title: Intermittent hepatic inflow occlusion during partial hepatectomy for hepatocellular carcinoma does not shorten overall survival or increase the likelihood of tumor recurrence.
abstract: OBJECTIVE
  To investigate whether the long-term outcomes of hepatocellular carcinoma (HCC) was adversely impacted by intermittent hepatic inflow occlusion (HIO) during hepatic resection.
  
  
  METHODS
  1549 HCC patients who underwent hepatic resection between 1998 and 2008 were identified from a prospectively maintained database. Intermittent HIO was performed in 931 patients (HIO group); of which 712 patients had a Pringle maneuver as the mechanism for occlusion (PM group), and 219 patients had selective hemi-hepatic occlusion (SO group). There were 618 patients that underwent partial hepatectomy without occlusion (occlusion-free, OF group).
  
  
  RESULTS
  The 1-, 3-, and 5- year overall survival (OS) rates were 79%, 59%, and 42% in the HIO group, and 83%, 53%, and 35% in the OF group, respectively. The corresponding recurrence free survival (RFS) rates were 68%, 39%, and 22% in the HIO group, and 74%, 41%, and 18% in the OF group, respectively. There was no significant difference between the 2 groups in OS or RFS (P=0.325 and P=0.416). Subgroup analysis showed patients with blood loss over 3000 mL and those requiring transfusion suffered significantly shorter OS and RFS. Blood loss over 3000 mL and blood transfusion were independent risk factors to OS and RFS.
  
  
  CONCLUSIONS
  The application of intermittent HIO (PM and SO) during hepatic resection did not adversely impact either OS or RFS in patients with HCC. Intermittent HIO is still a valuable tool in hepatic resection, because high intraoperative blood loss resulting in transfusion is associated with a reduction in both OS and RFS.
authors.affiliation: From the Department of Liver Surgery, Division of Liver Transplantation, West China Hospital, Sichuan University, Chengdu, China (JH, HW, ML, JL, YZ); Department of Hepato-Biliary-Pancreatic Surgery, University of Tokyo Hospital, University of Tokyo, Tokyo, Japan (WT); Department of Hepato-Biliary-Pancreatic Surgery, London Health Sciences Centre, Western University, London, Canada (RHA, KAB).
authors.forename: Jiwei
authors.initials: J
authors.lastname: Huang
authors.forename: Wei
authors.initials: W
authors.lastname: Tang
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernandez-Alejandro
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Bertens
authors.forename: Hong
authors.initials: H
authors.lastname: Wu
authors.forename: Mingheng
authors.initials: M
authors.lastname: Liao
authors.forename: Jiaxin
authors.initials: J
authors.lastname: Li
authors.forename: Yong
authors.initials: Y
authors.lastname: Zeng
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery*; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D008099:Liver / Q000098:blood supply / Q000503:physiopathology; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate