Background Hepatic resection is currently still the best choice of therapeutic

Background Hepatic resection is currently still the best choice of therapeutic strategies for liver cancer, but the long-term survival rate after surgery is unsatisfactory. After the completion of surgical intervention, patients will be included in a 3-year follow-up program. Discussion This multicenter surgical trial will examine whether the Pringle maneuver has a negative effect on the long-term outcome of hepatocellular carcinoma patients. The trial will also provide information about prognostic differences, protection, benefits and drawbacks between Pringle and non-Pringle surgical treatments. Ultimately, the outcomes increase the obtainable information about the consequences of ischemia-reperfusion damage on tumor recurrence, which is of immense advantage to general surgical treatment. Trial registration http://www.clinicaltrials.gov “type”:”clinical-trial”,”attrs”:”text”:”NCT00725335″,”term_id”:”NCT00725335″NCT00725335 strong course=”kwd-name” Keywords: Hepatocellular carcinoma, Ischemia/reperfusion, Hepatectomy, Pringle maneuver History Hepatocellular carcinoma (HCC) is among the many common cancers worldwide, and has been ranked the next leading malignancy killer in China because the 1990s [1]. Persistent hepatitis B virus (HBV) infection may be the most common etiology in China [2]. order NVP-BGJ398 Curative resection continues to be the best option of HCC therapeutic ways of date, but regional tumor recurrence and remote control metastasis sadly occur in lots of patients who’ve undergone surgical treatment. Although there were great advancements in the analysis and treatment of HCC, the long-term prognosis continues to be unsatisfactory because of a higher incidence of tumor recurrence, which range from 50% to 60% [3-6]. The reason behind this high recurrence price isn’t entirely very clear. Locoregional tumor recurrence with concomitant hepatic decompensation is the main cause of death. It is suggested that further strategies may be needed for the prevention and treatment of early and late recurrence [7]. The Pringle maneuver is a classical surgical technique widely used during hepatectomy since its advent in 1908[8]. During hepatic resection, severe bleeding represents order NVP-BGJ398 a major life-threatening risk [9,10]. The Pringle maneuver (continuous or intermittent clamping of the hepatic artery and portal vein) is routinely used to reduce intraoperative bleeding [11,12]. It seems inevitable that maneuver causes ischemia-reperfusion (I/R) injury, resulting in complex metabolic [13,14], immunological [15], and microvascular [16-18] changes, which together might contribute to hepatocellular damage and dysfunction[13,19]. Over the past century, the effects of the Pringle maneuver have been widely discussed [8,20-32]. From the reported data, order NVP-BGJ398 we know that the technique can significantly reduce blood loss during hepatectomy, meanwhile damaging the liver remnant through the I/R injury. Interestingly, the effects of the Pringle maneuver on the prognosis of oncology patients and on the behavior of tumor cells have not been specifically discussed. It remains unknown whether tumor recurrence and metastasis can be influenced by this surgical stress. However, this possibility has been raised by the results of recent animal studies [33,34]. It has been shown that surgical stress, such as I/R injury, might cause delayed damage to the residual liver (soil), and may also affect the behavior of the tumor cells (seeds) by activating cell invasion and migration signal pathways, thus accelerating tumor recurrence. I/R injury tends to disrupt normal liver tissues and create an environment that may promote tumor recurrence. Hepatic resection will also induce tumor cells to become order NVP-BGJ398 more aggressive Mouse monoclonal to CD15.DW3 reacts with CD15 (3-FAL ), a 220 kDa carbohydrate structure, also called X-hapten. CD15 is expressed on greater than 95% of granulocytes including neutrophils and eosinophils and to a varying degree on monodytes, but not on lymphocytes or basophils. CD15 antigen is important for direct carbohydrate-carbohydrate interaction and plays a role in mediating phagocytosis, bactericidal activity and chemotaxis by promoting the production of cytokines by nonparenchymal liver cells [35]. From the results of these studies, it can easily be concluded that I/R injury to the liver remnant may be a significant factor promoting tumor recurrence and metastasis in experimental animal models. Animal models may introduce potentially important concepts related to the mechanisms involved in tumor recurrence associated with surgical stress, specifically hepatic I/R injury. Furthermore, the promotion of liver metastasis by hepatic I/R injury during liver resection has been reported in colon cancer patients [36,37], and minimization of I/R injury can attenuate metastasis of colorectal cancer to the liver [38-40]. Liver transplant recipients with HCC who receive living-donor grafts experience a higher recurrence rate [41,42] due to the more severe acute-phase injury to the liver graft. For primary liver cancer patient undergoing hepatectomy, the effects of I/R injury on tumor recurrence have to be established. Because usage of the Pringle maneuver during hepatic resection will result in I/R problems for the liver remnant, we are order NVP-BGJ398 able to rationally deduce that it could damage liver function, make the tumor cellular material more intense, and raise the odds of recurrence. If that is discovered to be accurate in humans,.