Background Hepatic pedicle clamping (HPC) during Liver Resection (LR) is a vascular procedure designed to prevent bleeding from the liver during hepatectomy. Outgrowth of pre-existing colorectal micrometastases may occur 5-6 times faster in occluded liver lobes than in non-occluded lobes. We conducted a case-matched analysis at our Institution to assess the effects of HPC on overall and recurrence-free survival in highly selected patients, who underwent LR due to Colorectal liver metastases (CLM). Materials and methods From January 2002 to December 2010, 120 patients operated for CLM were included into this case-matched study. Patients were allocated to two groups: Group-A patients who underwent HPC during LR; Group-B patients who underwent LR without HPC. Results HPC during liver resection was associated with better overall patient 5-year survival (47.2% in Group-A and 32.1% in Group-B) (P-value = 0.06), and significantly better 5-year recurrence-free survival (49.9% in Group-A vs 18.3% in Group-B) (P-value = 0.010) The Cox regression model identified the following risk factors for worse prognosis in terms of shorter recurrence-free survival and higher incidence of tumor recurrence: no HPC (Group-B) (P-value = 0.032) and positive lymph nodes at the time of LR (P-value = 0.018). Conclusion Lack of HPC in selected patients who underwent LR for CLM results to be a strong independent risk factor for higher patient exposure to tumor recurrence. We suggest that hepatic hilum clamping should be seriously taken into consideration in this patient setting. Mini-abstract A case-matched study was performed in 120 patients undergoing liver resection due to colorectal liver metastases, comparing patients who received intermittent hepatic pedicle clamping (HPC) with those who did not. The 5-year overall survival rate was similar, but the 5-year recurrence-free rate was significantly higher with no HPC (p = 0.012). © 2013 Elsevier Ltd. All rights reserved

DE CARLIS, L., Di Sandro, S., Giacomoni, A., Mihaylov, P., Lauterio, A., Mangoni, I., et al. (2013). Colorectal liver metastases: Hepatic pedicle clamping during hepatectomy reduces the incidence of tumor recurrence in selected patients. Case-matched analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY, 39(7), 726-733 [10.1016/j.ejso.2013.03.015].

Colorectal liver metastases: Hepatic pedicle clamping during hepatectomy reduces the incidence of tumor recurrence in selected patients. Case-matched analysis

DE CARLIS, LUCIANO GREGORIO
Primo
;
Lauterio, A;BENCARDINO, KATIA BRUNA
Ultimo
2013

Abstract

Background Hepatic pedicle clamping (HPC) during Liver Resection (LR) is a vascular procedure designed to prevent bleeding from the liver during hepatectomy. Outgrowth of pre-existing colorectal micrometastases may occur 5-6 times faster in occluded liver lobes than in non-occluded lobes. We conducted a case-matched analysis at our Institution to assess the effects of HPC on overall and recurrence-free survival in highly selected patients, who underwent LR due to Colorectal liver metastases (CLM). Materials and methods From January 2002 to December 2010, 120 patients operated for CLM were included into this case-matched study. Patients were allocated to two groups: Group-A patients who underwent HPC during LR; Group-B patients who underwent LR without HPC. Results HPC during liver resection was associated with better overall patient 5-year survival (47.2% in Group-A and 32.1% in Group-B) (P-value = 0.06), and significantly better 5-year recurrence-free survival (49.9% in Group-A vs 18.3% in Group-B) (P-value = 0.010) The Cox regression model identified the following risk factors for worse prognosis in terms of shorter recurrence-free survival and higher incidence of tumor recurrence: no HPC (Group-B) (P-value = 0.032) and positive lymph nodes at the time of LR (P-value = 0.018). Conclusion Lack of HPC in selected patients who underwent LR for CLM results to be a strong independent risk factor for higher patient exposure to tumor recurrence. We suggest that hepatic hilum clamping should be seriously taken into consideration in this patient setting. Mini-abstract A case-matched study was performed in 120 patients undergoing liver resection due to colorectal liver metastases, comparing patients who received intermittent hepatic pedicle clamping (HPC) with those who did not. The 5-year overall survival rate was similar, but the 5-year recurrence-free rate was significantly higher with no HPC (p = 0.012). © 2013 Elsevier Ltd. All rights reserved
Articolo in rivista - Articolo scientifico
Colorectal liver metastases; Hepatic pedicle clamping; Liver resection; Adult; Aged; Aged, 80 and over; Analysis of Variance; Case-Control Studies; Colorectal Neoplasms; Constriction; Disease-Free Survival; Female; Hepatectomy; Humans; Incidence; Intraoperative Care; Italy; Liver Neoplasms; Male; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Patient Selection; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Survival Analysis; Young Adult; Oncology; Surgery
English
2013
39
7
726
733
none
DE CARLIS, L., Di Sandro, S., Giacomoni, A., Mihaylov, P., Lauterio, A., Mangoni, I., et al. (2013). Colorectal liver metastases: Hepatic pedicle clamping during hepatectomy reduces the incidence of tumor recurrence in selected patients. Case-matched analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY, 39(7), 726-733 [10.1016/j.ejso.2013.03.015].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/101019
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