Abstract:Objective: To compare the clinical effects of total hepatic inflow occlusion (Pringle’s maneuver) and hemihepatic inflow occlusion (HHO) in hepatectomy for hepatocellular carcinoma (HCC).
Methods: The clinical data of 141 patients with HCC undergoing liver resection from January 2012 to December 2016 were analyzed retrospectively. Of the patients, 71 cases underwent hepatic inflow occlusion with Pringle’s maneuver (Pringle group) and 70 cases underwent hepatic inflow occlusion with HHO method (HHO group). The main clinical variables between the two groups of patients were compared.
Results: There were no significant differences in the baseline data between the two groups of patients (all P>0.05). The operative time in HHO group was significantly longer than that in Pringle group (P=0.001), but no significant differences were noted in other clinical variables that included intraoperative blood loss, amount of blood transfusion, proportion needing blood transfusion, liver resection scope, length of postoperative hospital stay and incidence of postoperative complications between the two groups (all P>0.05). In terms of postoperative pathology, all variables except the presence of vessel tumor emboli (P=0.022) showed no significant differences between the two groups (all P>0.05). In the stratification analyses of patients with hepatitis B, liver cirrhosis or major liver resection, the operative times in HHO group were all significantly longer than those in Pringle group (all P<0.05); the majority of postoperative liver function parameters in HHO group were superior to those in Pringle group, but only the differences of albumin levels on postoperative day (POD) 7 in patients with hepatitis B and the ALB levels on POD 7 and aspartate aminotransferase levels on POD 5 in patients with major liver resection had statistical significance (all P<0.05), all differences in the remaining liver function parameters and other clinical variables did not reach a statistical significance (all P>0.05).
Conclusion: In hepatectomy for HCC, both methods for hepatic inflow occlusion are safe and effective. However, in those with hepatitis, cirrhosis or major hepatectomy, HHO method is recommended for hepatic inflow occlusion.