPC group vs. 92.6%, 65.8%, and 48.2% in NHPC group (p = 0.704). Disease-free survival was similar between the two groups: 1-, 3- and 5-year survival rates were 85.7%, 51.4%, and 34.3% in the HPC group vs. 84%, 51.5%, and 37.9% in NHPC group (p = 0.943). The incidence of hepatic recurrence was similar in the two groups (p = 0.506). Median time to hepatic recurrence was similar in the two groups (p = 0.482). Overall and disease-free survival rates were similar even when the Pringle maneuver was longer than 45 min (p = 0.571 and 0.948) and in patients with liver steatosis (p = 0.779 and 0.412).
Conclusions
The Pringle maneuver does not seem to affect the survival of patients with liver metastases.
References
- 1EkbergH, TranbergKG, AnderssonR et al. Major liver resection: perioperative course and management. Surgery (1986) 100: 1–83014674
- 2NagorneyDM, van HeerdenJA, IlstrupDM et al. Primary hepatic malignancy: surgical management and determinants of survival. Surgery (1989) 106: 740–7492799650
- 3YinXY, LaiPBS, LeeJFY et al. Effects of hepatic blood inflow occlusion on liver regeneration following partial hepatectomy in an experimental model of cirrhosis. Br J Surg (2000) 87: 1510–151510.1046/j.1365-2168.2000.01574.x11091238
- 4CardenDL, GrangerDN Pathophysiology of ischaemia-reperfusion injury. J Pathol (2000) 190: 255–26610.1002/(SICI)1096-9896(200002)190:3<255::AID-PATH526>3.0.CO;2-610685060
10.1002/(SICI)1096-9896(200002)190:3<255::AID-PATH526>3.0.CO;2-6 CAS PubMed Web of Science® Google Scholar
- 5JaeschkeH Molecular mechanisms of hepatic ischemia-reperfusion injury and preconditioning. Am J Physiol (2003) 284: G15–G26
- 6TeohNC, FarrellGC Hepatic ischemia reperfusion injury: pathogenic mechanisms and basis for hepatoprotection. J Gastroenterol Hepatol (2003) 18: 891–90210.1046/j.1440-1746.2003.03056.x12859717
- 7van der BiltJD, KranenburgO, NijkampMW et al. Ischemia/reperfusion accelerates the outgrowth of hepatic micrometastases in a highly standardized murine model. Hepatology (2005) 42: 165–17510.1002/hep.2073915962318
- 8van der BiltJD, KranenburgO, BorrenA, van HillegersbergR, Borel RinkesIH Ageing and hepatic steatosis exacerbate ischemia/reperfusion-accelerated outgrowth of colorectal micrometastases. Ann Surg Oncol (2008) 15: 1392–139810.1245/s10434-007-9758-018335279
- 9CapussottiL, MuratoreA, FerreroA, MassuccoP, RiberoD, PolastriR Randomized clinical trial of liver resection with and without hepatic pedicle clamping. Br J Surg (2006) 93: 685–68910.1002/bjs.530116703653
- 10BelghitiJ, CavienP-A, GadzijevE Terminology Committee of the International Hepato-Pancreato-Biliary Association et al. The Brisbane 2000 terminology of liver anatomy and resection. HPB (2000) 2: 333–339
10.1016/S1365-182X(17)30755-4 Google Scholar
- 11FongY, FortnerJ, SunRL et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg (1999) 230: 309–31810.1097/00000658-199909000-0000410493478
- 12AdamR, DelvartV, PascalG et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg (2004) 240: 644–65710.1097/01.sla.0000145964.08365.0115383792
- 13ErcolaniG, GraziGL, RavaioliM et al. Liver resection for multiple colorectal metastases: influence of parenchymal involvement and total tumor volume, vs number or location, on long-term survival. Arch Surg (2002) 137: 1187–119210.1001/archsurg.137.10.118712361432
- 14IwatsukiS, DvorchikI, MadariagaJR et al. Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system. J Am Coll Surg (1999) 189: 291–29910.1016/S1072-7515(99)00089-710472930
- 15SchindlM, WigmoreSJ, CurrieEJ et al. Prognostic scoring in colorectal cancer liver metastases: development and validation. Arch Surg (2005) 140: 183–18910.1001/archsurg.140.2.18315724001
- 16BuellJF, KoffronA, YoshidaA et al. Is any method of vascular control superior in hepatic resection of metastatic cancers? Longmire clamping, Pringle maneuver, and total vascular isolation. Arch Surg (2000) 136: 569–575
10.1001/archsurg.136.5.569 Google Scholar
- 17WongKH, HamadyZZ, MalikHZ et al. Intermittent Pringle manoeuvre is not associated with adverse long-term prognosis after resection for colorectal liver metastases. Br J Surg (2008) 95: 985–98910.1002/bjs.612918563791
- 18KoobyDA, StockmanJ, Ben-PoratL et al. Influence of transfusion on perioperative and long-term outcome in patients following hepatic resection for colorectal metastasis. Ann Surg (2003) 237: 860–86910.1097/00000658-200306000-0001512796583
- 19NaginoM, AraiT, NishioH et al. One hundred consecutive hepatobiliary resection for biliary hilar malignancy: preoperative blood donation, blood loss, transfusion, and outcome. Surgery (2005) 137: 148–15510.1016/j.surg.2004.06.00615674194
