Impact of intermittent portal clamping on the early recurrence of hepatocellular carcinoma after surgery

• Published in: Surgery today (Tokyo, Japan) Vol. 46; no. 11; pp. 1290 - 1295
• Main Authors: Hao, Shenghua, Chen, Shaofei, Yang, Xiangwu, Wan, Chidan
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.11.2016
• Subjects: Adult; Aged; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Cohort Studies; Constriction; Female; Follow-Up Studies; Hepatectomy - methods; Humans; Intraoperative Period; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - etiology; Neoplasm Staging; Original Article; Portal Vein; Retrospective Studies; Risk Factors; Surgery; Surgical Oncology; Time Factors; Young Adult; Early recurrence; Hepatocellular carcinoma; Intermittent portal clamping; Recurrence-free survival; Overall survival
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-016-1316-6

Purpose 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.