Effect Of Pringle Maneuver Time On Postoperative Recurrence Of Primary Liver Cancer

Background and Aims:Primary liver cancer is one of the most common cancers in the world.It has been ranked at second for the cause of cancer related death in China.Liver resection is considered as the best therapeutic strategy for prime liver cancer,but the recurrence rate is still very high with very poor prognosis,despite the improvement of surgical skills in recent years.Recent clinical studies have shown that 3 years postoperative recurrence rate of hepatocellular carcinoma is about 40%-50%,5 years recurrence rate is 60-70%,the overall survival rate is only 20-50%.Therefore,how to do to prevent or avoid the recurrence of liver cancer post surgery is becoming a new challenge in the field.Pringle Maneuver is an effective method which commonly be used to block hepatic inflow blood during hepatectomy.Although it can significantly reduce intraoperative blood loss,however,this technique inevitably leads to liver ischemic reperfusion injury(IRI)and damage the capacity of liver regeneration.Experimental studies have shown that IRI palys an important role in the migration,adhesion,colonization of residual tumor cells,which closely related to the recurrence and metastasis of hepatocellular carcinoma.With prolonged Pringle Maneuver time,liver IRI is getting worse.The influence of Pringle Maneuver time on tumor recurrence has not been clearly studied.Therefore,we conducted a retrospective study of the 120 patients who underwent curative resection of primary liver cancer in recent five years from our center and to analyze the effects of Pringle Maneuver on the recurrence of liver cancer post operatively,as well as the patient overall survival rate and tumor-free survival time.Materials and Methods:In this retrospective study,we enrolled 120 cases of liver cancer patients who underwent curative hepatectomy in China-Japan Union Hospital of Jilin University from January 2010 to October 2014.We collected and organized the data such as Pringle Maneuver time,recurrence free survival time,overall survival time,and other prognostic factors.The statistics were analyzed by SPSS 19.0 software.Results:Total 120 patients who were diagnosed with primary liver cancer and underwent resection were enrolled,96 patients were males and 24 were females.Ages were between 20 to 73 years old.The average age of the patients was 54 years old.82 cases underwent Pringle Maneuver operation and 38 cases didn't.There were 43 cases which Pringle Maneuver time ? 15 minutes and 39 cases > 15 minutes.75 cases were discovered postoperative tumor recurrence.Pringle maneuver time of greater than 15 minutes was considered an independent predictor of liver cancer recurrence(P<0.001).Whereas Pringle Maneuver was less than 15 minutes had no significant effect on liver cancer recurrence.The patients who underwent the Pringle maneuver for over 15 minutes had lower overall survival and tumor-free survival rate than those who either did not undergo the Pringle maneuver or the Pringle maneuver time was less than 15 minutes.Conclusions:Extended Pringle Maneuver time increase the risk of postoperative tumor recurrence in patients with primary liver cancer.