title: Selective Inflow Occlusion Technique Versus Intermittent Pringle Maneuver in Hepatectomy for Large Hepatocellular Carcinoma: A Retrospective Study.
abstract: Selective inflow occlusion (SIO) maneuver preserved inflow of nontumorous liver and was supposed to protect liver function. This study aims to evaluate whether SIO maneuver is superior to Pringle maneuver in patients undergoing partial hepatectomy with large hepatocellular carcinomas (HCCs). Between January 2008 and May 2012, 656 patients underwent large HCC resections and were divided into 2 groups: intermittent Pringle maneuver (IP) group (n = 336) and SIO group (n = 320). Operative parameters, postoperative laboratory tests, and morbidity and mortality were analyzed. In comparison to the IP maneuver, the SIO maneuver significantly decreased intraoperative blood loss (473 vs 691  mL, P = 0.001) and transfusion rates (11.3% vs 28.6%, P = 0.006). The rate of major complication between the 2 groups was comparable (22.6% vs 18.8%, P = 0.541). Patients with moderate/severe cirrhosis, total bilirubin > 17  μmol/L, or HBV DNA> = 104  copy/mL in SIO group resulted in lower major complication rates. The SIO maneuver is a safe and effective technique for large HCC resections. In patients with moderate/severe cirrhosis, total bilirubin > 17  μmol/L, or HBV DNA> = 104  copy/mL, the SIO technique is preferentially recommended.
authors.affiliation: From the Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhu
authors.forename: Binhao
authors.initials: B
authors.lastname: Zhang
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.forename: Bin
authors.initials: B
authors.lastname: Mei
authors.forename: Qi
authors.initials: Q
authors.lastname: Cheng
authors.forename: Lin
authors.initials: L
authors.lastname: Chen
authors.forename: Gang
authors.initials: G
authors.lastname: Wei
authors.forename: Da-Feng
authors.initials: DF
authors.lastname: Xu
authors.forename: Jie
authors.initials: J
authors.lastname: Yu
authors.forename: Hua
authors.initials: H
authors.lastname: Xiao
authors.forename: Bi-Xiang
authors.initials: BX
authors.lastname: Zhang
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Chen
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies