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Gundavda KK, Patkar S, Varty GP, Shah N, Velmurugan K, Goel M. Liver Resection for Hepatocellular Carcinoma: Recent Advances. J Clin Exp Hepatol 2025; 15:102401. [PMID: 39286759 PMCID: PMC11402310 DOI: 10.1016/j.jceh.2024.102401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/06/2024] [Indexed: 09/19/2024] Open
Abstract
Hepatocellular carcinoma (HCC) represents a significant global health burden. Surgery remains a cornerstone in the curative treatment of HCC, and recent years have witnessed notable advancements aimed at refining surgical techniques and improving patient outcomes. This review presents a detailed examination of the recent innovations in HCC surgery, highlighting key developments in both surgical approaches and adjunctive therapies. Advanced imaging technologies have revolutionized preoperative assessment, enabling precise tumour localization and delineation of vascular anatomy. The use of three-dimensional rendering has significantly augmented surgical planning, facilitating more accurate and margin-free resections. The advent of laparoscopic and robotic-assisted surgical techniques has ushered in an era of minimal access surgery, offering patients the benefits of shorter hospital stays and faster recovery times, while enabling equivalent oncological outcomes. Intraoperative innovations such as intraoperative ultrasound (IOUS) and fluorescence-guided surgery have emerged as valuable adjuncts, allowing real-time assessment of tumour extent and aiding in parenchyma preservation. The integration of multimodal therapies, including neoadjuvant and adjuvant strategies, has allowed for 'bio-selection' and shown the potential to optimize patient outcomes. With the advent of augmented reality and artificial intelligence (AI), the future holds immense potential and may represent significant strides towards optimizing patient outcomes and refining the standard of care.
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Affiliation(s)
- Kaival K Gundavda
- Department of Gastrointestinal and Hepatobiliary Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Shraddha Patkar
- Department of Gastrointestinal and Hepatobiliary Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Gurudutt P Varty
- Department of Gastrointestinal and Hepatobiliary Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Niket Shah
- Department of Gastrointestinal and Hepatobiliary Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Karthik Velmurugan
- Department of Gastrointestinal and Hepatobiliary Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Mahesh Goel
- Department of Gastrointestinal and Hepatobiliary Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
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Tebala GD, Avenia S, Cirocchi R, Delvecchio A, Desiderio J, Di Nardo D, Duro F, Gemini A, Giuliante F, Memeo R, Nuzzo G. Turning points in the practice of liver surgery: A historical review. Ann Hepatobiliary Pancreat Surg 2024; 28:271-282. [PMID: 38752233 PMCID: PMC11341877 DOI: 10.14701/ahbps.24-039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 08/23/2024] Open
Abstract
The history of liver surgery is a tale of progressive resolution of issues presenting one after another from ancient times to the present days when dealing with liver ailments. The perfect knowledge of human liver anatomy and physiology and the development of a proper liver resective surgery require time and huge efforts and, mostly, the study and research of giants of their own times, whose names are forever associated with anatomical landmarks, thorough descriptions, and surgical approaches. The control of parenchymal bleeding after trauma and during resection is the second issue that surgeons have to resolve. A good knowledge of intra and extrahepatic vascular anatomy is a necessary condition to develop techniques of vascular control, paving the way to liver transplantation. Last but not least, the issue of residual liver function after resection requires advanced techniques of volume redistribution through redirection of blood inflow. These are the same problems any young surgeon would face when approaching liver surgery for the first time. Therefore, obtaining a wide picture of historical evolution of liver surgery could be a great starting point to serve as an example and a guide.
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Affiliation(s)
| | - Stefano Avenia
- Department of General and Emergency Surgery, “S.Maria della Misericordia” Hospital Trust, Perugia, Italy
| | - Roberto Cirocchi
- Department of Digestive and Emergency Surgery, “S.Maria” Hospital Trust, Terni, Italy
| | - Antonella Delvecchio
- Department of Hepatobiliary Surgery, “F.Miulli” Hospital, Acquaviva delle Fonti, Italy
| | - Jacopo Desiderio
- Department of Digestive and Emergency Surgery, “S.Maria” Hospital Trust, Terni, Italy
| | - Domenico Di Nardo
- Department of Digestive and Emergency Surgery, “S.Maria” Hospital Trust, Terni, Italy
| | - Francesca Duro
- Department of Digestive and Emergency Surgery, “S.Maria” Hospital Trust, Terni, Italy
| | - Alessandro Gemini
- Department of Digestive and Emergency Surgery, “S.Maria” Hospital Trust, Terni, Italy
| | - Felice Giuliante
- Department of Hepatobiliary Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Memeo
- Department of Hepatobiliary Surgery, “F.Miulli” Hospital, Acquaviva delle Fonti, Italy
| | - Gennaro Nuzzo
- Catholic University of the Sacred Heart, Milan, Italy
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Tammaro V, Carlomagno N, Santangelo M, Calogero A, Dodaro CA, Vernillo A, Sica A, Peluso G, Campanile S, Sagnelli E, Sagnelli C. One-stage resection of primary colorectal cancer and hepatic metastases using the Habib Device: analysis of 40 consecutive cases treated in a Unit of general surgery. Minerva Med 2022; 113:846-852. [PMID: 32407049 DOI: 10.23736/s0026-4806.20.06613-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND More than 50% of patients with colorectal cancer (CRC) present or develop hepatic metastases (HM). The intraoperative use of the Habib 4X® radio frequency probe device is safe in resetting HM and allows a one-stage resection of both CRC and HM with a similar mortality rate than a two-stage surgical treatment. METHODS After an exhaustive residential training at the reference center for hepato-biliary surgery of the Imperial College of London, we treated at our unit of general surgery 40 consecutive patients with CRC and HM with the one-stage resection, using the Habib 4X® intraoperative radiofrequency probe device to reset HM. RESULTS None of the 40 patients died during the intra-operatory and post-operatory periods, none presented liver failures during the postoperative course nor complication related to the Habib's resection procedure (e.g. bleeding, abscess, bile leak). The amount of intra-operative liver bleeding was minimal. New HM arose in 10 (25%) cases, with a mean disease-free interval of 13 months, but the hepatic tissue close to previous resections remained cancer-free. The 69.7% of patients were disease-free at month 24 of the post-operative follow-up and 5-year rate was about 70%. CONCLUSIONS The data suggest that surgeons well trained at a reference center for hepato-biliary surgery may perform with excellent results the one-stage CRC and HM resection with the Habib 4X® device even in a Unit of general surgery.
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Affiliation(s)
- Vincenzo Tammaro
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy -
| | - Nicola Carlomagno
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Michele Santangelo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Concetta A Dodaro
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Vernillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonello Sica
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Gaia Peluso
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Silvia Campanile
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
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Deng Q, He M, Fu C, Feng K, Ma K, Zhang L. Radiofrequency ablation in the treatment of hepatocellular carcinoma. Int J Hyperthermia 2022; 39:1052-1063. [PMID: 35944905 DOI: 10.1080/02656736.2022.2059581] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The purpose of this article is to discuss the use, comparative efficacy, and research progress of radiofrequency ablation (RFA), alone or in combination with other therapies, for the treatment of hepatocellular carcinoma (HCC). METHOD To search and summarize the basic and clinical studies of RFA in recent years. RESULTS RFA is one of the radical treatment methods listed in the guidelines for the diagnosis and treatment of HCC. It has the characteristics of being minimally invasive and safe and can obtain good local tumor control, and it can improve the local immune ability, improve the tumor microenvironment and enhance the efficacy of chemotherapy drugs. It is commonly used for HCC treatment before liver transplantation and combined ALPPS and hepatectomy for HCC. In addition, the technology of RFA is constantly developing. The birth of noninvasive, no-touch RFA technology and equipment and the precise RFA concept have improved the therapeutic effect of RFA. CONCLUSION RFA has good local tumor control ability, is minimally invasive, is safe and has other beneficial characteristics. It plays an increasingly important role in the comprehensive treatment strategy of HCC. Whether RFA alone or combined with other technologies expands the surgical indications of patients with HCC and provides more benefits for HCC patients needs to be determined.
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Affiliation(s)
- Qingsong Deng
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Minglian He
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chunchuan Fu
- Department of Hepatobiliary Surgery, Xuanhan County People's Hospital, Xuanhan, China
| | - Kai Feng
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Kuansheng Ma
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Leida Zhang
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Hendriquez R, Keihanian T, Goyal J, Abraham RR, Mishra R, Girotra M. Radiofrequency ablation in the management of primary hepatic and biliary tumors. World J Gastrointest Oncol 2022; 14:203-215. [PMID: 35116111 PMCID: PMC8790419 DOI: 10.4251/wjgo.v14.i1.203] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/15/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023] Open
Abstract
In the United States, 80%-90% of primary hepatic tumors are hepatocellular carcinomas and 10%-15% are cholangiocarcinomas (CCA), both with high mortality rate, particularly CCA, which portends a worse prognosis. Traditional management with surgery has good outcomes in appropriately selected patients; however, novel ablative treatment options have emerged, such as radiofrequency ablation (RFA), which can improve the prognosis of both hepatic and biliary tumors. RFA is aimed to generate an area of necrosis within the targeted tissue by applying thermal therapy via an electrode, with a goal to completely eradicate the tumor while preserving surrounding healthy tissue. Role of RFA in management of hepatic and biliary tumors forms the focus of our current mini-review article.
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Affiliation(s)
- Richard Hendriquez
- Department of Internal Medicine, University of Central Florida, Orlando, FL 32816, United States
| | - Tara Keihanian
- Department of Gastroenterology and Hepatology, University of Miami, Miami, FL 33136, United States
| | - Jatinder Goyal
- Department of Gastroenterology and Hepatology, Wellspan Digestive Health - York Hospital, York, PA 17403, United States
| | - Rtika R Abraham
- Department of Endocrinology, Swedish Medical Center, Seattle, WA 98104, United States
| | - Rajnish Mishra
- Digestive Health Institute, Section of Gastroenterology and Interventional Endoscopy, Swedish Medical Center, Seattle, WA 98104, United States
| | - Mohit Girotra
- Digestive Health Institute, Section of Gastroenterology and Interventional Endoscopy, Swedish Medical Center, Seattle, WA 98104, United States
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Mulpuri VB, Gurijala DP, Yerolla BR, Kumar G, Dutt A. Liver Parenchymal Transection Through Radiofrequency Ablation Using a Radial Probe: Technical Report of a New Modality. Cureus 2021; 13:e20130. [PMID: 35003968 PMCID: PMC8726509 DOI: 10.7759/cureus.20130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/05/2022] Open
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Zhou Y, Ouyang J, Wang Z, Chen X, Zhu R, Li Q, Zhou J. A novel internal cold circulation radiofrequency-assisted device for liver transection. Int J Hyperthermia 2021; 38:308-315. [PMID: 33627010 DOI: 10.1080/02656736.2021.1889046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of a new internal cold circulation bipolar radiofrequency compared with Habib-4X bipolar radiofrequency device in the resection of liver tumors. METHODS A total of 85 patients with hepatocellular carcinoma who received radiofrequency-assisted liver resection from February 2017 to January 2020 were retrospectively enrolled in our study, in which 45 patients received the new internal cold circulation bipolar radiofrequency (New-RF) and 40 patients received Habib-4X bipolar radiofrequency (Habib-4X). Primary outcome measures were the speed of liver transection, the width of coagulation tissue, hemorrhage volume, blood transfusion rate, and operation time. RESULTS The baseline characteristics of patients in the New-RF and Habib-4X groups had no significant difference (p > 0.05). Compared to Habib-4X, the New-RF had a faster average speed of liver transection (4.81 ± 1.20 cm2/min vs 3.64 ± 1.08 cm2/min, p < 0.001), a narrower width of coagulation tissue (1.42 ± 0.23 cm2 vs 1.81 ± 0.20 cm2, p < 0.001), a less operation time (55.04 ± 16.12 min vs 64.02 ± 15.09 min, p = 0.010), a lower rate of needle path bleeding (13.3% vs 35.0%, p = 0.019), and a lower carbonization rate of electrode needle (22.2% vs 77.8%, p < 0.001). Hemorrhage during the transection (85.0 ml vs 105.0 ml, p = 0.438) and hemorrhage per square centimeter (3.28 ± 0.86 ml/cm2 vs 3.60 ± 1.12 ml/cm2, p = 0.141) in the New-RF group were smaller than those in Habib-4X group with no significant difference. CONCLUSION The new internal cold circulation bipolar radiofrequency was a safe and efficacious auxiliary device for liver resection with a faster speed of resection, lower carbonization rate of electrode needle, and more precise range of coagulation.
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Affiliation(s)
- Yanzhao Zhou
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan, People's Republic of China
| | - Jingzhong Ouyang
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan, People's Republic of China
| | - Zhengzheng Wang
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan, People's Republic of China
| | - Xun Chen
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan, People's Republic of China
| | - Ruili Zhu
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan, People's Republic of China
| | - Qingjun Li
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan, People's Republic of China
| | - Jinxue Zhou
- Department of Hepatopancreatobiliary Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Henan, People's Republic of China
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Yang Q, Li W, Chen Z, Chen D, Du Y, Lang L, Ye Z, Shen S, Lei Z, Zhang S. Water-cooled microwave ablation array for bloodless rapid transection of the liver. Int J Hyperthermia 2021; 38:823-829. [PMID: 34058947 DOI: 10.1080/02656736.2021.1912411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Microwaves (MWs) deliver relatively high temperatures into biological tissue and cover a large ablation zone. This study aims to evaluate the efficacy and effectiveness of water-cooled double-needle MW ablation arrays in assisting the hepatic transection of an in vivo pig model. METHODS Our research program comprised computer modeling, tissue-mimicking phantom experiments, and in vivo pig liver experiments. Computer modeling was based on the finite element method (FEM) to evaluate ablation temperature distributions. In tissue-mimicking phantom and in vivo pig liver ablation experiments, the performances of the water-cooled MW ablation array and conventional clamp crushing liver resection were compared. RESULTS FEM showed that the maximum lateral ablation diameter at 100 W output and a duration of 60 s was 3 cm (assessed at 50 °C isotherm). In the phantom, the maximum transverse ablation diameter of the double-needle MW ablation increased rapidly to 3 cm in 60 s at 50 W. The blood loss and blood loss per transection area in Group A were significantly lower than those in Group B (18 (7-26) ml vs. 34 (19-57) ml, and 2.4 (2-3.1) ml/cm2 vs. 6.9 (3.2-8.3) ml/cm2, respectively) (p < 0.05). The transection speed in Group A (2.6(1.9-3.8) cm2/min) was significantly faster than that in Group B (1.7(1.1-2.2) cm2/min) (p < 0.05). CONCLUSION In this experimental model, the new water-cooled MW array-assisted liver resection (LR) has the potential advantage of less blood loss and rapid removal than the conventional LR.
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Affiliation(s)
- Qiang Yang
- Department of Pancreatic Surgery, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Wei Li
- Department of Pancreatic Surgery, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Zubing Chen
- Department of General Surgery, The 7th Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Duidui Chen
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Yuxin Du
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Lang
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China.,National Key Laboratory of Science and Technology on Multi-Spectral Information Processing, Huazhong University of Science and Technology, Wuhan, China
| | - Zi Ye
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Shiqiang Shen
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Zhenyu Lei
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Siqi Zhang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
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Galun D, Bogdanovic A, Zivanovic M, Zuvela M. Short- and Long-Term Outcomes After Hepatectomy in Elderly Patients with Hepatocellular Carcinoma: An Analysis of 229 Cases from a Developing Country. J Hepatocell Carcinoma 2021; 8:155-165. [PMID: 33791251 PMCID: PMC8001645 DOI: 10.2147/jhc.s297296] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/09/2021] [Indexed: 01/27/2023] Open
Abstract
Background The number of elderly patients with HCC who undergo liver resection is increasing. Because of the advanced age of the patients, increased postoperative morbidity and reduced overall survival are expected in this population. The study aim was to compare clinicopathologic and operative features, short- and long-term outcomes among hepatocellular carcinoma (HCC) patients from three age groups undergoing potentially curative liver resection in a developing country. Methods Prospectively collected data relating to 229 patients who underwent curative-intent liver resection from January 2009 until December 2018 were analyzed. The patients were divided into two age groups: G1 was below 70 years old (n=151) and G2 was 70 years old and older (n=78). Demographic, clinical, operative data, short- and long-term outcomes were compared between the two groups. Univariate and multivariate analyses of prognostic factors were performed. Results The mean overall morbidity rate of the patients was 31.1% (G1), and 46.2% (G2) by age group. Postoperative morbidity was significantly higher in the G2 group (p=0.03). There was no difference in major morbidity between the two groups (p=0.214). No significant difference in mortality rate and overall survival was found between the study groups (p=0.280, p=0.383). Both age ≥70 years (ie, G2 group) and liver cirrhosis were identified as prognostic factors for postoperative morbidity, and a Child-Pugh score B as a negative prognostic factor for overall survival. In subgroup analysis of patients with cirrhosis, age ≥70, diabetes mellitus and perioperative transfusion were identified as prognostic factors for postoperative morbidity. Conclusion The study confirmed the safety and feasibility of liver resection in elderly patients with HCC. However, appropriate patient selection among the elderly is mandatory in order to improve short- and long-term outcomes.
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Affiliation(s)
- Danijel Galun
- HPB Unit, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, 11000, Serbia.,Medical School, University of Belgrade, Belgrade, 11000, Serbia
| | - Aleksandar Bogdanovic
- HPB Unit, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, 11000, Serbia.,Medical School, University of Belgrade, Belgrade, 11000, Serbia
| | - Marko Zivanovic
- HPB Unit, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, 11000, Serbia
| | - Marinko Zuvela
- HPB Unit, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, 11000, Serbia.,Medical School, University of Belgrade, Belgrade, 11000, Serbia
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Kusano T, Aoki T, Koizumi T, Matsuda K, Yamada K, Nogaki K, Tashiro Y, Wada Y, Hakozaki T, Shibata H, Tomioka K, Hirai T, Yamazaki T, Saito K, Mitamura K, Fujimori A, Koike R, Enami Y, Murakami M. Liver Transection with Precoagulation Therapy in Liver Cirrhosis: Effective Use of an Energy Device at Hepatectomy. Int Surg 2021; 105:603-610. [DOI: 10.9738/intsurg-d-20-00028.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background
Hepatectomy for liver cirrhosis patients requires skillful surgical technique and careful attention because of the fibrotic parenchyma, elevated portal pressure, and impaired coagulation. This report evaluated short- and long-term outcomes for liver cirrhosis patients receiving precoagulation therapy on the parenchymal transection plane, compared with noncoagulation cases.
Methods
Seventy-three patients diagnosed with cirrhosis via postoperative pathological findings were selected after reviewing 887 hepatectomy patient files. They were divided into a precoagulation group (n = 20) and a noncoagulation group (n = 53). There were no significant differences in patient and tumor factors between 2 groups.
Results
The precoagulation group had significantly less blood loss compared with noncoagulation group [282 vs 563g (P < 0.05)], shorter operative time [214 vs 276 min (P = 0.06)], and shorter postoperative hospital stays [14.5 vs 22.5 days (P = 0.12)]. The median recurrence free survival rates time in the pre-coagulation group (733 days) was significantly longer than that in the non-coagulation group (400 days) (P < 0.05). Overall survival rates showed rates showed no difference between the 2 groups (P = 0.62).
Conclusions
Precoagulation therapy may be the a preferred treatment application for hepatectomy patients with severe liver fibrosis.
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Affiliation(s)
- Tomokazu Kusano
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Takeshi Aoki
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Tomotake Koizumi
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Kazuhiro Matsuda
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Kosuke Yamada
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Koji Nogaki
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Yoshihiko Tashiro
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Yusuke Wada
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Tomoki Hakozaki
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Hideki Shibata
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Kodai Tomioka
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Takahito Hirai
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Tatsuya Yamazaki
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Kazuhiko Saito
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Keitaro Mitamura
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Akira Fujimori
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Reiko Koike
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Yuta Enami
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Masahiko Murakami
- Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan
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Hsiao CY, Yang PC, Huang KW. Linear radiofrequency ablation using dual switching-control mode achieves rapid and bloodless liver resection, an experimental research. Int J Hyperthermia 2021; 38:357-362. [PMID: 33641575 DOI: 10.1080/02656736.2021.1892215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/19/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Radiofrequency (RF)-assisted devices are widely used for hemostasis during liver resection. This study compared the use of dual switching (DS) versus single switching (SS) control modes for RF-based liver resections in a pig model. METHODS The RF-based system comprised a 200-W generator and three electrodes with 4-cm tips arranged in a linear configuration using an adaptor. Eight Lanyu pigs were used to assess ablation outcomes with electrode spacing of 2 or 3 cm, and ablation durations of 1.5, 2 or 3 min. All combinations were tested in DS and SS modes. Procedures were performed on left lateral, caudal and right anterior liver lobes, and after which transections were performed using a scalpel. Blood loss, complete ablation rate and ablation speed were compared. RESULTS DS mode was shown to induce significantly less blood loss than SS mode when the electrode spacing was set at 2 cm and the ablation duration was 2 min or 3 min (p=.010 and .012, respectively). Extended ablation duration and narrow electrode spacing tended to induce less blood loss, regardless of operating mode. Bloodless resection was achieved using DS mode with electrode spacing of 2 cm and ablation duration of 2-3 min. The highest rate of complete ablation (11.3 cm2/min) was achieved using DS mode with electrode spacing of 2 cm and ablation duration of 1.5 min. CONCLUSION RF-based hepatic resection using DS mode is safe and feasible, resulting in less blood loss than SS mode with a higher rate of complete ablation (i.e., superior ablation efficiency).
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Affiliation(s)
- Chih-Yang Hsiao
- College of Medicine, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Chih Yang
- College of Medicine, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- Center for Organ Transplantation and Liver Disease Treatment, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Kai-Wen Huang
- College of Medicine, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Centre of Mini-invasive Interventional Oncology, National Taiwan University Hospital, Taipei, Taiwan
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12
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Barth RJ. Profiles of Surgical Entrepreneurs. J Am Coll Surg 2020; 230:845-852. [PMID: 32147486 DOI: 10.1016/j.jamcollsurg.2019.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 10/24/2022]
Affiliation(s)
- Richard J Barth
- Section of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
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13
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Abstract
PURPOSE OF REVIEW The aim of this review is to evaluate the emerging role of endoscopic ultrasound (EUS) in the guidance of tumor-targeted therapies for patients with pancreatic cancer (PC). RECENT FINDINGS EUS-guided ablation, brachytherapy, fiducial marker placement, and antitumor agent injection have been described to date. EUS-guided fiducial placement for SBRT in pancreatic cancer has entered the clinical practice and is performed at many centers clinically without a research protocol. EUS-guided brachytherapy and RFA have been shown to be feasible and safe procedures, and potentially offer local disease control. Other potential techniques of EUS-guided treatment of pancreatic cancer are still considered experimental, with many of them appearing to be safe and reasonably well tolerated. However, their effectiveness and exact role in oncological treatment have yet to be established. Clinical trials with many of the techniques/agents described are underway and multicentric randomized trials with prospective design are eagerly awaited.
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14
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Satiya J, Schwartz I, Tabibian JH, Kumar V, Girotra M. Ablative therapies for hepatic and biliary tumors: endohepatology coming of age. Transl Gastroenterol Hepatol 2020; 5:15. [PMID: 32258519 PMCID: PMC7063520 DOI: 10.21037/tgh.2019.10.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
Ablative therapies refer to minimally invasive procedures performed to destroy abnormal tissue that may arise with many conditions, and can be achieved clinically using chemical, thermal, and other techniques. In this review article, we explore the different ablative therapies used in the management of hepatic and biliary malignancies, namely hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), with a particular focus on radiofrequency ablation (RFA) and photodynamic therapy (PDT) techniques.
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Affiliation(s)
- Jinendra Satiya
- Internal Medicine, University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, West Palm Beach, FL, USA
| | - Ingrid Schwartz
- Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - James H. Tabibian
- Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Vivek Kumar
- Gastroenterology and Hepatology, UPMC Susquehanna, Williamsport, PA, USA
| | - Mohit Girotra
- Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, FL, USA
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15
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Jin T, Liu X, Dai C, Jia C, Peng S, Zhao Y, Wang C, Zhang H, Xu F. Beneficial impact of microwave ablation-assisted laparoscopic hepatectomy in cirrhotic hepatocellular carcinoma patients: a propensity score matching analysis. Int J Hyperthermia 2019; 36:530-537. [PMID: 31066585 DOI: 10.1080/02656736.2019.1606456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE In this study, we evaluated the efficacy of microwave ablation-assisted laparoscopic hepatectomy (MLH) for the management of hepatocellular carcinoma (HCC) in cirrhotic patients. METHODS Data from HCC patients with liver cirrhosis who underwent laparoscopic hepatectomy (LH) or MLH in Shengjing Hospital (Shenyang, China) were retrospectively analyzed from January 2013 to June 2017. The demographic characteristics, clinical features, intraoperative parameters and surgical outcomes were analyzed and compared. Propensity scores matching (PSM) analysis was used to minimize bias. RESULTS A total of 54 patients were enrolled in the MLH group and 39 patients in the LH group. Following 1:1 matching by PSM analysis, 26 patients were selected from each group. Compared to the LH group, patients in the MLH group had significantly decreased intraoperative bleeding (48.0 vs. 203.9 ml, p < .0001) and reduced demand for hepatic inflow occlusion (0 vs. 6, p = .009). No significant difference was observed in average operation time (155.7 vs. 148.5 min) and postoperative hospitalization time (8.3 vs. 9.3 d) between the MLH and LH groups. Similarly, the 1-year and 3-year recurrence-free survival (RFS) rates as well as the 1-year and 3-year overall survival (OS) rates of the MLH and LH groups were not significantly different (83.1 vs. 82.4% and 64.6 vs. 36.6% as well as 100 vs. 95.8% and 93.8 vs. 59.1%, respectively: p > .05). CONCLUSIONS MLH significantly decreased intraoperative bleeding and reduced the need for hepatic occlusion without compromising the surgical outcome. Therefore, microwave ablation could be a valuable tool for LH in HCC patients with cirrhosis.
