title: Impact of intermittent portal clamping on the early recurrence of hepatocellular carcinoma after surgery.
abstract: OBJECTIVE
  To evaluate the impact of intermittent portal clamping (IPC) during surgery on the early recurrence of hepatocellular carcinoma (HCC).
  
  
  METHODS
  The subjects of this retrospective study were 266 patients who underwent curative liver resection for HCC. The patients were grouped as follows: an intermittent portal clamping (IPC) group, n = 78; a continuous portal clamping (CPC) group, n = 128; and a non-portal clamping (NPC) group, n = 60.
  
  
  RESULTS
  The median recurrence-free interval within 2 years of follow-up was significantly shorter in the IPC group (14.2 ± 4.6 months) than in the CPC group (18.0 ± 4.8 months, P = 0.008) or the NPC group (19.04 ± 4.1 months, P = 0.023). Moreover, 2-year recurrence-free survival was much lower in the IPC group than in the CPC group (63.6 vs. 75.8 %, P = 0.025) or the NPC group (63.6 vs. 78.0 %, P = 0.030). However, the 2-year OS rate among the three groups was comparable (72.7 vs. 79.9 %; P = 0.101) and 83.1 %, (P = 0.125). According to univariable analysis, tumor size (>5 cm), tumor number (≥2), tumor grade (low/undifferentiated), TNM stage (III), vascular infiltration, blood transfusion, and IPC were significantly associated with the early postoperative recurrence of HCC. After multivariate analysis, significance of tumor grade (low/undifferentiated) and TNM stage (III) disappeared, whereas tumor size (>5 cm), tumor number (≥2), vascular infiltration, blood transfusion, and IPC remained significant.
  
  
  CONCLUSIONS
  IPC is an independent risk factor for the early recurrence of HCC after surgery.
authors.affiliation: Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China. haoshenghua@126.com.
authors.forename: Shenghua
authors.initials: S
authors.lastname: Hao
authors.affiliation: Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
authors.forename: Shaofei
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of General Surgery, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, China.
authors.forename: Xiangwu
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
authors.forename: Chidan
authors.initials: C
authors.lastname: Wan
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D003250:Constriction; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000209:etiology*; D009367:Neoplasm Staging; D011169:Portal Vein; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: Early recurrence; Hepatocellular carcinoma; Intermittent portal clamping; Overall survival; Recurrence-free survival