title: Does hepatic ischemia-reperfusion injury induced by hepatic pedicle clamping affect survival after partial hepatectomy for hepatocellular carcinoma?
abstract: BACKGROUND
  Liver resection offers a chance of cure for patients with hepatocellular carcinoma (HCC). Hepatic pedicle clamping (HPC) is commonly used to reduce blood loss during hepatectomy. Hepatic ischemia-reperfusion (I/R) injury has recently been reported to be a major factor in accelerated tumor growth. We therefore evaluated the effect of intermittent HPC on the prognosis of patients after liver resection.
  
  
  METHODS
  The clinicopathological features and serum/tissue samples of 386 HCC patients who underwent curative liver resection were prospectively collected. The patients were divided into the HPC group (over 30 min) and the non-HPC group. Disease-free survival and overall survival were analyzed using multivariate analyses, Kaplan-Meier curves, and log-rank tests. Matrix metalloproteinases and E-selectin were measured to study hepatic I/R injury.
  
  
  RESULTS
  The preoperative clinicopathological data were comparable between the HPC group (n = 224) and the non-HPC group (n = 162). During the study period, 257 of the 386 patients (66.6 %) developed tumor recurrence. The overall tumor recurrence and intrahepatic tumor recurrence rates were not significantly different between the two groups. There were no significant differences between the two groups with respect to the 1-, 3-, and 5-year disease-free and overall survival rates. Similarly, subgroup analyses also showed no marked difference in survival rates for patients with cirrhosis in the two groups. The levels of mRNA in liver tissues and serum concentrations of MMP-2, MMP-9, and E-selectin showed no significant differences between the pre- and post-occlusion periods.
  
  
  CONCLUSIONS
  Intermittent HPC produced no adverse effect on disease-free and overall survival for patients who underwent liver resection for HCC.
authors.affiliation: Institute of Hepatobiliary Surgery and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing, China. frankfxia@gmail.com
authors.forename: Feng
authors.initials: F
authors.lastname: Xia
authors.forename: Wan-Yee
authors.initials: WY
authors.lastname: Lau
authors.forename: Yanmin
authors.initials: Y
authors.lastname: Xu
authors.forename: Lin
authors.initials: L
authors.lastname: Wu
authors.forename: Cheng
authors.initials: C
authors.lastname: Qian
authors.forename: Ping
authors.initials: P
authors.lastname: Bie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery*; D003250:Constriction; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000209:etiology / Q000401:mortality*; D015996:Survival Rate; D055815:Young Adult