Impact of intermittent portal clamping on the early recurrence of hepatocellular carcinoma after surgery.

Abstract

To evaluate the impact of intermittent portal clamping (IPC) during surgery on the early recurrence of hepatocellular carcinoma (HCC). The subjects of this retrospective study were 266 patients who underwent curative liver resection for HCC. The patients were grouped as follows: an intermittent portal clamping (IPC) group, n=78; a continuous portal clamping (CPC) group, n=128; and a non-portal clamping (NPC) group, n=60. The median recurrence-free interval within 2years of follow-up was significantly shorter in the IPC group (14.2±4.6months) than in the CPC group (18.0±4.8months, P=0.008) or the NPC group (19.04±4.1months, P=0.023). Moreover, 2-year recurrence-free survival was much lower in the IPC group than in the CPC group (63.6 vs. 75.8%, P=0.025) or the NPC group (63.6 vs. 78.0%, P=0.030). However, the 2-year OS rate among the three groups was comparable (72.7 vs. 79.9%; P=0.101) and 83.1%, (P=0.125). According to univariable analysis, tumor size (>5cm), tumor number (≥2), tumor grade (low/undifferentiated), TNM stage (III), vascular infiltration, blood transfusion, and IPC were significantly associated with the early postoperative recurrence of HCC. After multivariate analysis, significance of tumor grade (low/undifferentiated) and TNM stage (III) disappeared, whereas tumor size (>5cm), tumor number (≥2), vascular infiltration, blood transfusion, and IPC remained significant. IPC is an independent risk factor for the early recurrence of HCC after surgery.