Safety and Effectiveness of Hemihepatic Blood Flow Occlusion versus Pringle's Maneuver during Hepatectomy: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 CHANGLei , YUMan-cheng , YUANYu-feng , SHENWei-liang , WANGHai-tao , LIUQuan-yan , TANGSheng-li , HEYue-ming ,  LIUZhi-su

Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China;

Corresponding author：

LIUZhi-su, Email: liuzs53@sina.com

Keywords：

Hepatectomy; Hemihepatic blood flow occlusion; Pringle's maneuver; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140125

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the efficacy and safety of hemihepatic blood flow occlusion versus Pringle's maneuver during hepatectomy. Methods We electronically searched The Cochrane Library (Issue 8, 2013), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data for randomized controlled trials (RCTs) about hemihepatic blood flow occlusion versus Pringle's maneuver during hepatectomy. The duration of search was from the inception of the databases to August 2013. Meanwhile, references of the included studies were also retrieved. After literature selection, data extraction and quality assessment conducted by two reviewers independently, meta-analysis was conducted using RevMan 5.2 software. Results Seven studies involving 624 patients were finally included. The results of meta-analysis showed that: a) for safety, Pringle's maneuver was shorter than hemihepatic blood flow occlusion in operation time (SMD=0.34, 95%CI 0.02 to 0.66, P=0.04). But they were alike in intraoperative blood loss, transfusion requirements, hospitalization time, and complications. b) For effectiveness, Pringle's maneuver was lower than hemihepatic blood flow occlusion in the levels of 3rd day ALT (SMD=-0.71, 95%CI-1.28 to-0.14, P=0.02), 7^th day ALT (SMD=-1.73, 95%CI-2.85 to-0.62, P=0.002), 1^st day AST (SMD=-0.74, 95%CI-1.38 to-0.09, P=0.03), 7^th day AST (SMD=-0.99, 95%CI-1.26 to-0.71, P < 0.000 01), 3^rd day TBIL (SMD=-0.34, 95%CI-0.57 to-0.10, P=0.005), and 7^th day TBIL (SMD=-0.52, 95%CI-1.02 to-0.01, P=0.04). Conclusion Compared to the Pringle's maneuver, hemihepatic blood flow occlusion during hepatectomy could promote the recovery of liver function. However, the number of the included RCTs in the review is small and the quality is low, some of the main information is not reported and the information for analysis lacks. Therefore, the aforementioned conclusion needs to be verified by conducting more large-scale, multicenter and high-quality RCTs.

Citation： CHANGLei, YUMan-cheng, YUANYu-feng, SHENWei-liang, WANGHai-tao, LIUQuan-yan, TANGSheng-li, HEYue-ming, LIUZhi-su. Safety and Effectiveness of Hemihepatic Blood Flow Occlusion versus Pringle's Maneuver during Hepatectomy: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(6): 743-751. doi: 10.7507/1672-2531.20140125 Copy

