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HPB : the official journal of the International Hepato Pancreato Biliary Association
Sep, 2015;17 (9): 796-803.

The impact of portal pedicle clamping on survival from colorectal liver metastases in the contemporary era of liver resection: a matched cohort study.

Melanie E Tsang, Paul J Karanicolas, Rogeh Habashi, Eva Cheng, Sherif S Hanna, Natalie G Coburn, Calvin H L Law, Julie Hallet
Author Information
  1. Melanie E Tsang: Department of Surgery, University of Toronto, Toronto, ON, Canada.
  2. Paul J Karanicolas: Department of Surgery, University of Toronto, Toronto, ON, Canada.
  3. Rogeh Habashi: Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
  4. Eva Cheng: Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
  5. Sherif S Hanna: Department of Surgery, University of Toronto, Toronto, ON, Canada.
  6. Natalie G Coburn: Department of Surgery, University of Toronto, Toronto, ON, Canada.
  7. Calvin H L Law: Department of Surgery, University of Toronto, Toronto, ON, Canada.
  8. Julie Hallet: Department of Surgery, University of Toronto, Toronto, ON, Canada.
PMID: 26278322 DOI: 10.1111/hpb.12458

Abstract

INTRODUCTION: Portal pedicle clamping (PPC) may impact micro-metastases' growth. This study examined the association between PPC and survival after a hepatectomy for colorectal liver metastases (CRLM).
METHODS: A matched cohort study was conducted on hepatectomies for CRLM at a single institution (2003-2012). Cohorts were selected based on PPC use, with 1:1 matching for age, time period and the Clinical Risk Score. Outcomes were overall and recurrence-free survival (OS and RFS). Cox regression was performed to assess the association between PPC and survival.
RESULTS: Of 481 hepatectomies, 26.9% used PPC. One hundred and ten pairs of patients were matched in the cohorts. There was no significant difference in OS [hazard ratio (HR) 1.18; 95% confidence interval (CI): 0.76-1.83], with a 5-year OS of 57.8% (95%CI: 52.4-63.2%) with PPC versus 62.3% (95%CI: 57.1-67.5%) without. Five-year RFS did not differ (HR 0.98; 95%CI: 0.71-1.35) with 29.7% (95%CI: 24.9-34.5%) with PPC versus 28.0% (95%CI: 23.2-32.8%) without. When adjusting for extent of resection, transfusion, operative time and surgeon, there was no difference in OS (HR 0.91; 95%CI: 0.52-1.60) or RFS (HR: 0.86; 95%CI: 0.57-1.30).
CONCLUSIONS: PPC was not associated with a significant difference in OS or RFS in a hepatectomy for CRLM. PPC remains a safe technique during hepatectomy.

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MeSH Term

Aged
Blood Loss, Surgical
Colorectal Neoplasms
Constriction
Disease-Free Survival
Female
Follow-Up Studies
Hepatectomy
Humans
Liver Neoplasms
Male
Middle Aged
Ontario
Portal Vein
Retrospective Studies
Survival Rate
Journal Article

Word Cloud

Created with Highcharts 10.0.0PPC095%CI:OSsurvivalRFSstudyhepatectomyliverCRLMmatcheddifferenceHRpedicleclampingimpactassociationcolorectalmetastasescohorthepatectomiestimesignificant578%versus5%withoutINTRODUCTION:Portalmaymicro-metastases'growthexaminedMETHODS:conductedsingleinstitution2003-2012Cohortsselectedbaseduse1:1matchingageperiodClinicalRiskScoreOutcomesoverallrecurrence-freeCoxregressionperformedassessRESULTS:481269%usedOnehundredtenpairspatientscohorts[hazardratio11895%confidenceintervalCI:76-183]5-year524-632%623%1-67Five-yeardiffer9871-135297%249-34280%232-32adjustingextentresectiontransfusionoperativesurgeon9152-160HR:8657-130CONCLUSIONS:associatedremainssafetechniqueportalcontemporaryeraresection:

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