The impact of portal pedicle clamping on survival from colorectal liver metastases in the contemporary era of liver resection: a matched cohort study.
BACKGROUND
Portal pedicle clamping (PPC) may impact micro-metastases' growth. This study examined the association between PPC and survival after a hepatectomy for colorectal liver metastases (CRLM).


METHODS
A matched cohort study was conducted on hepatectomies for CRLM at a single institution (2003-2012). Cohorts were selected based on PPC use, with 1:1 matching for age, time period and the Clinical Risk Score. Outcomes were overall and recurrence-free survival (OS and RFS). Cox regression was performed to assess the association between PPC and survival.


RESULTS
Of 481 hepatectomies, 26.9% used PPC. One hundred and ten pairs of patients were matched in the cohorts. There was no significant difference in OS [hazard ratio (HR) 1.18; 95% confidence interval (CI): 0.76-1.83], with a 5-year OS of 57.8% (95%CI: 52.4-63.2%) with PPC versus 62.3% (95%CI: 57.1-67.5%) without. Five-year RFS did not differ (HR 0.98; 95%CI: 0.71-1.35) with 29.7% (95%CI: 24.9-34.5%) with PPC versus 28.0% (95%CI: 23.2-32.8%) without. When adjusting for extent of resection, transfusion, operative time and surgeon, there was no difference in OS (HR 0.91; 95%CI: 0.52-1.60) or RFS (HR: 0.86; 95%CI: 0.57-1.30).


CONCLUSIONS
PPC was not associated with a significant difference in OS or RFS in a hepatectomy for CRLM. PPC remains a safe technique during hepatectomy.
Department of Surgery, University of Toronto, Toronto, ON, Canada.
Melanie E
ME
Tsang
Department of Surgery, University of Toronto, Toronto, ON, Canada.|Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.
Paul J
PJ
Karanicolas
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Rogeh
R
Habashi
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Eva
E
Cheng
Department of Surgery, University of Toronto, Toronto, ON, Canada.|Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.
Sherif S
SS
Hanna
Department of Surgery, University of Toronto, Toronto, ON, Canada.|Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.
Natalie G
NG
Coburn
Department of Surgery, University of Toronto, Toronto, ON, Canada.|Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.
Calvin H L
CH
Law
Department of Surgery, University of Toronto, Toronto, ON, Canada.|Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.
Julie
J
Hallet
D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D003250:Constriction; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011169:Portal Vein; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends