Proper hepatic pedicle clamping during hepatectomy is associated with improved postoperative long-term prognosis in patients with AJCC stage IIIB hepatocellular carcinoma

Abstract

Intermittent hepatic pedicle clamping (HPC) is often performed duringhepatectomy. Whether it affects the long-term prognosis of hepatocellular carcinoma(HCC) patients is still controversial. This study evaluated the impact of HPC in patientswith different stages of HCC. The study included 1401 patients who underwenthepatectomy in the primary cohort with 129 AJCC stage IIIB HCC patients; there were80 AJCC stage IIIB HCC patients in the validation cohort. In each cohort, patients wereplaced in the long-term HPC (LTHPC) group or the short-term HPC (STHPC) groupbased on the cut-off time of HPC estimated by the receiver-operating characteristic(ROC) curve. Although HPC did not show significant effects on the prognosis of stageI-IIIA HCC patients in the primary cohort, 1-, 3-, and 5-year overall survival (OS) andrecurrence-free survival (RFS) rates of stage IIIB HCC patients who received LTHPC(HPC time > 12 minutes) were significantly higher than those with STHPC (HPC time ≤ 12 minutes or received no HPC), similar in the validation cohort. Multivariate analysisdemonstrated HPC time was an independent protective factor for RFS and OS in stageIIIB HCC patients. Herein, we report that proper HPC improved the postoperativeprognosis of stage IIIB HCC patients and served as an independent protective factor.