title: Hepatic pedicle clamping during hepatic resection for colorectal liver metastases: no impact on survival or hepatic recurrence.
abstract: BACKGROUND
  Hepatic pedicle clamping is often used during liver resection. While its use reduces blood loss and transfusion requirements, the long-term effect on survival and recurrence has been debated. This study evaluates the effect of hepatic pedicle clamping [i.e., Pringle maneuver (PM)] on survival and recurrence following hepatic resection for colorectal liver metastasis (CRLM).
  
  
  METHODS
  Patients who underwent R0 resection for CRLM from 1991 to 2004 were identified from a prospectively maintained database. Operative, perioperative, and clinicopathological variables were analyzed. The primary outcomes were disease-free survival (DFS) and liver recurrence (LR). Disease extent was categorized using a well-defined clinical risk score (CRS). Subgroup analysis was performed for patients given preoperative systemic chemotherapy and postoperative pump chemotherapy.
  
  
  RESULTS
  This study included 928 consecutive patients with median follow-up of 8.9 years. PM was utilized in 874 (94%) patients, with median time of 35 min (range 1-181 min). On univariate analysis, only resection type (p<0.001) and tumor number (p=0.002) were associated with use of PM. Younger age (p=0.006), longer operative time (p<0.001), and multiple tumors (p=0.006) were associated with prolonged PM (>60 min). There was no association between DFS, overall survival (OS) or LR and Pringle time. Neither the CRS nor use of neoadjuvant therapy stratified disease-related outcome with respect to use of PM.
  
  
  CONCLUSIONS
  PM was used in most patients undergoing resection for CRLM and did not adversely influence intrahepatic recurrence, DFS, or OS.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Weiss
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ito
authors.forename: Raphael L C
authors.initials: RL
authors.lastname: Araujo
authors.forename: Emily C
authors.initials: EC
authors.lastname: Zabor
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.forename: Ronald P
authors.initials: RP
authors.lastname: DeMatteo
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.forename: Leslie H
authors.initials: LH
authors.lastname: Blumgart
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D003250:Constriction; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D061646:Operative Time; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D052096:Warm Ischemia / Q000009:adverse effects*; D055815:Young Adult