1.	Bergoc RM, Caro RA. The competitive nature of reticuloendothelial "blockade". Int J Nucl Med Biol, 1975, 2(1):33-36.
2.	Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection:analysis of 1, 803 consecutive cases over the past decade. Ann Surg, 2002, 236(4):397-406, 406-407.
3.	Pringle JHV. Notes on the Arrest of Hepatic Hemorrhage Due to Trauma. Ann Surg, 1908, 48(4):541-549.
4.	Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg, 1982, 6(1):3-9.
5.	Lau WY, Lai EC, Lau SH. Methods of vascular control technique during liver resection:a comprehensive review. Hepatobiliary Pancreat Dis Int, 2010, 9(5):473-481.
6.	Zhang J, Lai EC, Zhou WP, et al. Selective hepatic vascular exclusion versus Pringle manoeuvre in liver resection for tumours encroaching on major hepatic veins. Br J Surg, 2012, 99(7):973-977.
7.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
8.	Figueras J, Llado L, Ruiz D, et al. Complete versus selective portal triad clamping for minor liver resections:a prospective randomized trial. Ann Surg, 2005, 241(4):582-590.
9.	Yuan FS, Lau WY, Li GG, et al. A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy. Am J Surg, 2011, 201(1):62-69.
10.	Ni JS, Lau WY, Yang Y, et al. A prospective randomized controlled trial to compare pringle manoeuvre with hemi-hepatic vascular inflow occlusion in liver resection for hepatocellular carcinoma with cirrhosis. J Gastrointest Surg, 2013, 17(8):1414-1421.
11.	Wu CC, Yeh DC, Ho WM, et al. Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients:a randomized comparison of hemihepatic and total hepatic occlusion techniques. Arch Surg, 2002, 137(12):1369-1376.
12.	Liang G, Wen T, Yan L, et al. A prospective randomized comparison of continuous hemihepatic with intermittent total hepatic inflow occlusion in hepatectomy for liver tumors. Hepatogastroenterology, 2009, 56(91-92):745-750.
13.	李广罡, 唐庆贺, 傅思源, 等.选择性与全肝人肝血流阻断法在肝切除术应用的随机对照研究.国际外科学杂志, 2009, 36(4):235-238.
14.	李良科, 段勇. 2种肝血流阻断法在肝癌切除术中的比较.中国医学工程, 2007, 15(9):761-763, 766.
15.	Nakai T, Koh K, Funai S, et al. Comparison of controlled and Glisson's pedicle transections of hepatic hilum occlusion for hepatic resection. J Am Coll Surg, 1999, 189(3):300-304.
16.	Shimada M, Matsumata T, Akazawa K, et al. Estimation of risk of major complications after hepatic resection. Am J Surg, 1994, 167(4): 399-403.
17.	Nagao T, Inoue S, Goto S, et al. Hepatic resection for hepatocellular carcinoma. Clinical features and long-term prognosis. Ann Surg, 1987, 205(1):33-40.
18.	Zhang J, Lai EC, Zhou WP, et al. Selective hepatic vascular exclusion versus Pringle manoeuvre in liver resection for tumours encroaching on major hepatic veins. Br J Surg, 2012, 99(7):973-977.
19.	Xiaobin F, Shuguo Z, Jian Z, et al. Effect of the pringle maneuver on tumor recurrence of hepatocellular carcinoma after curative resection (EPTRH):a randomized, prospective, controlled multicenter trial. BMC Cancer, 2012, 12:340.
20.	Herman P, Perini MV, Coelho F, et al. Half-Pringle maneuver:a useful tool in laparoscopic liver resection. J Laparoendosc Adv Surg Tech A, 2010, 20(1):35-37.
21.	Wen Y, Miao X, Xiong L, et al. Application of hemihepatic vascular occlusion with hanging maneuver in hepatectomy. Hepatogastroenterology, 2009, 56(90):442-446.
22.	Chau G Y, Lui W Y, King KL, et al. Evaluation of effect of hemihepatic vascular occlus ion and the Pringle maneuver during hepatic resection for patients with hepatocellular ca rcinoma and impaired liver function. World J Surg, 2005, 29(11):1374-1383.
23.	Wen T, Chen Z, Yan L, et al. Continuous normothermic hemihepatic vascular inflow occlusion over 60 min for hepatectomy in patients with cirrhosis caused by hepatitis B virus. Hepatol Res, 2007, 37(5): 346-352.
24.	Rahbari NN, Koch M, Mehrabi A, et al. Portal triad clamping versus vascular exclusion for vascular control during hepatic resection:a systematic review and meta-analysis. J Gastrointest Surg, 2009, 13(3): 558-568.
25.	Yoshizumi T, Yanaga K, Soejima Y, et al. Amelioration of liver injury by ischaemic preconditioning. Br J Surg, 1998, 85(12):1636-1640.
26.	Rudiger HA, Kang KJ, Sindram D, et al. Comparison of ischemic preconditioning and intermittent and continuous inflow occlusion in the murine liver. Ann Surg, 2002, 235(3):400-407.
27.	Ezaki T, Seo Y, Tomoda H, et al. Partial hepatic resection under intermittent hepatic inflow occlusion in patients with chronic liver disease. Br J Surg, 1992, 79(3):224-226.
28.	Takayama T, Makuuchi M, Inoue K, et al. Selective and unselective clamping in cirrhotic liver. Hepatogastroenterology, 1998, 45(20): 376-380.
29.	Rudiger HA, Kang KJ, Sindram D, et al. Comparison of ischemic preconditioning and intermittent and continuous inflow occlusion in the murine liver. Ann Surg, 2002, 235(3):400-407.

