Hepatocellular Carcinoma
Conditions
Keywords
hepatectomy, vascular inflow occlusion
Brief summary
Bleeding is a major problem during liver resection. Vascular inflow occlusion, also known as Pringle maneuver, has been commonly employed to reduce blood loss during liver surgery. However, Pringle maneuver might cause ischaemic insult to the remnant liver and lead to post-operative liver dysfunction. The investigators hypothesize that liver resection without the use of vascular inflow occlusion (Pringle maneuver) is associated with lower postoperative complications rate. The aim of this study is to evaluate whether elective open liver resection without vascular inflow occlusion (Pringle Maneuvre) would lead to a reduction of post-operative surgical complications in patient with hepatocellular carcinoma. Eligible patients undergoing liver resection in the Prince of Wales Hospital will be recruited and randomized into 2 study arms comparing the effect of Pringle maneuver.
Interventions
PROCEDUREPringle
Vascular clamp is applied across hepatoduodenal ligament intermittently in 15 minutes on / 5 minutes off interval
Sponsors
Chinese University of Hong Kong
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \>18 * Child's A or B cirrhosis
Exclusion criteria
* Informed consent not available * Presence of portal vein thrombosis, portal vein tumor thrombus, or previous portal vein embolisation * Presence of hepatic artery thrombosis, previous transarterial therapy like TACE, lipiodol-ethanol mixture injection or transarterial internal radiation * Anticipation of portal vein resection * Emergency hepatectomy * Ruptured HCC * Adhesion or anatomical variation that preclude safe and successful application of Pringle maneuver * Anticipation of concomitant bowel or bile duct resection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Post-operative surgical complications | 1 month | 30-day morbidity after open liver resection, which includes ascites, pleural effusion, wound infection and intra-abdominal collection |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Other post-operative complications | 1 month | post-operative liver failure, post-op mortality, operative blood loss, duration of operation and hospital stay |
| Survival | 5 year | Overall and disease-free survival at 1, 3, 5-year |
| Recurrence rate of hepatocellular carcinoma | 5 year | Recurrence rate of hepatocellular carcinoma at 1,3,5 year |
Countries
China
Outcome results
None listed