title: Pringle maneuver induces hepatic metastasis by stimulating the tumor vasculature.
abstract: OBJECTIVE
  The Pringle maneuver is traditionally used to avoid hemorrhage during hepatectomy for hepatic metastasis. However, metastasis can occur under ischemic conditions due to some unknown mechanism.
  
  
  METHODS
  An orthotopic model of murine colon cancer was established in syngeneic BALB/c mice. Viable CT-26 cells were implanted into the spleen of these mice. The mice underwent a laparotomy 5 days after the implantation and the hepato-duodenal ligament was clamped for 0 or 10 minutes (Pringle maneuver). The mice were sacrificed 7 days after this maneuver and the number of hepatic metastasis were counted.
  
  
  RESULTS
  The mice that underwent the maneuver developed a greater number of hepatic metastasis. An immunohistochemical analysis revealed that the expression of microvessel density, VEGF and KDR/Flk-1 were higher in the hepatic metastasis in the mice treated with the maneuver. In addition, the mice which were treated by the maneuver had a higher level VEGF in the serum.
  
  
  CONCLUSIONS
  These data suggest that the Pringle maneuver induces hepatic metastasis by stimulating the overexpression of tumor vasculature.
authors.affiliation: Department of Surgery Chichibu Hospital, Saitama, Japan. shutaro@saitama-med.ac.jp
authors.forename: Shutaro
authors.initials: S
authors.lastname: Ozawa
authors.forename: Naoe
authors.initials: N
authors.lastname: Akimoto
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tawara
authors.forename: Masami
authors.initials: M
authors.lastname: Yamada
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sato
authors.forename: Jo
authors.initials: J
authors.lastname: Tashiro
authors.forename: Tomonori
authors.initials: T
authors.lastname: Hosonuma
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Ishii
authors.forename: Shigeki
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Yusuhe
authors.initials: Y
authors.lastname: Husejima
authors.forename: Mineo
authors.initials: M
authors.lastname: Hanawa
authors.forename: Isamu
authors.initials: I
authors.lastname: Koyama
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003110:Colonic Neoplasms / Q000473:pathology*; D004195:Disease Models, Animal; D004797:Enzyme-Linked Immunosorbent Assay; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D007124:Immunoenzyme Techniques; D008026:Ligation; D008113:Liver Neoplasms / Q000098:blood supply / Q000556:secondary / Q000601:surgery*; D051379:Mice; D008807:Mice, Inbred BALB C; D008833:Microcirculation; D018709:Statistics, Nonparametric; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000097:blood
chemical_list: D040301:Vascular Endothelial Growth Factor Receptor-2