Longer duration of the Pringle maneuver is associated with hepatocellular carcinoma recurrence following curative resection.
OBJECTIVE
To evaluate the effect of Pringle maneuver time on tumor recurrence following liver resection in patients with hepatocellular carcinoma (HCC).


METHODS
In this single-center study, we retrospectively evaluated the effect of Pringle maneuver time on HCC recurrence over a 10-year period from 1999 to 2008 using a Cox regression analysis.


RESULTS
This study enrolled a total of 2,368 patients. A Pringle maneuver time of 15 min was associated with HCC recurrence (log likelihood ratio test, P = 0.001). A Pringle maneuver time less than 15 min was not a significant risk factor for HCC recurrence (hazard ratio, HR = 0.97, P = 0.708). However, a Pringle maneuver time greater than 15 min was an independent predictor of HCC recurrence (HR = 1.41, P < 0.001). The patients who underwent the Pringle maneuver for over 15 min had lower overall survival (OS) and recurrence-free survival (RFS) than did those who either did not undergo the maneuver or underwent the maneuver for less than 15 min (both P < 0.001).


CONCLUSIONS
These results suggest that a longer duration of the Pringle maneuver increases the risk of tumor recurrence in patients with HCC. However, a shorter duration of the Pringle maneuver decreases this risk. J. Surg. Oncol. 2016;114:112-118. © 2016 Wiley Periodicals, Inc.
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Key Laboratory of Carcinogenesis and Cancer Invasion, Fundan University, Ministry of Education, Shanghai, P. R. China.
Shuang
S
Liu
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Key Laboratory of Carcinogenesis and Cancer Invasion, Fundan University, Ministry of Education, Shanghai, P. R. China.
Xiaoqiang
X
Li
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Key Laboratory of Carcinogenesis and Cancer Invasion, Fundan University, Ministry of Education, Shanghai, P. R. China.
Hui
H
Li
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Key Laboratory of Carcinogenesis and Cancer Invasion, Fundan University, Ministry of Education, Shanghai, P. R. China.
Lei
L
Guo
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Key Laboratory of Carcinogenesis and Cancer Invasion, Fundan University, Ministry of Education, Shanghai, P. R. China.
Bo
B
Zhang
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Key Laboratory of Carcinogenesis and Cancer Invasion, Fundan University, Ministry of Education, Shanghai, P. R. China.
Zijun
Z
Gong
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Key Laboratory of Carcinogenesis and Cancer Invasion, Fundan University, Ministry of Education, Shanghai, P. R. China.
Jubo
J
Zhang
Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Key Laboratory of Carcinogenesis and Cancer Invasion, Fundan University, Ministry of Education, Shanghai, P. R. China.
Qinghai
Q
Ye
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000009:adverse effects* / Q000379:methods; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
Pringle maneuver; hepatocellular carcinoma; ischemia time; recurrence