title: Effect of the pringle maneuver on tumor recurrence of hepatocellular carcinoma after curative resection (EPTRH): a randomized, prospective, controlled multicenter trial.
abstract: BACKGROUND
  Hepatic resection is currently still the best choice of therapeutic strategies for liver cancer, but the long-term survival rate after surgery is unsatisfactory. Most patients develop intra- and/or extrahepatic recurrence. The reasons for this high recurrence rate are not entirely clear. Recent studies have indicated that ischemia-reperfusion injury to the liver may be a significant factor promoting tumor recurrence and metastasis in animal models. If this is also true in humans, the effects of the Pringle maneuver, which has been widely used in hepatectomy for the past century, should be examined. To date, there are no reported data or randomized controlled studies examining the relationship between use of the Pringle maneuver and local tumor recurrence. We hypothesize that the long-term prognosis of patients with liver cancer could be worsened by use of the Pringle maneuver due to an increase in the rate of tumor recurrence in the liver remnant. We designed a multicenter, prospective, randomized surgical trial to test this hypothesis.
  
  
  METHODS
  At least 498 eligible patients from five participating centers will be enrolled and randomized into either the Pringle group or the non-Pringle group in a ratio of 1:1 using a permuted-blocks randomization protocol. After the completion of surgical intervention, patients will be included in a 3-year follow-up program.
  
  
  CONCLUSIONS
  This multicenter surgical trial will examine whether the Pringle maneuver has a negative effect on the long-term outcome of hepatocellular carcinoma patients. The trial will also provide information about prognostic differences, safety, advantages and disadvantages between Pringle and non-Pringle surgical procedures. Ultimately, the results will increase the available information about the effects of ischemia-reperfusion injury on tumor recurrence, which will be of immense benefit to general surgery.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov NCT00725335.
authors.affiliation: Institute of hepatobiliary surgery, Southwest Hospital, Third Military Medical University, Chongqing, P, R, China. fengxiaobin200708@yahoo.com.cn
authors.forename: Feng
authors.initials: F
authors.lastname: Xiaobin
authors.forename: Zheng
authors.initials: Z
authors.lastname: Shuguo
authors.forename: Zhou
authors.initials: Z
authors.lastname: Jian
authors.forename: Qiu
authors.initials: Q
authors.lastname: Yudong
authors.forename: Liang
authors.initials: L
authors.lastname: Lijian
authors.forename: Ma
authors.initials: M
authors.lastname: Kuansheng
authors.forename: Li
authors.initials: L
authors.lastname: Xiaowu
authors.forename: Xia
authors.initials: X
authors.lastname: Feng
authors.forename: Yi
authors.initials: Y
authors.lastname: Dong
authors.forename: Wang
authors.initials: W
authors.lastname: Shuguang
authors.forename: Bie
authors.initials: B
authors.lastname: Ping
authors.forename: Dong
authors.initials: D
authors.lastname: Jiahong
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D015427:Reperfusion Injury / Q000150:complications* / Q000209:etiology