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Affiliation(s)
- Tianqiang Jin
- a Department of Hepatobiliary and Splenic Surgery , Shengjing Hospital, China Medical University , Shenyang , PR China
| | - Xiaolin Liu
- a Department of Hepatobiliary and Splenic Surgery , Shengjing Hospital, China Medical University , Shenyang , PR China.,b Department of Hepatobiliary Surgery , Jiaxing Second Hospital , Jiaxing , PR China
| | - Chaoliu Dai
- a Department of Hepatobiliary and Splenic Surgery , Shengjing Hospital, China Medical University , Shenyang , PR China
| | - Changjun Jia
- a Department of Hepatobiliary and Splenic Surgery , Shengjing Hospital, China Medical University , Shenyang , PR China
| | - Songlin Peng
- a Department of Hepatobiliary and Splenic Surgery , Shengjing Hospital, China Medical University , Shenyang , PR China
| | - Yang Zhao
- a Department of Hepatobiliary and Splenic Surgery , Shengjing Hospital, China Medical University , Shenyang , PR China
| | - Chao Wang
- a Department of Hepatobiliary and Splenic Surgery , Shengjing Hospital, China Medical University , Shenyang , PR China
| | - Heyue Zhang
- a Department of Hepatobiliary and Splenic Surgery , Shengjing Hospital, China Medical University , Shenyang , PR China
| | - Feng Xu
- a Department of Hepatobiliary and Splenic Surgery , Shengjing Hospital, China Medical University , Shenyang , PR China
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16
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Shen H, Zhou S, Lou Y, Gao Y, Cao S, Wu D, Li G. Microwave-Assisted Ablation Improves the Prognosis of Patients With Hepatocellular Carcinoma Undergoing Liver Resection. Technol Cancer Res Treat 2018; 17:1533033818785980. [PMID: 29983095 PMCID: PMC6048665 DOI: 10.1177/1533033818785980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: We evaluated microwave-assisted liver resection for hepatocellular carcinoma. Patients and Methods: We enrolled 79 patients in this study, and microwave ablation was used for liver
resection. Patients were randomized to group A (50.6%; n = 40), liver resection without
microwave ablation, or group B (49.4%; n = 39), liver resection performed using
microwave ablation. Data were analyzed for statistical significance. Results: Of the participants enrolled, 60 were male, and the participant’s average age was 59.32
± 10.34 years. The mean overall tumor diameter was 4.39 (2.00) cm, and this did not
differ between groups. Intraoperative blood loss in group B was significantly less than
that in group A (P < .001). No differences were reported between the
2 groups regarding surgical time (P = .914), postoperative morbidity
(P = .718), and late postoperative complications (P
= .409). Postoperative drainage volume for group B was less than that of group A on the
first (P = .005) and third (P = .019) day after
surgery. The time of postoperative hospitalization in group B was significantly shorter
than that in group A (P < .001). Local recurrence was noted in
18.99% of cases (n = 15) in group B, which is less than that of group A
(P = 0.047), while in group B distant metastasis is less but not
statistically significant (P = 0.061). The 1-year and 3-year cumulative
survival rates were 57% and 93.7%, respectively. Conclusions: The curative effects of liver resection combined with microwave ablation during
operation are superior to only liver resection in the treatment of primary liver
cancer.
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Affiliation(s)
- Haiyuan Shen
- 1 Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Shu Zhou
- 1 Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yun Lou
- 1 Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yangjuan Gao
- 2 Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Shouji Cao
- 1 Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Du Wu
- 1 Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Guoqiang Li
- 1 Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Jayant K, Sodergren MH, Reccia I, Kusano T, Zacharoulis D, Spalding D, Pai M, Jiao LR, Huang KW. A Systematic Review and Meta-Analysis Comparing Liver Resection with the Rf-Based Device Habib™-4X with the Clamp-Crush Technique. Cancers (Basel) 2018; 10:428. [PMID: 30413094 PMCID: PMC6266432 DOI: 10.3390/cancers10110428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/25/2018] [Accepted: 11/01/2018] [Indexed: 02/06/2023] Open
Abstract
Liver cancer is the sixth most common cancer and third most common cause of cancer-related mortality. Presently, indications for liver resections for liver cancers are widening, but the response is varied owing to the multitude of factors including excess intraoperative bleeding, increased blood transfusion requirement, post-hepatectomy liver failure and morbidity. The advent of the radiofrequency energy-based bipolar device Habib™-4X has made bloodless hepatic resection possible. The radiofrequency-generated coagulative necrosis on normal liver parenchyma provides a firm underpinning for the bloodless liver resection. This meta-analysis was undertaken to analyse the available data on the clinical effectiveness or outcomes of liver resection with Habib™-4X in comparison to the clamp-crush technique. The RF-assisted device Habib™-4X is considered a safe and feasible modality for liver resection compared to the clamp-crush technique owing to the multitude of benefits and mounting clinical evidence supporting its role as a superior liver resection device. The most intriguing advantage of the RF-device is its ability to induce systemic and local immunomodulatory changes that further expand the boundaries of survival outcomes following liver resection.
