An Tailai, Wang Yan, Liu Linsen, Wang Yawei, Deng Lingna, Wu Meilong
Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, Dongmen North Road 1017, Luohu District, Shenzhen, 518020, Guangdong, China.
Department of Radiology, Shenzhen People's Hospital, Dongmen North Road 1017, Luohu District, Shenzhen, 518020, Guangdong, China.
Langenbecks Arch Surg. 2024 Feb 6;409(1):53. doi: 10.1007/s00423-024-03248-5.
Pringle maneuver (PM) is a double-edged sword in liver resection, which is beneficial in reducing blood loss but also causes ischemia-reperfusion injury which may stimulate the outgrowth of micrometastases. The impact of PM on tumor recurrence remains controversial. This study aimed to assess whether PM has effect on the prognosis of colorectal cancer liver metastases (CRLM) after hepatectomy.
PubMed and the Cochrane Library databases were searched. The PM is defined as the portal triad clamping for several minutes, followed by several minutes of reperfusion, repeated as needed. Prolonged PM was defined as continuous clamping ≥ 20 min or ≥ 3 cycles for maximally 15-min intermittent ischemia.
Eleven studies encompassing 4054 patients were included in this meta-analysis. The pooled hazard ratio (HR) did not show significant differences between PM and non-PM groups for disease-free survival (DFS) (HR = 0.91, 95% confidence interval (CI) 0.76-1.11, P = 0.36) and overall survival (HR = 1.03, 95% CI 0.76-1.39, P = 0.87). Subgroup analysis revealed that prolonged PM has adverse impact on DFS (HR 1.75, 95% CI = 1.28-2.40, P = 0.0005). However, non-prolonged PM is a protective factor for DFS (HR 0.82, 95% CI = 0.73-0.92, P = 0.001).
These findings suggested that prolonged PM may have an adverse impact on the DFS of patients with CRLM and non-prolonged PM is a protective factor for DFS. Further prospective multicenter studies are warranted.
在肝切除术中，普林格尔手法（PM）是一把双刃剑，它有助于减少失血，但也会导致缺血再灌注损伤，这可能会刺激微转移灶的生长。PM对肿瘤复发的影响仍存在争议。本研究旨在评估PM对肝切除术后结直肠癌肝转移（CRLM）患者预后的影响。
检索PubMed和Cochrane图书馆数据库。PM定义为门静脉三联征夹闭数分钟，然后再灌注数分钟，根据需要重复进行。延长的PM定义为持续夹闭≥20分钟或≥3个周期，最大间歇性缺血时间为15分钟。
本荟萃分析纳入了11项研究，共4054例患者。在无病生存期（DFS）方面，PM组和非PM组的合并风险比（HR）无显著差异（HR = 0.91，95%置信区间（CI）0.76 - 1.11，P = 0.36）；在总生存期（OS）方面，合并HR也无显著差异（HR = 1.03，95% CI 0.76 - 1.39，P = 0.87）。亚组分析显示，延长的PM对DFS有不利影响（HR 1.75，95% CI = 1.28 - 2.40，P = 0.0005）。然而，非延长的PM是DFS的保护因素（HR 0.82，95% CI = 0.73 - 0.92，P = 0.001）。
这些发现表明，延长的PM可能对CRLM患者的DFS有不利影响，而非延长的PM是DFS的保护因素。有必要进行进一步的前瞻性多中心研究。
