title: Prolonged portal triad clamping during liver surgery for colorectal liver metastases is associated with decreased time to hepatic tumour recurrence.
abstract: OBJECTIVE
  The aim of this study was to evaluate the oncological outcome of portal triad clamping during hepatectomy in colorectal cancer patients.
  
  
  METHODS
  160 patients with colorectal liver metastases underwent a partial hepatectomy with curative intent. Data were collected in a prospective database and were retrospectively analyzed for time to liver recurrence (TTLiR) and time to overall recurrence (TTR). The prognostic significance of portal triad clamping of any type and severe ischemia due to prolonged portal triad clamping was determined by Cox regression models.
  
  
  RESULTS
  TTLiR was reduced after clamping of any type, although not statistically significant (p=0.061). Severe ischemia due to prolonged portal triad clamping significantly decreased TTLiR (p=0.022), but not TTR. Furthermore, severe ischemia independently predicted TTLiR in a multivariable analysis (p=0.038).
  
  
  CONCLUSIONS
  Severe ischemia due to prolonged portal triad clamping during hepatic resection for colorectal liver metastases appears to be associated with decreased TTLiR. Further research remains necessary to determine the causative effect of prolonged vascular clamping on liver tumour recurrence.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: Nijkamp
authors.forename: J D W
authors.initials: JD
authors.lastname: van der Bilt
authors.forename: N
authors.initials: N
authors.lastname: Snoeren
authors.forename: F J H
authors.initials: FJ
authors.lastname: Hoogwater
authors.forename: W J
authors.initials: WJ
authors.lastname: van Houdt
authors.forename: I Q
authors.initials: IQ
authors.lastname: Molenaar
authors.forename: O
authors.initials: O
authors.lastname: Kranenburg
authors.forename: R
authors.initials: R
authors.lastname: van Hillegersberg
authors.forename: I H M
authors.initials: IH
authors.lastname: Borel Rinkes
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D003250:Constriction; D003428:Cross Infection; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D011168:Portal System; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors