Open AccessShorter Survival after Liver Pedicle Clamping in Patients Undergoing Liver Resection for Hepatocellular Carcinoma Revealed by a Systematic Review and Meta-Analysis
Author(s) -
Charles-Henri Wassmer,
Beat Moeckli,
Thierry Berney,
Christian Toso,
Lorenzo A. Orci
Publication year - 2021
Publication title -
cancers
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.818
H-Index - 76
ISSN - 2072-6694
DOI - 10.3390/cancers13040637
Subject(s) - medicine , hepatocellular carcinoma , clamping , meta analysis , hepatectomy , odds ratio , randomized controlled trial , liver cancer , carcinoma , surgery , resection , oncology , gastroenterology , mechanical engineering , engineering
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, I 2 = 76.8%) and higher tumor recurrence rates (odds ratio 1.36 1.01 to 1.83. p = 0.044, I 2 = 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.