Shorter Survival after Liver Pedicle Clamping in Patients Undergoing Liver Resection for Hepatocellular Carcinoma Revealed by a Systematic Review and Meta-Analysis.
Charles-Henri WassmerBeat MoeckliThierry BerneyChristian TosoLorenzo A OrciPublished in: Cancers (2021)
Liver pedicle clamping minimizes surgical bleeding during hepatectomy. However, by inducing ischemia-reperfusion injury to the remnant liver, pedicle clamping may be associated with tumor recurrence in the regenerating liver. Hepatocellular carcinoma (HCC) having a high rate of recurrence, evidences demonstrating an eventual association with pedicle clamping is strongly needed. We did a systematic review of the literature until April 2020, looking at studies reporting the impact of liver pedicle clamping on long-term outcomes in patients undergoing liver resection for HCC. Primary and secondary outcomes were overall survival (OS) and disease-free survival, respectively. Results were obtained by random-effect meta-analysis and expressed as standardized mean difference (SMD). Eleven studies were included, accounting for 8087 patients. Results of seven studies were pooled in a meta-analysis. Findings indicated that, as compared to control patients who did not receive liver pedicle clamping, those who did had a significantly shorter OS (SMD = -0.172, 95%CI: -0.298 to -0.047, p = 0.007, I2 = 76.8%) and higher tumor recurrence rates (odds ratio 1.36 1.01 to 1.83. p = 0.044, I2 = 50.7%). This meta-analysis suggests that liver pedicle clamping may have a deleterious impact on long-term outcomes. An individual patient-data meta-analysis of randomized trials evaluating liver pedicle clamping is urgently needed.
Keyphrases
- minimally invasive
- free survival
- robot assisted
- systematic review
- patients undergoing
- ischemia reperfusion injury
- end stage renal disease
- case control
- randomized controlled trial
- chronic kidney disease
- adipose tissue
- clinical trial
- prognostic factors
- type diabetes
- meta analyses
- newly diagnosed
- skeletal muscle
- peritoneal dialysis
- ejection fraction
- big data
- machine learning
- patient reported
- open label
- weight loss
- study protocol
- drug induced