Study of Liver Resection With Versus Without Hepatic Inflow Occlusion for the HBV-related HCC (OHx-NOHx)
Short- and Long-term Outcomes of Liver Resection With Versus Without Hepatic Inflow Occlusion for the Hepatitis B Virus-related Hepatocellular Carcinoma: a Prospective Randomized Controlled Trial
調査の概要
詳細な説明
High prevalence of hepatitis B virus (HBV) imposes a huge burden of hepatocellular carcinoma (HCC) in Asia. Liver resection remains the mainstay of treatment for HCC. Hepatic inflow occlusion, known as the Pringle maneuver, is most commonly used to reduce blood loss during liver parenchymal transection. A major issue about this maneuver is the ischemia-reperfusion injury to the remnant liver. And the hemodynamic disturbance to the tumor-bearing liver remains an oncologic concern. Given the technical advances in living donor liver transplantation, vascular occlusion can be avoided in liver resection by experienced hands. This study aims to compare the perioperative and long-term outcomes of liver resection for HBV-related HCC without versus with hepatic inflow occlusion.
This study will include eligible patients with HBV-related HCC elected for liver resection. 57 patients will be enrolled in each randomized arm to detect a 20% difference in the serum level of total bilirubin on postoperative day 5 (80% power and α = 0.05). The secondary endpoints include procedural parameters, perioperative liver function and inflammatory response, postoperative morbidity and mortality, and long-term outcomes. Patients will be followed for up to five years. Data will be statistically analyzed on an intention-to-treat basis.
This prospective randomized controlled trial is designed to evaluate the feasibility of liver resections for HBV-related HCC without vascular occlusion. Clinical implication of its outcomes may change the present surgical practice and fill the oncologic gaps therein.
研究の種類
入学 (予想される)
段階
- 適用できない
連絡先と場所
研究場所
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Beijing
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Beijing、Beijing、中国、100853
- 募集
- Chinese PLA General Hospital
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コンタクト:
- Yinzhe Xu, M.D., Ph.D.
- 電話番号:86-10-66936609
- メール:james_hbp@163.com
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主任研究者:
- Shichun Lu, M.D., Ph.D.
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Elective liver resection due to HBV-related HCC with Barcelona-Clinic Liver Cancer (BCLC) staging 0 or A;
- Child-Pugh classified A with or without cirrhosis, or reversed to A from B after conventional therapy;
- Tumors located either in the left or right hemiliver;
- Resection extent was a hemi-hepatectomy or less;
- Informed consent.
Exclusion Criteria:
- Having comorbidity that contraindicates surgery;
- Participation in concurrent interventional trials with interference to this study;
- Eligible for laparoscopic hepatectomy;
- Requiring concomitant procedures, such as digestive, vascular or biliary reconstruction;
- Lack of compliance for treatment or future follow-up.
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:独身
武器と介入
参加者グループ / アーム |
介入・治療 |
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介入なし:Hx with hepatic inflow occlusion
Hepatectomy is carried out using Pringle maneuver in cycles of 15 minutes clamping + 5 minutes unclamping of the hepatoduodenal ligament.
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実験的:Hx with non-occlusion technique
Hepatectomy without hepatic inflow occlusion (non-occlusion technique)
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Hepatectomy is carried out without hepatic inflow control.
(non-occlusion technique)
他の名前:
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Serum total bilirubin on postoperative day 5
時間枠:5 days
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Postoperative liver insufficiency characterized by the serum total bilirubin on POD 5.
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5 days
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Intraoperative blood loss
時間枠:Entire operation duration
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Total blood loss from the incision to the closure of abdomen
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Entire operation duration
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Requirement of blood transfusion
時間枠:Entire operation duration
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The amount of intraoperative blood transfusion
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Entire operation duration
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Operative time
時間枠:Entire operation duration
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The time from induction of anesthesia to the closure of abdomen
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Entire operation duration
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Postoperative intensive-care unit (ICU) stay
時間枠:Duration of stay in ICU
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Duration of stay in ICU
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Duration of stay in ICU
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Hospital stay
時間枠:Duration of hospital stay
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Duration of hospital stay
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Duration of hospital stay
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Total hospital expenditure
時間枠:Duration of hospital stay
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Total costs during hospital stay
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Duration of hospital stay
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Perioperative systemic inflammatory response
時間枠:an expected average of 7 days
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Perioperative systemic inflammatory response is characterized by elevated serum level of tumor necrosis factor-α (TNF-α), interleukins (IL)-1α, 2, 6, 8 and 10, procalcitonin (PCT) and C-reactive protein (CRP) at different time points.
