Prognosis Of Continuous Pringle Maneuver After Hepatectomy For Patients With Hepatocellular Carcinoma

Backgrounds: Hepatocellular Carcinoma is the most common liver malignancy,liver resection remains the most used “curative” treatment for patients with hepatocellular carcinoma.However,massive blood loss during liver resection often difficult to control,heavy bleeding and blood transfusion has been shown to negatively impact on patients' outcomes.Continuous Pringle maneuver(PM)is often used to reduce blood loss and transfusion requirements during liver resection.The impact of continuous PM on short-term and long-term outcomes after hepatectomy for hepatocellular carcinoma(HCC)has been debated.Research has shown that continuous Pringle maneuver does not adversely impact the outcomes of HCC patients,but there are also research shown that longer duration of the Pringle maneuver increases the risk of tumor recurrence in patients with HCC.Objective: The study aim to evaluate the prognosis of continuous PM after hepatectomy for patients with HCC.The conclusions obtained will provide guidance for whether perform continuous Pringle maneuver in the future hepatectomy.Methods: Patients who underwent radical liver resection for HCC from January 2012 to January 2015 at the first affiliated hospital of An Hui Medical University were identified from a large retrospective databases.Patients were then divided into two groups(no-PM group,PM group)based on the use of the continuous PM or not during liver resection,the continuous further divided into two subgroups(PM-1 group,PM-2 group)according to the PM time>15min.Primary outcomes of short-term were postoperative liver function and complications while the long-term outcomes were overall survival(OS)and disease-free survival(DFS).Results: This study included 250 patients.Of these,100 patients did not undergo PM(no-PM group),104 patients underwent continuous PM?15min(PM-1 group),and 46 patients underwent continuous PM>15min(PM-2 group).The PM group showed less estimated blood loss(P<0.001)and blood transfusion requirement(P=0.010)than the no-PM group and no difference in postoperative complication rate between these two groups.The ALT and AST levels of the PM group were higher and had decreased lower than no-PM group.There was no significant difference in overall survival(OS)(P=0.185)and disease-free survival(DFS)(P=0.086)between no-PM group and PM group,while the PM-1 group and PM-2 group also did not show significant difference in postoperative complication rate and the ALT and AST levels and OS and DFS(P=0.454 and 0.559,respectively).Conclusions: The results suggest that PM increases the recovery time of liver function,but does not increase the risk of hepatocellular carcinoma recurrence or decrease long-term survival.It is recommended to use continuous Pringle maneuver when necessary during liver resection.