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. 2020 Dec 29;13(1):72.
doi: 10.3390/cancers13010072.

Prognostic Impact of Pedicle Clamping during Liver Resection for Colorectal Metastases

Tobias S Schiergens  1 , Moritz Drefs  1 , Maximilian Dörsch  1 , Florian Kühn  1 , Markus Albertsmeier  1 , Hanno Niess  1 , Markus B Schoenberg  1 , Matthias Assenmacher  2 , Helmut Küchenhoff  2 , Wolfgang E Thasler  1 , Markus O Guba  1 , Martin K Angele  1 , Markus Rentsch  1 , Jens Werner  1 , Joachim Andrassy  1
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Prognostic Impact of Pedicle Clamping during Liver Resection for Colorectal Metastases

Tobias S Schiergens et al. Cancers (Basel). .

Abstract

Pedicle clamping (PC) during liver resection for colorectal metastases (CRLM) is used to reduce blood loss and allogeneic blood transfusion (ABT). The effect on long-term oncologic outcomes is still under debate. A retrospective analysis of the impact of PC on ABT-demand regarding overall (OS) and recurrence-free survival (RFS) in 336 patients undergoing curative resection for CRLM was carried out. Survival analysis was performed by both univariate and multivariate methods and propensity-score (PS) matching. PC was employed in 75 patients (22%). No increased postoperative morbidity was monitored. While the overall ABT-rate was comparable (35% vs. 37%, p = 0.786), a reduced demand for more than two ABT-units was observed (p = 0.046). PC-patients had better median OS (78 vs. 47 months, p = 0.005) and RFS (36 vs. 23 months, p = 0.006). Multivariate analysis revealed PC as an independent prognostic factor for OS (HR = 0.60; p = 0.009) and RFS (HR = 0.67; p = 0.017). For PC-patients, 1:2 PS-matching (N = 174) showed no differences in the overall ABT-rate compared to no-PC-patients (35% vs. 40%, p = 0.619), but a trend towards reduced transfusion requirement (>2 ABT-units: 9% vs. 21%, p = 0.052; >4 ABT-units: 2% vs. 11%, p = 0.037) and better survival (OS: 78 vs. 44 months, p = 0.088; RFS: 36 vs. 24 months; p = 0.029). Favorable long-term outcomes and lower rates of increased transfusion demand were observed in patients with PC undergoing resection for CRLM. Further prospective evaluation of potential oncologic benefits of PC in these patients may be meaningful.

Keywords: Pringle; blood loss; colorectal liver metastasis; pedicle clamping; transfusion.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overall survival (OS) and recurrence-free survival (RFS) of the entire cohort depending on the employment of pedicle clamping (PC).
Figure 2
Figure 2
Propensity-score (PS) adjusted overall survival (PS-OS) and recurrence-free survival (PS-RFS) depending on the employment of pedicle clamping (PC).
See this image and copyright information in PMC

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References

    1. Cooper G.S., Yuan Z., Landefeld C.S., Johanson J.F., Rimm A.A. A national population-based study of incidence of colorectal cancer and age: Implications for screening in older Americans. Cancer. 1995;75:775–781. doi: 10.1002/1097-0142(19950201)75:3<775::AID-CNCR2820750305>3.0.CO;2-D. - DOI - PubMed
    1. Brown R.E., Bower M.R., Martin R.C. Hepatic resection for colorectal liver metastases. Surg. Clin. 2010;90:839–852. doi: 10.1016/j.suc.2010.04.012. - DOI - PubMed
    1. Quan D., Gallinger S., Nhan C., Auer R.A., Biagi J.J., Fletcher G.G., Law C.H., Moulton C.A., Ruo L., Wei A.C., et al. The role of liver resection for colorectal cancer metastases in an era of multimodality treatment: A systematic review. Surgery. 2012;151:860–870. doi: 10.1016/j.surg.2011.12.018. - DOI - PubMed
    1. Schiergens T.S., von Einem J., Thomas M.N., Albertsmeier M., Giessen-Jung C., Dörsch M., Heiliger C., Drefs M., Andrassy J., Modest D.P., et al. Multidisciplinary treatment of colorectal liver metastases. Minerva Med. 2017;108:527–546. doi: 10.23736/S0026-4806.17.05371-X. - DOI - PubMed
    1. Jones R.P., Kokudo N., Folprecht G., Mise Y., Unno M., Malik H.Z., Fenwick S.W., Poston G.J. Colorectal liver metastases: A critical review of state of the art. Liver Cancer. 2016;6:66–71. doi: 10.1159/000449348. - DOI - PMC - PubMed

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