Association of Pringle maneuver with postoperative recurrence and survival following hepatectomy for hepatocellular carcinoma: a multicenter propensity score and competing-risks regression analysis.

IF 6.1 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Hepatobiliary surgery and nutrition Pub Date : 2024-06-01 Epub Date: 2023-07-05 DOI:10.21037/hbsn-23-7
Shi-Chuan Tang, Yong-Kang Diao, Kong-Ying Lin, Chao Li, Xiao Xu, Lei Liang, Jie Kong, Qing-Jing Chen, Xian-Ming Wang, Fu-Bao Liu, Wei-Min Gu, Ya-Hao Zhou, Ying-Jian Liang, Hong-Zhi Liu, Ming-Da Wang, Lan-Qing Yao, Timothy M Pawlik, Feng Shen, Wan Yee Lau, Tian Yang, Yong-Yi Zeng
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Abstract

Background: The application of Pringle maneuver (PM) during hepatectomy reduces intraoperative blood loss and the need for perioperative transfusion, but its effect on long-term recurrence and survival for patients with hepatocellular carcinoma (HCC) remains controversial. We sought to determine the association between the application of PM and post-hepatectomy oncologic outcomes for patients with HCC.

Methods: Patients who underwent curative hepatectomy for HCC at 9 Chinese hospitals from January 2010 to December 2018 were identified. Using two propensity score methods [propensity score matching (PSM) and inverse probability of treatment weight (IPTW)], cumulative recurrence rate and cancer-specific mortality (CSM) were compared between the patients in the PM and non-PM groups. Multivariate competing-risks regression models were performed to adjust for the effect of non-cancer-specific mortality and other prognostic risk factors.

Results: Of the 2,798 included patients, 2,404 and 394 did and did not adopt PM (the PM and non-PM groups), respectively. The rates of intraoperative blood transfusion, postoperative 30-day mortality and morbidity were comparable between the two groups (all P>0.05). In the PSM cohort by the 1:3 ratio, compared to 382 patients in the non-PM group, 1,146 patients in the PM group also had the higher cumulative 5-year recurrence rate and CSM (63.9% and 39.1% vs. 55.3% and 31.6%, both P<0.05). Similar results were also yielded in the entire cohort and the IPTW cohort. Multivariate competing-risks regression analyses demonstrated that no application of the PM was independently associated with lower recurrence rate and CSM based on various analytical cohorts [hazard ratio (HR), 0.82 and 0.77 in the adjusted entire cohort, HR 0.80 and 0.73 in the PSM cohort, and HR 0.80 and 0.76 in the IPTW cohort, respectively].

Conclusions: The findings suggested that no application of PM during hepatectomy for patients with HCC reduced the risk of postoperative recurrence and cancer-specific death by approximately 20-25%.

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普林格尔手法与肝细胞癌肝切除术后复发和存活率的关系:多中心倾向评分和竞争风险回归分析。
背景:在肝切除术中应用普林格尔手法(PM)可减少术中失血和围手术期输血需求,但其对肝细胞癌(HCC)患者长期复发和生存的影响仍存在争议。我们试图确定 PM 的应用与 HCC 患者肝切除术后肿瘤结局之间的关系:确定了 2010 年 1 月至 2018 年 12 月期间在 9 家中国医院接受治愈性肝切除术的 HCC 患者。采用两种倾向评分方法[倾向评分匹配(PSM)和治疗权重反概率(IPTW)],比较了PM组和非PM组患者的累积复发率和癌症特异性死亡率(CSM)。采用多变量竞争风险回归模型来调整非癌症特异性死亡率和其他预后风险因素的影响:在纳入的 2,798 例患者中,分别有 2,404 例和 394 例采用和未采用 PM(PM 组和非 PM 组)。两组患者的术中输血率、术后 30 天死亡率和发病率相当(P 均大于 0.05)。在按1:3比例计算的PSM队列中,与非PM组的382名患者相比,PM组的1146名患者的5年累计复发率和CSM也更高(分别为63.9%和39.1% vs. 55.3%和31.6%,均为PConclusions):研究结果表明,HCC 患者在肝切除术中不应用 PM 可将术后复发和癌症特异性死亡的风险降低约 20%-25%。
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来源期刊
自引率
10.00%
发文量
392
期刊介绍: Hepatobiliary Surgery and Nutrition (HBSN) is a bi-monthly, open-access, peer-reviewed journal (Print ISSN: 2304-3881; Online ISSN: 2304-389X) since December 2012. The journal focuses on hepatopancreatobiliary disease and nutrition, aiming to present new findings and deliver up-to-date, practical information on diagnosis, prevention, and clinical investigations. Areas of interest cover surgical techniques, clinical and basic research, transplantation, therapies, NASH, NAFLD, targeted drugs, gut microbiota, metabolism, cancer immunity, genomics, and nutrition and dietetics. HBSN serves as a valuable resource for professionals seeking insights into diverse aspects of hepatobiliary surgery and nutrition.
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