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Severe ischemic changes of the liver remnant after hepatectomy could expedite tumor recurrence on the residual liver. Our study aimed at assessing the effect of warm ischemic/reperfusion (I/R) injuries on surgery-to-local recurrence interval and patient overall survival, during major hepatectomies under inflow and outflow vascular control.
One hundred and eighteen patients were subjected to liver resection under total inflow and outflow vascular clamping and were assigned as study group. These individuals were retrospectively matched to 112 counterparts, who underwent liver surgery applying inflow and outflow vascular clamping only of the segment harboring the tumor, sparing the liver remnant from any I/R injury (control group). The two cohorts were compared regarding recurrence-free survival and overall survival.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| study group | patients subjected to major hepatectomy with vascular control of blood inflow and outflow of the whole liver |
| |
| control group | patients subjected to major hepatectomy by selectively clamping the portal and hepatic vessels only of the lobe harboring the tumor |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| selective hepatic vascular exclusion | Procedure | major hepatectomy with vascular control of blood inflow and outflow of the whole liver |
|
| Measure | Description | Time Frame |
|---|---|---|
| time to malignant recurrence | recurrence-free survival | from time of operation until time of malignant recurrence, assessed up to 15 years |
| time to death | overall survival | from time of operation until time of death, assessed up to 20 years |
| Measure | Description | Time Frame |
|---|---|---|
| aspartate aminotrasferase (AST) levels | aspartate aminotransferase levels | second postoperative day |
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Inclusion Criteria:
Exclusion Criteria:
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retrospective analysis of an internal hepatectomy database
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| Name | Affiliation | Role |
|---|---|---|
| Kassiani Theodoraki, PhD | Aretaieion University Hospital | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 16222453 | Background | Smyrniotis V, Farantos C, Kostopanagiotou G, Arkadopoulos N. Vascular control during hepatectomy: review of methods and results. World J Surg. 2005 Nov;29(11):1384-96. doi: 10.1007/s00268-005-0025-x. | |
| 14509502 | Background | Smyrniotis VE, Kostopanagiotou GG, Contis JC, Farantos CI, Voros DC, Kannas DC, Koskinas JS. Selective hepatic vascular exclusion versus Pringle maneuver in major liver resections: prospective study. World J Surg. 2003 Jul;27(7):765-9. doi: 10.1007/s00268-003-6978-8. |
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| ID | Term |
|---|---|
| D009369 | Neoplasms |
| D008113 | Liver Neoplasms |
| D015427 | Reperfusion Injury |
| ID | Term |
|---|---|
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
| D004066 | Digestive System Diseases |
| D008107 | Liver Diseases |
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| semielective hepatic vascular exclusion | Procedure | major liver resection by selectively clamping the portal and hepatic vessels only of the lobe harboring the tumor |
|
| 25526466 | Background | Huang J, Tang W, Hernandez-Alejandro R, Bertens KA, Wu H, Liao M, Li J, Zeng Y. Intermittent hepatic inflow occlusion during partial hepatectomy for hepatocellular carcinoma does not shorten overall survival or increase the likelihood of tumor recurrence. Medicine (Baltimore). 2014 Dec;93(28):e288. doi: 10.1097/MD.0000000000000288. |
| 19832842 | Background | Liu L, Ren ZG, Shen Y, Zhu XD, Zhang W, Xiong W, Qin Y, Tang ZY. Influence of hepatic artery occlusion on tumor growth and metastatic potential in a human orthotopic hepatoma nude mouse model: relevance of epithelial-mesenchymal transition. Cancer Sci. 2010 Jan;101(1):120-8. doi: 10.1111/j.1349-7006.2009.01363.x. Epub 2009 Sep 14. |
| 11425059 | Background | Serracino-Inglott F, Habib NA, Mathie RT. Hepatic ischemia-reperfusion injury. Am J Surg. 2001 Feb;181(2):160-6. doi: 10.1016/s0002-9610(00)00573-0. |
| 18044786 | Background | Man K, Ng KT, Lo CM, Ho JW, Sun BS, Sun CK, Lee TK, Poon RT, Fan ST. Ischemia-reperfusion of small liver remnant promotes liver tumor growth and metastases--activation of cell invasion and migration pathways. Liver Transpl. 2007 Dec;13(12):1669-77. doi: 10.1002/lt.21193. |
| 18044752 | Background | Ozaki M, Todo S. Surgical stress and tumor behavior: impact of ischemia-reperfusion and hepatic resection on tumor progression. Liver Transpl. 2007 Dec;13(12):1623-6. doi: 10.1002/lt.21230. No abstract available. |
| 28052154 | Background | Cho JY, Han HS, Choi Y, Yoon YS, Kim S, Choi JK, Jang JS, Kwon SU, Kim H. Association of Remnant Liver Ischemia With Early Recurrence and Poor Survival After Liver Resection in Patients With Hepatocellular Carcinoma. JAMA Surg. 2017 Apr 1;152(4):386-392. doi: 10.1001/jamasurg.2016.5040. |
| 16432356 | Background | Portolani N, Coniglio A, Ghidoni S, Giovanelli M, Benetti A, Tiberio GA, Giulini SM. Early and late recurrence after liver resection for hepatocellular carcinoma: prognostic and therapeutic implications. Ann Surg. 2006 Feb;243(2):229-35. doi: 10.1097/01.sla.0000197706.21803.a1. |
| 32619621 | Derived | Theodoraki K, Papadoliopoulou M, Petropoulou Z, Theodosopoulos T, Vassiliu P, Polydorou A, Xanthakos P, Fragulidis G, Smyrniotis V, Arkadopoulos N. Does vascular occlusion in liver resections predispose to recurrence of malignancy in the liver remnant due to ischemia/reperfusion injury? A comparative retrospective cohort study. Int J Surg. 2020 Aug;80:68-73. doi: 10.1016/j.ijsu.2020.06.019. Epub 2020 Jun 30. |
| D014652 |
| Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |