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Updated: Mar 16, 2026
Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
Continuous Pringle maneuver does not affect outcomes of patients with hepatocellular carcinoma after curative
Wei Xu1, Haifeng Xu1, Huayu Yang1
1Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Continuous Pringle maneuver (PM) reduces bleeding during liver cancer surgery without negatively affecting patient outcomes. This technique is a valuable tool for hepatic resections, including complex cases.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Hepatocellular carcinoma (HCC) is a major global health concern.
- Surgical resection is a primary treatment for HCC.
- The Pringle maneuver (PM) is used to control bleeding during liver surgery.
Purpose of the Study:
- To evaluate the impact of continuous Pringle maneuver (PM) on patient outcomes after hepatocellular carcinoma (HCC) resection.
- To determine if prolonged hepatic inflow occlusion affects survival rates.
Main Methods:
- A retrospective analysis of 586 HCC patients undergoing curative resection.
- Comparison between patients who underwent continuous PM (n=290) and those without inflow occlusion (occlusion-free, OF group, n=296).
- Subgroup analysis of PM group based on occlusion time (<15 min vs. 15-30 min).
Main Results:
- The PM group had significantly less estimated blood loss than the OF group (P=0.005).
- No significant differences in overall survival or disease-free survival (DFS) were observed between PM and OF groups.
- Hepatic inflow occlusion time was not an independent risk factor for overall survival or DFS.
Conclusions:
- Continuous PM is effective in reducing intraoperative bleeding during HCC resection.
- PM does not adversely affect patient outcomes, including survival and DFS.
- PM is a valuable tool for hepatic resection, even in complex cases requiring extended clamping times.
Aim:
To investigate whether the use of continuous Pringle maneuver (PM) adversely impacts the outcome of patients with hepatocellular carcinoma (HCC).
Methods:
From January 1989 to January 2011, 586 HCC patients who underwent curative resection in Peking Union Medical College Hospital were identified from the database. Continuous PM was performed in 290 patients (PM group), including 163 patients with a hepatic inflow occlusion time of <15 min (PM-1 group) and 127 with 15-30 min (PM-2 group). An additional 296 patients underwent partial hepatectomy without inflow occlusion (occlusion-free, OF group).
Results:
The PM group showed less estimated blood loss during hepatectomy than the OF group (P = 0.005) and the two groups experienced similar incidence of perioperative complications. There were no significant differences in either overall survival or disease-free survival (DFS) between the PM and OF groups (P = 0.117 and 0.291, respectively), and between the PM-1 and PM-2 groups (P = 0.344 and 0.103, respectively). Hepatic inflow occlusion and occlusion time were not independent risk factors for OS or DFS.
Conclusions:
Continuous PM effectively reduces intraoperative bleeding and does not adversely impact the outcomes of HCC patients. It remains a valuable tool in hepatic resection, even difficult, complicated resections requiring prolonged clamping times.
