Abstract
Purpose: Pringle maneuver (PM) includes continuous PM, intermittent PM (IPM), prolonged PM and other different types of blocking blood flow. The impact of PM on tumor recurrence of hepatectomy in patients with colorectal cancer liver metastases (CRLM) remains controversial. The present study aimed to assess whether different types of PM have an adverse effect on the recurrence of CRLM. Methods: PubMed, Embase, Web of Science, and the Cochrane Library databases were searched. We registered the protocol at the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42020179534). The IPM is defined as the portal triad clamping for several min, followed by several min of reperfusion, repeated as needed. Prolonged PM was defined as ≥20 min continuous or ≥3 cycles for maximally 15-min intermittent ischemia. Results: Nine studies encompassing 3562 patients were included in this meta-analysis. The pooled HR did not show any significant difference between IPM and non-IPM groups for disease-free survival (DFS) (HR = 0.91, 95% CI 0.80–1.04, P = 0.18). The results showed significant differences between prolonged PM and non-PM groups for DFS (HR = 1.75, 95% CI 1.28–2.40, P = 0.0005) and 1-year DFS rate (odds ratio = 2.77, 95% CI 1.15–6.72, P = 0.02). Conclusion: These findings suggested that IPM has no effect on DFS, but prolonged PM has an adverse impact on the early recurrence of patients with CRLM; however, further prospective and multicenter studies are needed.
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