Abstract
Intermittent hepatic pedicle clamping (HPC) is often performed during hepatectomy. Whether it affects the long-term prognosis of hepatocellular carcinoma (HCC) patients is still controversial. This study evaluated the impact of HPC in patients with different stages of HCC. The study included 1401 patients who underwent hepatectomy in the primary cohort with 129 AJCC stage IIIB HCC patients; there were 80 AJCC stage IIIB HCC patients in the validation cohort. In each cohort, patients were placed in the long-term HPC (LTHPC) group or the short-term HPC (STHPC) group based on the cut-off time of HPC estimated by the receiver-operating characteristic (ROC) curve. Although HPC did not show significant effects on the prognosis of stage I–IIIA HCC patients in the primary cohort, 1−, 3−, and 5-year overall survival (OS) and recurrence-free survival (RFS) rates of stage IIIB HCC patients who received LTHPC (HPC time > 12 minutes) were significantly higher than those with STHPC (HPC time ≤ 12 minutes or received no HPC), similar in the validation cohort. Multivariate analysis demonstrated HPC time was an independent protective factor for RFS and OS in stage IIIB HCC patients. Herein, we report that proper HPC improved the postoperative prognosis of stage IIIB HCC patients and served as an independent protective factor.
Highlights
Primary liver cancer, 75–80% of which is hepatocellular carcinoma (HCC), is the fifth most common cancer and the second leading cause of cancer death in males worldwide [1]
We redistributed the patients into the short-term hepatic pedicle clamping group (STHPC group; HPC time ≤ 4 min or without HPC; n = 993) and the long-term hepatic pedicle clamping group (LTHPC group; HPC time > 4 min; n = 408)
In 2010, the Japan Society of Hepatology proposed that resection and transcatheter arterial chemoembolization (TACE) can be performed when there is portal invasion in HCC patients [19]
Summary
75–80% of which is hepatocellular carcinoma (HCC), is the fifth most common cancer and the second leading cause of cancer death in males worldwide [1]. Liver resection is still the main curative treatment for HCC patients [5,6,7]. Several animal studies reported that hepatic ischemia–reperfusion (I/R) injury due to hepatic pedicle clamping (HPC) caused accelerated tumour growth and promoted metastases [9,10,11,12]. Whether this is the case in HCC patients is still controversial, but intermittent HPC is widely used to reduce blood loss during hepatectomy [13]. Yang et al found that selective main portal vein occlusion could minimize the risk of recurrence after curative resection of HCC [15]
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