Proper hepatic pedicle clamping during hepatectomy is associated with improved postoperative long-term prognosis in patients with AJCC stage IIIB hepatocellular carcinoma
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Xiaoqiang Li1,2,*, Shuang Liu1,2,*, Hui Li1,2,*, Lei Guo1,2, Bo Zhang1,2, Zhenhai Lin3, Jubo Zhang4, Qinghai Ye1,2
1Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
2Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai 200032, P.R. China
3Department of Hepatic Surgery, Shanghai Cancer Center, Fudan University, Shanghai 200032, P.R. China
4Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
*These authors contributed equally to this work
Qinghai Ye, e-mail: email@example.com
Jubo Zhang, e-mail: firstname.lastname@example.org
Keywords: hepatocellular carcinoma, hepatic pedicle clamping, hepatectomy, tumour stage, prognosis
Received: January 17, 2016 Accepted: February 28, 2016 Published: March 24, 2016
Intermittent hepatic pedicle clamping (HPC) is often performed during hepatectomy. Whether it affects the long-term prognosis of hepatocellular carcinoma (HCC) patients is still controversial. This study evaluated the impact of HPC in patients with different stages of HCC. The study included 1401 patients who underwent hepatectomy in the primary cohort with 129 AJCC stage IIIB HCC patients; there were 80 AJCC stage IIIB HCC patients in the validation cohort. In each cohort, patients were placed in the long-term HPC (LTHPC) group or the short-term HPC (STHPC) group based on the cut-off time of HPC estimated by the receiver-operating characteristic (ROC) curve. Although HPC did not show significant effects on the prognosis of stage I–IIIA HCC patients in the primary cohort, 1−, 3−, and 5-year overall survival (OS) and recurrence-free survival (RFS) rates of stage IIIB HCC patients who received LTHPC (HPC time > 12 minutes) were significantly higher than those with STHPC (HPC time ≤ 12 minutes or received no HPC), similar in the validation cohort. Multivariate analysis demonstrated HPC time was an independent protective factor for RFS and OS in stage IIIB HCC patients. Herein, we report that proper HPC improved the postoperative prognosis of stage IIIB HCC patients and served as an independent protective factor.
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