Hepatic Pedicle Clamping Does Not Worsen Survival after Hepatic Resection for Colorectal Liver Metastasis: Results from a Systematic Review and Meta-analysis

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• 作者：Akihisa Matsuda MD (1)
  Masao Miyashita MD (1)
  Satoshi Matsumoto MD (1)
  Takeshi Matsutani MD (2)
  Nobuyuki Sakurazawa MD (1)
  Ichiro Akagi MD (2)
  Taro Kishi MD (3)
  Kimiyoshi Yokoi MD (1)
  Eiji Uchida MD (2)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2013
• 出版时间：November 2013
• 年：2013
• 卷：20
• 期：12
• 页码：3771-3778
• 全文大小：
• 作者单位：Akihisa Matsuda MD (1)
  Masao Miyashita MD (1)
  Satoshi Matsumoto MD (1)
  Takeshi Matsutani MD (2)
  Nobuyuki Sakurazawa MD (1)
  Ichiro Akagi MD (2)
  Taro Kishi MD (3)
  Kimiyoshi Yokoi MD (1)
  Eiji Uchida MD (2)
  
  1. Department of Surgery, Chiba-Hokuso Hospital Nippon Medical School, Inzai, Chiba, Japan
  2. Department of Gastroenterological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
  3. Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
  
• ISSN：1534-4681

文摘

Background Hepatic pedicle clamping (HPC) has been demonstrated to be effective for short-term outcomes during hepatic resection. However, HPC-induced hepatic ischemia/reperfusion injury can accelerate the outgrowth of hepatic micrometastases in experimental studies. The conclusive evidence regarding effects of HPC on long-term patient outcomes after hepatic resection for colorectal liver metastasis (CRLM) has not been determined. Methods A comprehensive electronic literature search was performed to identify studies evaluating the oncological effects of HPC after hepatic resection for CRLM. The main outcome measures were intrahepatic recurrence (IHR), disease-free survival (DFS), and overall survival (OS). A meta-analysis was performed using the random-effects models to compute odds ratio (OR) along with 95% confidence intervals (CI). Results Four studies, with a total of 2,114 patients (73.7% HPC, 26.3% non-HPC), matched the inclusion criteria. Meta-analyses revealed that IHR (OR 0.88; 95% CI 0.69.11; P=0.27), DFS (OR 0.88; 95% CI 0.70.10; P=0.27) and OS (OR 0.99; 95% CI 0.79.24; P=0.90) did not differ significantly between the HPC and non-HPC groups. Conclusions This meta-analysis provides persuasive evidence that HPC during hepatic resection for CRLM has no significant adverse oncological outcomes. HPC should be considered an option during parenchymal liver resection from current available evidence.