- 20de BoerMT, MolenaarIQ, PorteRJ Impact of blood loss on outcome after liver resection. Dig Surg (2007) 24: 259–26410.1159/00010365617657150
- 21PoonRT, FanST, LoCM et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg (2004) 240: 698–70815383797
- 22GurusamyKS, ShethH, KumarY et al. Methods of vascular occlusion for elective liver resections. Cochrane Database Syst Rev (2009) 21(1): CD007632
- 23CapussottiL, NuzzoG, PolastriR et al. Continuous versus intermittent portal triad clamping during hepatectomy in cirrhosis. Results of a prospective, randomized clinical trial. Hepatogastroenterology (2003) 52: 1073–1077
- 24BelghitiJ, NounR, MalafosseR et al. Continuous versus intermittent portal triad clamping for liver resection: a controlled study. Ann Surg (1999) 229: 369–37510.1097/00000658-199903000-0001010077049
- 25KimuraN, MuraokaR, HoriuchiT et al. Intermittent hepatic pedicle clamping reduces liver and lung injury. J Surg Res (1998) 78: 11–1710.1006/jsre.1998.53119733610
- 26UchinamiM, MuraokaR, HoriuchiT et al. Effect of intermittent hepatic pedicle clamping on free radical generation in the rat liver. Surgery (1998) 124: 49–569663251
- 27HoriuchiT, MuraokaR, TaboT et al. Optimal cycles of hepatic ischemia and reperfusion for intermittent pedicle clamping during liver surgery. Arch Surg (1995) 130: 754–7587611865
- 28LiuDL, JeppssonB, HakanssonCH et al. Multiple-system organ damage resulting from prolonged hepatic inflow interruption. Arch Surg (1996) 1131: 442–447
10.1001/archsurg.1996.01430160100022 Google Scholar
- 29MartiHJ, BernaudinM, BellailA et al. Hypoxia induced vascular endothelial growth factor expression precedes neovascularization after cerebral ischemia. Am J Pathol (2000) 156: 965–97610702412
- 30KhanZ, MichalopoulosGK, StolzDB Peroxisomal localization of hypoxia inducible factors and hypoxia-inducible factor regulatory hydroxylases in primary rat hepatocytes exposed to hypoxia-reoxygenation. Am J Pathol (2006) 169: 1251–126910.2353/ajpath.2006.06036017003483
- 31CarmelietP, DorY, HerbertJM et al. Role of HIF-1alpha in hypoxia-mediated apoptosis, cell proliferation and tumour angiogenesis. Nature (1998) 394: 485–49010.1038/288679697772
- 32PughCW, RatcliffePJ Regulation of angiogenesis by hypoxia: role of the HIF system. Nat Med (2003) 9: 677–68410.1038/nm0603-67712778166
- 33MaxwellPH The HIF pathway in cancer. Semin Cell Dev Biol (2005) 16: 523–53010.1016/j.semcdb.2005.03.00116144689
- 34Brahimi-HornC, PouyssegurJ The role of the hypoxia-inducible factor in tumor metabolism growth and invasion. Bull Cancer (2006) 93: E73–E8016935775
- 35HinesIN, HoffmanJM, ScheerensH et al. Regulation of postischemic liver injury following different durations of ischemia. Am J Physiol Gastrointest Liver Physiol (2003) 284: G536–G54512444015
- 36Le CouteurDG, RivoryLP, PondSM The effects of aging and nutritional state on hypoxia-reoxygenation injury in the perfused rat liver. Transplantation (1994) 58: 531–53610.1097/00007890-199409150-000018091478
- 37HigashiyamaA, WatanabeH, OkumuraK et al. Involvement of tumor necrosis factor alpha and very late activation antigen 4/vascular cell adhesion molecule 1 interaction in surgical-stress-enhanced experimental metastasis. Cancer Immunol Immunother (1996) 42: 231–23610.1007/s0026200502758665570
- 38AnasagastiMJ, AlvarezA, MartinJJ et al. Sinusoidal endothelium release of hydrogen peroxide enhances very late antigen-4-mediated melanoma cell adherence and tumor cytotoxicity during interleukin-1 promotion of hepatic melanoma metastasis in mice. Hepatology (1997) 25: 840–84610.1002/hep.5102504109096586
- 39Vidal-VanaclochaF, AlvarezA, AsumendiA et al. Interleukin 1 (IL-1)-dependent melanoma hepatic metastasis in vivo; increased endothelial adherence by IL-1-induced mannose receptors and growth factor production in vitro. J Natl Cancer Inst (1996) 88: 198–20510.1093/jnci/88.3-4.1988632494
- 40Vidal-VanaclochaF, AmezagaC, AsumendiA et al. Interleukin-1 receptor blockade reduces the number and size of murine B16 melanoma hepatic metastases. Cancer Res (1994) 54: 2667–26728168095
- 41BelghitiJ, NounR, MalafosseR et al. Continuous versus intermittent portal triad clamping for liver resection. A controlled study. Ann Surg (1999) 229: 369–37510.1097/00000658-199903000-0001010077049
- 42ClavienPA, SelznerM, RüdigerHA et al. A prospective randomized study in 100 consecutive patients undergoing major liver resection with versus without ischemic preconditioning. Ann Surg (2003) 238: 843–85210.1097/01.sla.0000098620.27623.7d14631221