Abstract
The use of the Pringle maneuver (PM) varies widely among surgical departments. Its use depends on the operator and type of liver resection. The aim of this study was to determine the impact of the PM on patient outcomes when undergoing major liver resections. This retrospective study comprised 179 colorectal liver metastasis patients from two liver centers from Leeds and Warsaw. Only right or right extended hepatectomies with negative oncological margins were included. The primary outcome measure was the 5-year overall survival (OS). The PM was applied during 60 (33.5%) major hepatectomies included in the study and was associated with a higher peak 3-day postoperative bilirubin concentration (p = 0.002), yet not with the peak 3-day alanine aminotransferase activity (p = 0.415). The 5-year OS after liver resections with the PM and without the PM were 55.0% and 33.4%, respectively (p = 0.019). Following stratification by the Tumor Burden Score, after resections with the use of the PM, superior survival was particularly found in the subgroup of patients at intermediate risk of recurrence (p = 0.004). However, the use of the PM had no significant effect on the 5-year overall survival following adjustment for the confounding effect of the carcinoembryonic antigen concentration (p = 0.265). The use of the PM had no negative effects on the long-term outcomes in patients undergoing major, oncologically radical liver resections for colorectal metastases.
Highlights
Liver resection is the most effective method of treatment of patients with resectable primary cancers and metastatic liver tumors
The ischemia-reperfusion injury (IRI) is caused by a rapid inflow of blood to the previously ischemic liver, which results in impaired microcirculation and damage to hepatocytes and stimulates the synthesis of inflammatory mediators [5]
The study cohort was selected from a group of a total of 505 patients who underwent major liver resection between January 2009 and December 2013 at Warsaw’s (259 patients) and Leeds’ units
Summary
Liver resection is the most effective method of treatment of patients with resectable primary cancers and metastatic liver tumors. Despite the usefulness of these techniques during resection procedures and the relative safety of stopping the hepatic inflow, occlusion of blood flow to the liver and its subsequent restoration causes ischemia-reperfusion injury (IRI) [4]. The IRI is caused by a rapid inflow of blood to the previously ischemic liver, which results in impaired microcirculation and damage to hepatocytes and stimulates the synthesis of inflammatory mediators [5]. All these factors may represent one of the main causes of post-hepatectomy liver failure and potentially increase the risk of postoperative cancer recurrence [6,7]
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