The impact of aging on morbidity and mortality after liver resection: a systematic review and meta-analysis

Abstract Objective 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. Methods 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 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, I2=76.8%) and higher tumor recurrence rates (odds ratio 1.36 1.01 to 1.83. p = 0.044, I2=50.7%). Conclusion 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.

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Morbidity and mortality following major liver resection in patients with perihilar cholangiocarcinoma: A systematic review and meta-analysis

HPB ◽

10.1016/j.hpb.2020.04.197 ◽

2020 ◽

Vol 22 ◽

pp. S279-S280

Author(s):

L. Franken ◽

A.M. Schreuder ◽

E. Roos ◽

S. Van Dieren ◽

O. Busch ◽

...

Keyword(s):

Systematic Review ◽

Liver Resection ◽

Meta Analysis ◽

Morbidity And Mortality ◽

Perihilar Cholangiocarcinoma ◽

Major Liver Resection

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Shorter Survival after Liver Pedicle Clamping in Patients Undergoing Liver Resection for Hepatocellular Carcinoma Revealed by a Systematic Review and Meta-Analysis

Cancers ◽

10.3390/cancers13040637 ◽

2021 ◽

Vol 13 (4) ◽

pp. 637

Author(s):

Charles-Henri Wassmer ◽

Beat Moeckli ◽

Thierry Berney ◽

Christian Toso ◽

Lorenzo A. Orci

Keyword(s):

Hepatocellular Carcinoma ◽

Systematic Review ◽

Liver Resection ◽

Tumor Recurrence ◽

Ischemia Reperfusion ◽

Meta Analysis ◽

Remnant Liver ◽

Long Term Outcomes ◽

The Impact

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, I2 = 76.8%) and higher tumor recurrence rates (odds ratio 1.36 1.01 to 1.83. p = 0.044, I2 = 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.

Download Full-text