Safety of intermittent Pringle maneuver during minimally invasive liver resection in patients with hepatocellular carcinoma with and without cirrhosis View Full Text


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Article Info

DATE

2021-11-17

AUTHORS

Santiago A. Ortiz Galindo, Philipp K. Haber, Christian Benzing, Felix Krenzien, Anna Riddermann, Oliver Frisch, Wenzel Schöning, Moritz Schmelzle, Johann Pratschke, Linda Feldbrügge

ABSTRACT

PurposeThe aim of this study was to analyze the impact of minimally invasive intermittent Pringle maneuver (IPM) on postoperative outcomes in patients with hepatocellular carcinoma (HCC) and liver cirrhosis.MethodsIn this retrospective cohort study, we evaluated the safety of IPM in patients with HCC who underwent minimally invasive liver resection during five years at our center. Factors influencing the use of IPM were examined in univariate and multivariate regression analysis. Cases with use of IPM (IPM) and those without use of IPM (no IPM) were then compared regarding intraoperative and postoperative outcomes after propensity score matching (PSM) for surgical difficulty.ResultsOne hundred fifty-one patients underwent liver resection for HCC at our center and met inclusion criteria. Of these, 73 patients (48%) received IPM with a median duration of 18 min (5–78). One hundred patients (66%) had confirmed liver cirrhosis. In multivariate analysis, patients with large tumors (≥ 3 cm) and difficult tumor locations (segments VII or VIII) were more likely to undergo IPM (OR 1.176, p = 0.043, and OR 3.243, p = 0.001, respectively). After PSM, there were no differences in intraoperative blood transfusion or postoperative complication rates between the IPM and no IPM groups. Neither did we observe any differences in the subgroup analysis for cirrhotic patients. Postoperative serum liver function tests were not affected by the use of IPM.ConclusionsBased on our findings, we conclude that the use of IPM in minimally invasive liver resection is safe and feasible for patients with HCC, including those with compensated liver cirrhosis. More... »

PAGES

235-244

References to SciGraph publications

  • 2020-06-01. Pringle Maneuver in Extended Liver Resection: A propensity score analysis in SCIENTIFIC REPORTS
  • 2019-08-13. Effect of the intermittent Pringle maneuver on liver damage after hepatectomy: a retrospective cohort study in WORLD JOURNAL OF SURGICAL ONCOLOGY
  • 2021-06-02. Safety and feasibility of robotic liver resection after previous abdominal surgeries in SURGICAL ENDOSCOPY
  • 2019-08-16. Impact of Intermittent Pringle Maneuver on Long-Term Survival After Hepatectomy for Hepatocellular Carcinoma: Result from Two Combined Randomized Controlled Trials in WORLD JOURNAL OF SURGERY
  • 2018-02-07. Intermittent Pringle Versus Continuous Half-Pringle Maneuver for Laparoscopic Liver Resections of Tumors in Segment 7 in INDIAN JOURNAL OF SURGERY
  • 2018-06-25. A novel very simple laparoscopic hepatic inflow occlusion apparatus for laparoscopic liver surgery in SURGICAL ENDOSCOPY
  • 2020-04-28. A propensity-matched study of full laparoscopic versus hand-assisted minimal-invasive liver surgery in SURGICAL ENDOSCOPY
  • 2005-10-05. Evaluation of Effect of Hemihepatic Vascular Occlusion and the Pringle Maneuver during Hepatic Resection for Patients with Hepatocellular Carcinoma and Impaired Liver Function in WORLD JOURNAL OF SURGERY
  • 2020-07-01. Laparoscopic liver resection: indications, limitations, and economic aspects in LANGENBECK'S ARCHIVES OF SURGERY
  • 2018-10-30. Early Morbidity and Mortality after Minimally Invasive Liver Resection for Hepatocellular Carcinoma: a Propensity-Score Matched Comparison with Open Resection in JOURNAL OF GASTROINTESTINAL SURGERY
  • 2020-04-09. Minimally Invasive Versus Open Liver Resection for Hepatocellular Carcinoma in the Setting of Portal Vein Hypertension: Results of an International Multi-institutional Analysis in ANNALS OF SURGICAL ONCOLOGY
  • 2018-04-25. Does Intermittent Pringle Maneuver Increase Postoperative Complications After Hepatectomy for Hepatocellular Carcinoma? A Randomized Controlled Trial in WORLD JOURNAL OF SURGERY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00423-021-02361-z

    DOI

    http://dx.doi.org/10.1007/s00423-021-02361-z

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1142633024

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/34787706


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    25 schema:description Abstract PurposeThe aim of this study was to analyze the impact of minimally invasive intermittent Pringle maneuver (IPM) on postoperative outcomes in patients with hepatocellular carcinoma (HCC) and liver cirrhosis.MethodsIn this retrospective cohort study, we evaluated the safety of IPM in patients with HCC who underwent minimally invasive liver resection during five years at our center. Factors influencing the use of IPM were examined in univariate and multivariate regression analysis. Cases with use of IPM (IPM) and those without use of IPM (no IPM) were then compared regarding intraoperative and postoperative outcomes after propensity score matching (PSM) for surgical difficulty.ResultsOne hundred fifty-one patients underwent liver resection for HCC at our center and met inclusion criteria. Of these, 73 patients (48%) received IPM with a median duration of 18 min (5–78). One hundred patients (66%) had confirmed liver cirrhosis. In multivariate analysis, patients with large tumors (≥ 3 cm) and difficult tumor locations (segments VII or VIII) were more likely to undergo IPM (OR 1.176, p = 0.043, and OR 3.243, p = 0.001, respectively). After PSM, there were no differences in intraoperative blood transfusion or postoperative complication rates between the IPM and no IPM groups. Neither did we observe any differences in the subgroup analysis for cirrhotic patients. Postoperative serum liver function tests were not affected by the use of IPM.ConclusionsBased on our findings, we conclude that the use of IPM in minimally invasive liver resection is safe and feasible for patients with HCC, including those with compensated liver cirrhosis.
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    36 PurposeThe aim
    37 ResultsOne hundred fifty
    38 aim
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    41 carcinoma
    42 cases
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    44 cirrhosis
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    48 complication rate
    49 criteria
    50 differences
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    52 difficulties
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    54 factors
    55 fifties
    56 findings
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    61 impact
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    64 intraoperative blood transfusion
    65 invasive liver resection
    66 large tumors
    67 liver cirrhosis
    68 liver function tests
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    72 median duration
    73 min
    74 multivariate analysis
    75 outcomes
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    77 postoperative complication rate
    78 postoperative outcomes
    79 propensity score
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    82 resection
    83 retrospective cohort study
    84 safety
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    87 study
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