Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun 1;13(3):412-424.
doi: 10.21037/hbsn-23-7. Epub 2023 Jul 5.

Association of Pringle maneuver with postoperative recurrence and survival following hepatectomy for hepatocellular carcinoma: a multicenter propensity score and competing-risks regression analysis

Shi-Chuan Tang #  1 , Yong-Kang Diao #  2 , Kong-Ying Lin #  1 , Chao Li #  2 , Xiao Xu  3 , Lei Liang  4 , Jie Kong  5 , Qing-Jing Chen  1 , Xian-Ming Wang  6 , Fu-Bao Liu  7 , Wei-Min Gu  8 , Ya-Hao Zhou  9 , Ying-Jian Liang  10 , Hong-Zhi Liu  1 , Ming-Da Wang  2 , Lan-Qing Yao  2 , Timothy M Pawlik  11 , Feng Shen  2 , Wan Yee Lau  2   12 , Tian Yang  1   2   4 , Yong-Yi Zeng  1   13   14
Affiliations

Association of Pringle maneuver with postoperative recurrence and survival following hepatectomy for hepatocellular carcinoma: a multicenter propensity score and competing-risks regression analysis

Shi-Chuan Tang et al. Hepatobiliary Surg Nutr. .

Abstract

Background: The application of Pringle maneuver (PM) during hepatectomy reduces intraoperative blood loss and the need for perioperative transfusion, but its effect on long-term recurrence and survival for patients with hepatocellular carcinoma (HCC) remains controversial. We sought to determine the association between the application of PM and post-hepatectomy oncologic outcomes for patients with HCC.

Methods: Patients who underwent curative hepatectomy for HCC at 9 Chinese hospitals from January 2010 to December 2018 were identified. Using two propensity score methods [propensity score matching (PSM) and inverse probability of treatment weight (IPTW)], cumulative recurrence rate and cancer-specific mortality (CSM) were compared between the patients in the PM and non-PM groups. Multivariate competing-risks regression models were performed to adjust for the effect of non-cancer-specific mortality and other prognostic risk factors.

Results: Of the 2,798 included patients, 2,404 and 394 did and did not adopt PM (the PM and non-PM groups), respectively. The rates of intraoperative blood transfusion, postoperative 30-day mortality and morbidity were comparable between the two groups (all P>0.05). In the PSM cohort by the 1:3 ratio, compared to 382 patients in the non-PM group, 1,146 patients in the PM group also had the higher cumulative 5-year recurrence rate and CSM (63.9% and 39.1% vs. 55.3% and 31.6%, both P<0.05). Similar results were also yielded in the entire cohort and the IPTW cohort. Multivariate competing-risks regression analyses demonstrated that no application of the PM was independently associated with lower recurrence rate and CSM based on various analytical cohorts [hazard ratio (HR), 0.82 and 0.77 in the adjusted entire cohort, HR 0.80 and 0.73 in the PSM cohort, and HR 0.80 and 0.76 in the IPTW cohort, respectively].

Conclusions: The findings suggested that no application of PM during hepatectomy for patients with HCC reduced the risk of postoperative recurrence and cancer-specific death by approximately 20-25%.

Keywords: Hepatocellular carcinoma (HCC); Pringle maneuver (PM); hepatectomy; recurrence; survival.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-23-7/coif). T.M.P. serves as an unpaid Deputy Editor-in-Chief of Hepatobiliary Surgery and Nutrition. T.Y. serves as an unpaid editorial board member of Hepatobiliary Surgery and Nutrition. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Cumulative recurrence rate curves between patients with and without the application of PM. (A) CRR in the entire cohort; (B) CRR in the PSM cohort; (C) CRR in the IPTW cohort. PM, Pringle maneuver; CRR, cumulative recurrence rate; PSM, propensity score matching; IPTW, inverse probability of treatment weight.
Figure 2
Figure 2
Cancer-specific mortality curves between patients with and without the application of PM. (A) CSM in the entire cohort; (B) CSM in the PSM cohort; (C) CSM in the IPTW cohort. PM, Pringle maneuver; CSM, cancer-specific mortality; PSM, propensity score matching; IPTW, inverse probability of treatment weight.
See this image and copyright information in PMC

References

    1. Llovet JM, Kelley RK, Villanueva A, et al. Hepatocellular carcinoma. Nat Rev Dis Primers 2021;7:6. 10.1038/s41572-020-00240-3 - DOI - PubMed
    1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin 2016;66:115-32. 10.3322/caac.21338 - DOI - PubMed
    1. Gunasekaran G, Bekki Y, Lourdusamy V, et al. Surgical Treatments of Hepatobiliary Cancers. Hepatology 2021;73 Suppl 1:128-36. 10.1002/hep.31325 - DOI - PubMed
    1. Vibert E, Schwartz M, Olthoff KM. Advances in resection and transplantation for hepatocellular carcinoma. J Hepatol 2020;72:262-76. 10.1016/j.jhep.2019.11.017 - DOI - PubMed
    1. Kamiyama T, Nakanishi K, Yokoo H, et al. Perioperative management of hepatic resection toward zero mortality and morbidity: analysis of 793 consecutive cases in a single institution. J Am Coll Surg 2010;211:443-9. 10.1016/j.jamcollsurg.2010.06.005 - DOI - PubMed