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Affiliation(s)
- Kumar Jayant
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK.
| | - Mikael H Sodergren
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK.
| | - Isabella Reccia
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK.
| | - Tomokazu Kusano
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK.
| | - Dimitris Zacharoulis
- Department of General Surgery, University Hospital of Larissa, Mezourlo, 413 34 Larissa, Greece.
| | - Duncan Spalding
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK.
| | - Madhava Pai
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK.
| | - Long R Jiao
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK.
| | - Kai Wen Huang
- Department of Surgery and Hepatitis Research Center, National Taiwan University Hospital, Taipei 100, Taiwan.
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18
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915-MHz microwave-assisted laparoscopic hepatectomy: a new technique for liver resection. Surg Endosc 2018; 33:395-400. [PMID: 30374791 DOI: 10.1007/s00464-017-5945-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 10/17/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Hemorrhage during the liver transection is the major hazard for laparoscopic hepatectomy (LH). We aimed to evaluate the feasibility and safety of a 915-MHz microwave device used in LH. METHODS Data were retrospectively analyzed regarding 60 patients who underwent LH with or without 915-MHz microwave coagulation at our center from January 2016 to June 2016. 30 patients underwent the 915-MHz microwave-assisted LH (MW group), and 30 patients otherwise were considered as control group. RESULTS No perioperative mortality was observed. Intraoperative blood loss amounts in microwave group and control group were 26.83 ml and 186.33 ml, respectively (P < 0.001). The durations of parenchyma transaction (55.17 vs. 70.83 min, P < 0.001), blood occlusion (2.17 vs. 25.33 min, P < 0.001), and operation (120.67 vs. 148.00 min, P < 0.001) were much shorter in microwave group compared with control group. Lower incidence of postoperative complications (0.0 vs. 14.3%, P = 0.038) and shorter length of postoperative hospital stay (6.00 vs. 7.23 days, P = 0.027) were also noted in the microwave group, compared with the control group. CONCLUSION 915-MHz microwave-assisted LH was found to be safe and efficient.
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19
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Reccia I, Kumar J, Kusano T, Giakoustidis A, Zanellato A, Retsas P, Habib N, Jiao L, Spalding D, Pai M. Radiofrequency-assisted liver resection: Technique and results. Surg Oncol 2018; 27:415-420. [PMID: 30217296 DOI: 10.1016/j.suronc.2018.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/13/2018] [Accepted: 05/26/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Radiofrequency (RF)-assisted liver resection allows non-anatomical liver resection with reduced blood loss and offers the opportunity for a combination of resection and ablation. However, there are still concerns with regard to postoperative complications related to this technique. In the present study, we discuss the technical aspects of RF-assisted liver resections and analyse the rate of perioperative complications, focusing on post-hepatectomy liver failure (PLF), bile leak and abscess, and mortality. METHODS Between 2001 and 2015, 857 consecutive open and laparoscopic elective RF-assisted liver resections for benign and malignant liver tumours were reviewed retrospectively to assess perioperative outcomes. RESULTS Median intraoperative blood loss was 130 mL, with 9.8% of patients requiring blood transfusion. Intra-abdominal collections requiring percutaneous drainage developed in 8.7% of all patients, while bile leak at resection margin developed in 2.8% of the cases. Major liver resection was performed in 34% of patients and the incidence of PLF was 1.5% with one directly related mortality (0.1%). CONCLUSION RF-assisted liver resection has evolved into a feasible and safe technique of liver resection with an acceptable incidence of perioperative morbidity and a low incidence of PLF and related mortality.
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Affiliation(s)
- Isabella Reccia
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK.
| | - Jayant Kumar
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK.
| | - Tomokazu Kusano
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK
| | | | - Artur Zanellato
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Phil Retsas
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Long Jiao
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Duncan Spalding
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Madhava Pai
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK.
