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Feng Xiaobin, Zheng Shuguo,
Zhou Jian,
Qiu Yudong,
Liang Lijian,
Ma Kuansheng,
Li Xiaowu,
Xia Feng,
Yi Dong,
Wang Shuguang,
Bie Ping,
Dong Jiahong
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ABSTRACT: BACKGROUND: Hepatic resection is currently still the best choice of therapeutic strategies for liver cancer, but the long-term survival rate after surgery is unsatisfactory. Most patients develop intra- and/or extrahepatic recurrence. The reasons for this high recurrence rate are not entirely clear. Recent studies have indicated that ischemia-reperfusion injury to the liver may be a significant factor promoting tumor recurrence and metastasis in animal models. If this is also true in humans, the effects of the Pringle maneuver, which has been widely used in hepatectomy for the past century, should be examined. To date, there are no reported data or randomized controlled studies examining the relationship between use of the Pringle maneuver and local tumor recurrence. We hypothesize that the long-term prognosis of patients with liver cancer could be worsened by use of the Pringle maneuver due to an increase in the rate of tumor recurrence in the liver remnant. We designed a multicenter, prospective, randomized surgical trial to test this hypothesis. Methods At least 498 eligible patients from five participating centers will be enrolled and randomized into either the Pringle group or the non-Pringle group in a ratio of 1:1 using a permuted-blocks randomization protocol. After the completion of surgical intervention, patients will be included in a 3-year follow-up program. Discussion This multicenter surgical trial will examine whether the Pringle maneuver has a negative effect on the long-term outcome of hepatocellular carcinoma patients. The trial will also provide information about prognostic differences, safety, advantages and disadvantages between Pringle and non-Pringle surgical procedures. Ultimately, the results will increase the available information about the effects of ischemia-reperfusion injury on tumor recurrence, which will be of immense benefit to general surgery. Trial Registration: www.clinicaltrials.gov NCT00725335 KEYWORDS: Hepatocellular carcinoma, ischemia/reperfusion, hepatectomy, Pringle maneuver.
BMC Cancer 08/2012; 12(1):340. · 3.01 Impact Factor
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ABSTRACT: Up to now, curative hepatectomy remains the best treatment for patients with liver cancer, during which ischemia/reperfusion injuries of the liver is inevitable. While the ischemia/reperfusion is a major cause of morbidity and mortality in patients undergone hepatectomy and transplantation, so how to reduce it to an acceptable level and to enhance the tolerance of liver to ischemia/reperfusion injury seem to be an eternal challenge for the hepatobiliary surgeon. Considering the broad protective effect of alcohol, we rationally proposed that the protection induced by ethanol consumption might take place without creature species limitation and without organ specific. To our interests, the liver is the most important place where the alcohol mainly metabolized in our body. The metabolic process of alcohol subsequently induces oxidative stress and inflammatory reaction to the liver. If it simulates the same effect as it acts on other organs, alcohol consumption might be advantageous to the liver undergone subsequent ischemia/reperfusion injuries. Since we are not trying to cure diseases occurring only in rats, the likely relevance of human liver injury should be carefully considered. To adequately evaluate our hypothesis that ethanol preconditioning before liver surgery may do good for the patients due to its induction of the tolerance of the liver to ischemia and reperfusion injuries, at least two studies need to be performed in future. The objective is to find out a simple and effective method to prevent the ischemia/reperfusion injuries during hepatectomy as well as other liver surgery and improve the perioperative outcome of the affected patients. Whether alcohol consumption can protect the liver ischemia/reperfusion injuries both from animals to human, or can only take effect in experiments, or neither of them? All these questions might be answered by the presumed studies. Of course, it would be more useful to testify the true effects of ethanol preconditioning in a clinical situation.
Medical Hypotheses 04/2009; 73(2):207-10. · 1.39 Impact Factor
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ABSTRACT: Curative hepatectomy is still the best therapeutic strategy for liver cancer treatment up to now. The Pringle manoeuvre has been commonly used to avoid massive blood loss during operation since its advent, which greatly accelerates the advance of liver surgery and oncological surgery. In the past century, more attentions have been paid to different effects of ischemia-reperfusion injury elicited by Pringle manoeuvre. Theses include its impacts on complex metabolic, immunological, and microvascular changes, which altogether might contribute to hepatocellular damage and dysfunction, and contribute to haemodynamic instability. Despite these adverse impacts, the short-term outcome of affected patients under hepatectomy was greatly improved with the advances of surgical techniques and perioperative management in recent years. While the long-term prognosis remains unsatisfactory due to a high incidence of intra/extrahepatic recurrence. The reason for it was not totally elucidated. Furthermore, the effect of the Pringle manoeuvre on the prognosis of oncologic patients and behavior of the tumor cell was not deliberately mentioned. This point was put forward to the front-desk by the specific phenomenon from recent animal studies. It is showed that ischemia-reperfusion injury of the liver remnant may be a significant factor to promote the tumor recurrence and metastasis. If it is a truth in human, there must be a big challenge to the Pringle manoeuvre. So we hypothesized that the long-term prognosis of cancer patients could be worsened by the ischemia-reperfusion injury elicited by Pringle manoeuvre during the hepatectomy and it should be revised, or even, avoided in future hepatectomy for oncologic patients. The less surgical stress including ischemia-reperfusion injury in the hepatic resection without Pringle manoeuvre might contribute to a better prognosis. To get a deeper understanding, prospective randomized clinical trials need to be done. It is surely supposed to provide more important information about the long-term effects of the Pringle manoeuvre, and to our hypothesis.
Medical Hypotheses 02/2009; 72(4):398-401. · 1.39 Impact Factor
