Liver resection for colorectal liver metastases: risk of recurrence from liver-first approach associated with pringles manoeuvre

Abstract

Background: Animal studies have previously demonstrated that hepatic ischaemia reperfusion injury induces the expression of adhesion molecules which promote colorectal liver metastasis. However, no association has been identified between the Pringle manoeuvre and recurrence risk in clinical studies. We aim to investigate the risk of metastatic recurrence due to hepatic ischaemia reperfusion injury in liver-first resections which more closely resemble animal models of colorectal liver metastases. Methods: This study included patients undergoing liver-first resections for synchronous colorectal liver metastases between 2012 and 2016. Demographic, oncological, operative and follow up data were retrospectively collected from medical records. Results: Twenty patients were included in this study and were divided into two groups: Patients in the PM+ group (n=8) were subjected to inflow clamping at the time of liver resection while those in the PM- group (n=12) were not. No significant differences were noted between the two groups in demographics, tumour features, adjuvant therapy or operative procedure. Recurrence after liver resection was demonstrated in 87.5% and 50% of cases in group PM+ and PM- respectively (P=0.15). The 2-year recurrence-free survival was 12.5% in the PM+ group (versus 33.6% in the PM- group; Log rank P=0.6). Conclusion: We could not demonstrate any increased risk of recurrence as a result of the Pringle manoeuvre during liver-first resections. This may be due to the small sample size in this study.