ORIGINAL ARTICLE   

Minerva Medica 2017 August;108(4):324-33

DOI: 10.23736/S0026-4806.17.04788-7

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Comparison of hepatectomy with or without hepatic inflow occlusion in patients with hepatocellular carcinoma: a single-center experience

Jing-Hang JIANG ^{1, 2}, Kai-Xiu WANG ³, Ji-Ye ZHU ⁴, Pei-Pei YANG ², Zhe GUO ⁵, Song-Lin MA ², Yang LÜ ², Bang-De XIANG ¹ ✉, Jian-Hong ZHONG ¹, Le-Qun LI ¹

¹ Department of Hepatobiliary Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China; ² Department of General Surgery, Second People’s Hospital of Jingmen, Jingmen, China; ³ Department of Obstetrics and Gynecology, Second People’s Hospital of Jingmen, Jingmen, China; ⁴ Department of Hepatobiliary Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China; ⁵ Department of Thyroid and Breast Surgery, Wuhan Central Hospital, Wuhan, China

BACKGROUND: The negative effects of hepatic inflow occlusion (HIO) on postoperative liver function of patients with hepatocellular carcinoma (HCC) after liver resection have been reported. Nevertheless, whether or not HIO could influence the long-term outcomes remains unclear.
METHODS: A total of 396 patients were included in this study and divided into without occlusion (WO) group (N.=112) and HIO group (N.=284). Aiming to minimize influence of selection bias and confounding variables, we used propensity score matching (PSM) of a 0.2 caliper to balance baseline variables. Overall survival (OS) and disease-free survival (DFS) were compared by the Kaplan-Meier method. Independent prognostic factors for OS and DFS were identified by Cox proportional hazards regression model.
RESULTS: PSM were used to generate 101 pairs of patients. After PSM, OS was not significantly different between WO and HIO group (1-year: 86.1% vs. 83.2%; 3-year: 61.4% vs. 61.4%; 5-year: 45.5% vs. 39.6%; P = 0.626). Similar results of DFS were obtained between WO and HIO group (1-year: 54.5% vs. 53.5%; 3-year: 30.5% vs. 28.7%; 5-year: 14.2% vs. 14.9%; P=0.873). WO and HIO groups did not differ in 30-day, 90-day mortality and rate of postoperative complications (all P>0.05).
CONCLUSIONS: Our data indicates that HIO might not negatively affect the OS and DFS of HCC patients undergoing liver resection and is likely to be a safe and viable option for intraoperative blood loss control.

KEY WORDS: Hepatocellular carcinoma - Hepatic insufficiency - Mortality - Disease-free survival - Hepatectomy