Einfluss des Pringle-Manövers auf Morbidität und Mortalität nach Leberresektion — eine systematische Übersichtsarbeit mit Meta-Analyse

Abstract

Background: Advances in surgical technique, imaging tools, and perioperative care have substantially reduced blood loss during hepatic resection. Based on these developments the need for portal triad clamping (PTC; Pringle-Manoeuvre) either alone or with previous ischemic preconditioning (IPC) in these patients is controversially discussed. The objective of this systematic review and metaanalysis is to quantitatively evaluate impact of portal triad clamping on outcome of patients undergoing hepatic resection. Methods: A systematic literature search was performed following the guidelines of the Cochrane Collaboration. Randomised controlled trials (RCTs) comparing hepatic resection with and without PTC or using PTC with and without previous IPC were eligible for inclusion. Primary outcome measures were overall morbidity and mortality. Further analyses included intraoperative blood loss, number of patients requiring blood transfusion, and postoperative alanine aminotransferase (ALT) levels. Meta-analyses were carried out with a random-effects model. Results: A total of 8 RCTs with a cumulative sample size of 558 patients matched our predefined inclusion criteria. Meta-analyses revealed no difference between study groups with and without PTC regarding morbidity, mortality, intraoperative blood loss, need for blood transfusion, and postoperative ALT levels. Meta-analyses of studies on PTC with and without previous IPC did also show no difference between study groups, except for significantly lower postoperative ALT levels in patients with IPC. Conclusion: The present meta-analysis of available RCTs demonstrates no advantage of PTC and PTC with previous IPC on morbidity, mortality, blood loss, and need for blood transfusion in patients undergoing hepatic resection. Due to potential ischemia and reperfusion injury these data do not support routine use of PTC. If required, PTC should be performed intermittently or after previous IPC.