Prognostic Impact of Pedicle Clamping During Liver Resection for Colorectal Metastases
| Autor: | Moritz Drefs, Martin K. Angele, Maximilian Dörsch, Markus B. Schoenberg, Matthias Assenmacher, Helmut Küchenhoff, Hanno Niess, Markus Albertsmeier, Markus Rentsch, Wolfgang E. Thasler, Tobias S. Schiergens, Markus Guba, Jens Werner, Joachim Andrassy, Florian Kühn |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Curative resection
Cancer Research medicine.medical_specialty Prognostic factor Multivariate analysis 030230 surgery Gastroenterology lcsh:RC254-282 Article Resection 03 medical and health sciences 0302 clinical medicine Blood loss Transfusion requirement Internal medicine medicine Pringle In patient blood loss Survival analysis transfusion business.industry lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens pedicle clamping Oncology 030220 oncology & carcinogenesis business colorectal liver metastasis |
| Zdroj: | Cancers, Vol 13, Iss 72, p 72 (2021) Cancers Volume 13 Issue 1 |
| ISSN: | 2072-6694 |
| Popis: | Pedicle clamping (PC) during liver resection for colorectal metastases (CRLM) is used to reduce blood loss and allogeneic blood transfusion (ABT). The effect on long-term oncologic outcomes is still under debate. A retrospective analysis of the impact of PC on ABT-demand regarding overall (OS) and recurrence-free survival (RFS) in 336 patients undergoing curative resection for CRLM was carried out. Survival analysis was performed by both univariate and multivariate methods and propensity-score (PS) matching. PC was employed in 75 patients (22%). No increased postoperative morbidity was monitored. While the overall ABT-rate was comparable (35% vs. 37%, p = 0.786), a reduced demand for more than two ABT-units was observed (p = 0.046). PC-patients had better median OS (78 vs. 47 months, p = 0.005) and RFS (36 vs. 23 months, p = 0.006). Multivariate analysis revealed PC as an independent prognostic factor for OS (HR = 0.60 p = 0.009) and RFS (HR = 0.67 p = 0.017). For PC-patients, 1:2 PS-matching (N = 174) showed no differences in the overall ABT-rate compared to no-PC-patients (35% vs. 40%, p = 0.619), but a trend towards reduced transfusion requirement (> 2 ABT-units: 9% vs. 21%, p = 0.052 > 4 ABT-units: 2% vs. 11%, p = 0.037) and better survival (OS: 78 vs. 44 months, p = 0.088 RFS: 36 vs. 24 months p = 0.029). Favorable long-term outcomes and lower rates of increased transfusion demand were observed in patients with PC undergoing resection for CRLM. Further prospective evaluation of potential oncologic benefits of PC in these patients may be meaningful. |
| Databáze: | OpenAIRE |
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