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an expected average of 7 days
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Postoperative morbi-mortality
時間枠:an expected average of 12 days in hospital
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Postoperative morbi-mortality is characterized by postoperative complication and its severity based on Clavien-Dindo classification and in-hospital mortality
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an expected average of 12 days in hospital
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Long-term oncologic outcomes
時間枠:5 years after operation
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1, 3, 5-year tumor recurrence rate
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5 years after operation
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Long-term survival
時間枠:5 years after operation
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1, 3, 5-year overall survival (OS) and disease (tumor)-free survival (DFS)
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5 years after operation
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協力者と研究者
捜査官
- 主任研究者:Shichun Lu, MD, PhD、Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
出版物と役立つリンク
一般刊行物
- Llovet JM, Fuster J, Bruix J; Barcelona-Clinic Liver Cancer Group. The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl. 2004 Feb;10(2 Suppl 1):S115-20. doi: 10.1002/lt.20034.
- Katz SC, Shia J, Liau KH, Gonen M, Ruo L, Jarnagin WR, Fong Y, D'Angelica MI, Blumgart LH, Dematteo RP. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg. 2009 Apr;249(4):617-23. doi: 10.1097/SLA.0b013e31819ed22f.
- Dong JH, Yang SZ, Duan WD, Ji WB, Cai SW, Wang J, Shi XJ, Jiang K, Xia HT, He L, Zhang WZ, Huang XQ, Huang ZQ. [Clinical application of precise liver resection techniques in patients with complicated liver space-occupying lesions]. Zhonghua Wai Ke Za Zhi. 2009 Nov 1;47(21):1610-5. Chinese.
- Huang ZQ, Xu LN, Yang T, Zhang WZ, Huang XQ, Liu R, Cai SW, Zhang AQ, Feng YQ, Zhou NX, Dong JH. [Liver resection: single center experiences of 2008 consecutive resections in 20 years]. Zhonghua Wai Ke Za Zhi. 2008 Sep 1;46(17):1314-21. Chinese.
- Dong J, Yang S, Zeng J, Cai S, Ji W, Duan W, Zhang A, Ren W, Xu Y, Tan J, Bu X, Zhang N, Wang X, Wang X, Meng X, Jiang K, Gu W, Huang Z. Precision in liver surgery. Semin Liver Dis. 2013 Aug;33(3):189-203. doi: 10.1055/s-0033-1351781. Epub 2013 Aug 13. Danish, English.
- Sugiyama Y, Ishizaki Y, Imamura H, Sugo H, Yoshimoto J, Kawasaki S. Effects of intermittent Pringle's manoeuvre on cirrhotic compared with normal liver. Br J Surg. 2010 Jul;97(7):1062-9. doi: 10.1002/bjs.7039.
- Kim YI, Song KE, Ryeon HK, Hwang YJ, Yun YK, Lee JW, Chun BY. Enhanced inflammatory cytokine production at ischemia/reperfusion in human liver resection. Hepatogastroenterology. 2002 Jul-Aug;49(46):1077-82.
- Fu SY, Lau WY, Li GG, Tang QH, Li AJ, Pan ZY, Huang G, Yin L, Wu MC, Lai EC, Zhou WP. A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy. Am J Surg. 2011 Jan;201(1):62-9. doi: 10.1016/j.amjsurg.2009.09.029. Epub 2010 Apr 20. Erratum In: Am J Surg. 2011 Jul;202(1):117. multiple author names corrected.
- Xu Y, Chen J, Wang H, Zheng H, Feng D, Zhang A, Leng J, Duan W, Yang Z, Chen M, Shi X, Cai S, Ji W, Jiang K, Zhang W, Chen Y, Gu W, Dong J, Lu S. Perioperative and long-term outcomes of liver resection for hepatitis B virus-related hepatocellular carcinoma without versus with hepatic inflow occlusion: study protocol for a prospective randomized controlled trial. Trials. 2016 Oct 11;17(1):492. doi: 10.1186/s13063-016-1621-9.
研究記録日
主要日程の研究
研究開始
一次修了 (予想される)
研究の完了 (予想される)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
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