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Does Hepatic Pedicle Clamping Affect Disease-Free Survival Following Liver Resection for Colorectal Metastases?

Giuliante, Felice MD*; Ardito, Francesco MD*; Pulitanò, Carlo MD; Vellone, Maria MD, PhD*; Giovannini, Ivo MD*; Aldrighetti, Luca MD; Ferla, Gianfranco MD; Nuzzo, Gennaro MD*

Annals of Surgery:
doi: 10.1097/SLA.0b013e3181f66918
Original Articles: ORIGINAL STUDY
Abstract

Objective: To evaluate the impact of liver ischemia from hepatic pedicle clamping (HPC) on long-term outcome after hepatectomy for colorectal liver metastases (CRLM).

Background: Liver resection offers the only chance of cure for patients with CRLM. Several clinical and pathologic factors have been reported as determinants of poor outcome after hepatectomy for CRLM. A controversial issue is that hepatic ischemia/reperfusion injury from HPC may adversely affect long-term outcome by accelerating the outgrowth of residual hepatic micrometastases.

Methods: Patients undergoing liver resection for CRLM in 2 tertiary referral centers, between 1992 and 2008, were included. Disease-free survival and specific liver-free survival were analyzed according to the use, type, and duration of HPC.

Results: Five hundred forty-three patients had primary hepatectomy for CRLM. Hepatic pedicle clamping was performed in 355 patients (65.4%), and intermittently applied in 254 patients (71.5%). Postoperative mortality and morbidity rates were 1.3% and 18.5%, respectively. Hepatic pedicle clamping had a highly significant impact in reducing the risk of blood transfusions and was not correlated with significantly higher postoperative morbidity. Liver recurrence rate was not significantly different according to the use, type, and duration of HPC, in patients resected after preoperative chemotherapy as well. On univariate analysis, HPC did not significantly affect overall and disease-free survival. These results were confirmed on the multivariate analysis where blood transfusions, primary tumor nodal involvement, and the size of CRLM of more than 5 cm prevailed as determinants of poor outcome.

Conclusions: This study confirms the safety and effectiveness of HPC and demonstrates that in the human situation, there is no evidence that HPC may adversely affect long-term outcome after hepatectomy for CRLM.

In Brief

The impact of liver ischemia from hepatic pedicle clamping (HPC) on long-term outcome was assessed after 536 hepatectomies for colorectal metastases. The purpose was to verify the clinical relevance of experimental investigations suggesting that HPC might adversely affect outcome by accelerating tumor progression. The results of the study showed no dismal impact of HPC on long-term outcome.

Author Information

*Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy;

Department of Surgery, Liver Unit, San Raffaele Hospital, Milan, Italy.

The authors have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted manuscript.

Reprints: Francesco Ardito, MD, Catholic University of the Sacred Heart, School of Medicine, Department of Surgery, Hepatobiliary Surgery Unit, L.go A. Gemelli 8, I-00168 Rome, Italy. E-mail: arditofra@gmail.com.

© 2010 Lippincott Williams & Wilkins, Inc.