1. Bergoc RM, Caro RA. The competitive nature of reticuloendothelial "blockade". Int J Nucl Med Biol, 1975, 2(1):33-36.
2. Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection:analysis of 1, 803 consecutive cases over the past decade. Ann Surg, 2002, 236(4):397-406, 406-407.
3. Pringle JHV. Notes on the Arrest of Hepatic Hemorrhage Due to Trauma. Ann Surg, 1908, 48(4):541-549.
4. Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg, 1982, 6(1):3-9.
5. Lau WY, Lai EC, Lau SH. Methods of vascular control technique during liver resection:a comprehensive review. Hepatobiliary Pancreat Dis Int, 2010, 9(5):473-481.
6. Zhang J, Lai EC, Zhou WP, et al. Selective hepatic vascular exclusion versus Pringle manoeuvre in liver resection for tumours encroaching on major hepatic veins. Br J Surg, 2012, 99(7):973-977.
7. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
8. Figueras J, Llado L, Ruiz D, et al. Complete versus selective portal triad clamping for minor liver resections:a prospective randomized trial. Ann Surg, 2005, 241(4):582-590.
9. Yuan FS, Lau WY, Li GG, et al. A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy. Am J Surg, 2011, 201(1):62-69.
10. Ni JS, Lau WY, Yang Y, et al. A prospective randomized controlled trial to compare pringle manoeuvre with hemi-hepatic vascular inflow occlusion in liver resection for hepatocellular carcinoma with cirrhosis. J Gastrointest Surg, 2013, 17(8):1414-1421.
11. Wu CC, Yeh DC, Ho WM, et al. Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients:a randomized comparison of hemihepatic and total hepatic occlusion techniques. Arch Surg, 2002, 137(12):1369-1376.
12. Liang G, Wen T, Yan L, et al. A prospective randomized comparison of continuous hemihepatic with intermittent total hepatic inflow occlusion in hepatectomy for liver tumors. Hepatogastroenterology, 2009, 56(91-92):745-750.
13. 李广罡, 唐庆贺, 傅思源, 等.选择性与全肝人肝血流阻断法在肝切除术应用的随机对照研究.国际外科学杂志, 2009, 36(4):235-238.
14. 李良科, 段勇. 2种肝血流阻断法在肝癌切除术中的比较.中国医学工程, 2007, 15(9):761-763, 766.
15. Nakai T, Koh K, Funai S, et al. Comparison of controlled and Glisson's pedicle transections of hepatic hilum occlusion for hepatic resection. J Am Coll Surg, 1999, 189(3):300-304.
16. Shimada M, Matsumata T, Akazawa K, et al. Estimation of risk of major complications after hepatic resection. Am J Surg, 1994, 167(4): 399-403.
17. Nagao T, Inoue S, Goto S, et al. Hepatic resection for hepatocellular carcinoma. Clinical features and long-term prognosis. Ann Surg, 1987, 205(1):33-40.
18. Zhang J, Lai EC, Zhou WP, et al. Selective hepatic vascular exclusion versus Pringle manoeuvre in liver resection for tumours encroaching on major hepatic veins. Br J Surg, 2012, 99(7):973-977.
19. Xiaobin F, Shuguo Z, Jian Z, et al. Effect of the pringle maneuver on tumor recurrence of hepatocellular carcinoma after curative resection (EPTRH):a randomized, prospective, controlled multicenter trial. BMC Cancer, 2012, 12:340.
20. Herman P, Perini MV, Coelho F, et al. Half-Pringle maneuver:a useful tool in laparoscopic liver resection. J Laparoendosc Adv Surg Tech A, 2010, 20(1):35-37.
21. Wen Y, Miao X, Xiong L, et al. Application of hemihepatic vascular occlusion with hanging maneuver in hepatectomy. Hepatogastroenterology, 2009, 56(90):442-446.
22. Chau G Y, Lui W Y, King KL, et al. Evaluation of effect of hemihepatic vascular occlus ion and the Pringle maneuver during hepatic resection for patients with hepatocellular ca rcinoma and impaired liver function. World J Surg, 2005, 29(11):1374-1383.
23. Wen T, Chen Z, Yan L, et al. Continuous normothermic hemihepatic vascular inflow occlusion over 60 min for hepatectomy in patients with cirrhosis caused by hepatitis B virus. Hepatol Res, 2007, 37(5): 346-352.
24. Rahbari NN, Koch M, Mehrabi A, et al. Portal triad clamping versus vascular exclusion for vascular control during hepatic resection:a systematic review and meta-analysis. J Gastrointest Surg, 2009, 13(3): 558-568.
25. Yoshizumi T, Yanaga K, Soejima Y, et al. Amelioration of liver injury by ischaemic preconditioning. Br J Surg, 1998, 85(12):1636-1640.
26. Rudiger HA, Kang KJ, Sindram D, et al. Comparison of ischemic preconditioning and intermittent and continuous inflow occlusion in the murine liver. Ann Surg, 2002, 235(3):400-407.
27. Ezaki T, Seo Y, Tomoda H, et al. Partial hepatic resection under intermittent hepatic inflow occlusion in patients with chronic liver disease. Br J Surg, 1992, 79(3):224-226.
28. Takayama T, Makuuchi M, Inoue K, et al. Selective and unselective clamping in cirrhotic liver. Hepatogastroenterology, 1998, 45(20): 376-380.
29. Rudiger HA, Kang KJ, Sindram D, et al. Comparison of ischemic preconditioning and intermittent and continuous inflow occlusion in the murine liver. Ann Surg, 2002, 235(3):400-407.

Chinese Journal of Evidence-Based Medicine

Safety and Effectiveness of Hemihepatic Blood Flow Occlusion versus Pringle's Maneuver during Hepatectomy: A Meta-Analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content