Efficiency and safety of radiofrequency-assisted hepatectomy for hepatocellular carcinoma with cirrhosis: A single-center retrospective cohort study

Abstract

AIM:To assess the efficiency and safety of radiofrequencyassisted hepatectomy in patients with hepatocellular carcinoma (HCC) and cirrhosis. METHODS:From January 2010 to December 2013, 179 patients with HCC and cirrhosis were recruited for this retrospective study. Of these, 100 patients who received radiofrequency-assisted hepatectomy (RF+ group) were compared to 79 patients who had hepatectomy without ablation (RF-group). The primary endpoint was intraoperative blood loss. The secondary endpoints included liver function, postoperative complications, mortality, and duration of hospital stay. RESULTS:The characteristics of the two groups were closely matched. The Pringle maneuver was not used in the RF+ group. There was significantly less median intraoperative blood loss in the RF+ group (300 vs 400 mL, P = 0.01). On postoperative days (POD) 1 and 5, median alanine aminotransferase was significantly higher in the RF+ group than in the RF-group (POD 1: 348.5 vs 245.5, P = 0.01; POD 5: 112 vs 82.5, P = 0.00), but there was no significant difference between the two groups on POD 3 (260 vs 220, P = 0.24). The median AST was significantly higher in the RF+ group on POD 1 (446 vs 268, P = 0.00), but there was no significant difference between the two groups on POD 3 and 5 (POD 3: 129.5 vs 125, P = 0.65; POD 5: 52.5 Core tip: The purpose of this study was to assess the efficiency and safety of radiofrequency-assisted hepatectomy in patients with hepatocellular carcinoma and cirrhosis. Radiofrequency-assisted hepatectomy can reduce intraoperative blood loss during liver resection effectively. However, this method should be used with caution in patients with concomitant cirrhosis because it may cause severe liver damage and even liver failure.Zhang F, Yan J, Feng XB, Xia F, Li XW, Ma KS, Bie P. Efficiency and safety of radiofrequency-assisted hepatectomy for hepatocellular carcinoma with cirrhosis: A single-center retrospective cohort study.

Microwave-assisted liver resection vs. clamp crushing liver resection in cirrhosis patients with hepatocellular carcinoma

“…Another issue associated with coagulated-assisted LR is infectious complications. The rate of abdominal abscesses varies from 0% to 9.0% (Table 5) [15][16][17][18][19]31]. In our study, the rate of biliary leakage was 7.1%, and the rate of abdominal abscess was 8.9%.…”

“…We also used this procedure in this study. RF-LR or MW-LR was successfully performed with minimal blood loss and limited Pringle manoeuvre times for cirrhotic patients with HCC in some reports [15][16][17][18][19]31]. In the present study, intraoperative blood loss was reduced to 253 ml.…”

“…Postoperative bile complications remain controversial in the performance of precoagulated LR. The rate of bile leakage varied from 0% to 10.5% in a series of studies in HCC patients with underlying cirrhosis (Table 5) [15][16][17][18][19]31]. Another issue associated with coagulated-assisted LR is infectious complications.…”

Feasibility of Precoagulation Without the Pringle Maneuver for Endoscopic Hepatectomy of Cirrhotic Liver

“…As in other studies, the alanine transaminase ALT and aspartate transaminase AST levels were measured postoperatively to assess the extent of hepatic damage to the remnant liver. RFA-assisted hepatectomy patients showed signi cantly higher serum ALT levels than did those undergoing non-RFA-assisted hepatectomy ; moreover, RFA-assisted hepatectomy can further damage the cirrhotic liver 21 . However, the AST and ALT levels quickly improved in the present study, and the lack of PM might have contributed to the absence of severe hepatic damage.…”

A Systematic Review and Meta-Analysis Comparing Liver Resection with the Rf-Based Device Habib™-4X with the Clamp-Crush Technique

“…The device is simple, cost effective, facilitates safe and efficient liver resection and fosters the practice of parenchymal sparing liver resections with a significant reduction in bleeding and subsequent perioperative complications [ 46 , 47 ]. To date, several retrospective and prospective (randomized or non-randomized studies) have been reported comparing various techniques of liver resections’ however, a meta-analysis comparing “bloodless technique of liver resection” (Habib™-4X) with the standard clamp-crush (CC) technique is lacking [ 48 , 49 , 50 , 51 , 52 ].…”