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20
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Reccia I, Sodergren MH, Jayant K, Kurz E, Carneiro A, Spalding D, Pai M, Jiao L, Habib N. The journey of radiofrequency-assisted liver resection. Surg Oncol 2018; 27:A16-A18. [PMID: 29449067 DOI: 10.1016/j.suronc.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Isabella Reccia
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Mikael H Sodergren
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
| | - Kumar Jayant
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Elena Kurz
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Adriano Carneiro
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Duncan Spalding
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Madhava Pai
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Long Jiao
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
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21
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Chen ZB, Qin F, Ye Z, Shen SQ, Li W, Ding YM, Hu QY, Ma Y. Microwave-assisted liver resection vs. clamp crushing liver resection in cirrhosis patients with hepatocellular carcinoma. Int J Hyperthermia 2018; 34:1359-1366. [PMID: 29353503 DOI: 10.1080/02656736.2018.1429678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE This study aimed to evaluate the safety and effectiveness of microwave-ablation-assisted liver resection (MW-LR) and clamp crushing liver resection (CC-LR) in cirrhotic patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS From July 2005 to January 2015, cirrhotic HCC patients who underwent CC-LR (n = 191) or MW-LR (n = 112) were retrospectively analysed. We compared morbidity, mortality, disease-free survival (DFS) time and overall survival time between the CC-LR and MW-LR groups. RESULTS The blood loss volume was significantly higher in the CC-LR group (mean of 752 ml) than that in the MW-LR group (mean of 253 ml, p < 0.001). The abdominal abscess rate was higher in the MW-LR group (8.9%) than that in the CC-LR group (3.1%, p = 0.029). The 30-day mortality rate (1.5% vs. 0.8%) and postoperative complication rate (32.9% vs. 25.0%) were both similar between the CC-LR and MW-LR groups. MW-LR provided a survival benefit over CC-LR at 1, 3 and 5 years in the entire population (93.5% vs. 87.0%, 77.0% vs. 62.5% and 50.0% vs. 36.5%, respectively; p = 0.003). In a subgroup analysis, MW-LR provided a survival benefit over CC-LR for Barcelona Clinic Liver Cancer stage A (BCLC-A) HCC (p = 0.026) and stage B (BCLC-B) HCC (p = 0.035) patients and provided DFS benefits for BCLC-A HCC patients (p = 0.036). CONCLUSIONS MW-LR is a safe and feasible procedure for HCC patients with a cirrhotic liver history.
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Affiliation(s)
- Zu-Bing Chen
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Feng Qin
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Zi Ye
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Shi-Qiang Shen
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Wei Li
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - You-Ming Ding
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Qin-Yong Hu
- b Department of Oncology , Renmin Hospital of Wuhan University , Wuhan , China
| | - Yi Ma
- c Department of General Surgery , The First Affiliated Hospital, Sun Yat-Sen University , Guangzhou , China
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22
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Cholecystectomy of an Intrahepatic Gallbladder in an Ectopic Pelvic Liver: A Case Report and Review of the Literature. Case Rep Surg 2017; 2017:3568768. [PMID: 29225990 PMCID: PMC5684543 DOI: 10.1155/2017/3568768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 10/03/2017] [Indexed: 12/29/2022] Open
Abstract
Introduction Ectopic pelvic liver is an exceedingly rare condition usually resulting after repair of congenital abdominal wall defects. Intrahepatic gallbladder is another rare condition predisposing patients to cholelithiasis and its sequelae. We describe a cholecystectomy in a patient with an intrahepatic gallbladder in a pelvic ectopic liver. Presentation of Case A 33-year-old woman with a history of omphalocele repair as an infant presented with signs and symptoms of symptomatic cholelithiasis and chronic cholecystitis, however, in an unusual location. After extensive workup and symptomatic treatment, cholecystectomy was recommended and performed via laparotomy and hepatotomy using microwave technology for parenchymal hepatic transection. Discussion Given the rare combination of an intrahepatic gallbladder and an ectopic pelvic liver, advanced surgical techniques must be employed for cholecystectomies, in addition to involvement of hepatobiliary experienced surgeons due to the distortion of the biliary and hepatic vascular anatomy. Conclusion Cholecystectomy by experienced hepatobiliary surgeons is a safe and effective treatment for cholecystitis in patients with intrahepatic gallbladders in ectopic pelvic livers.
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Rossi P, Montuori M, Bove P, De Majo A, Ricciardi E, Mattei M, Bernardini R, Calzetta L, Mauti P, Intini L, Quattrini V, Chiaramonte C, Mauriello A, Vespasiani G. Partial renal resection by LaparoNewPro: in vivo open and laparoscopic study in an animal model. MINIM INVASIV THER 2017; 26:315-321. [PMID: 28378603 DOI: 10.1080/13645706.2017.1307854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aim of this research project was to test an incremental bipolar radiofrequency generator with open and laparoscopic inline electrode probe for partial renal resection without vascular clamping. MATERIAL AND METHODS Sixteen polar resections with clamping and six without were performed in four pigs in the acute phase. Three pigs underwent laparoscopic polar resection and were live housed for ten days and reoperated to verify the presence of hematic and urinary collection and the condition of the renal edge. Five pigs underwent laparoscopic polar resection without clamping, and two of these were live housed and reoperated after ten days. RESULTS Polar renal resection by our system (LaparoNewPro) turned out to be effective and safe, without cardio-respiratory complications or damage to the remaining parenchyma. Coagulation of the renal parenchyma before resection is effective and safe; at the reoperation, no complications were observed. The laparoscopic version of the probe is ergonomic and safe, with effective coagulation and a small amount of smoke produced. No complications occurred in the housed animals. No damage, local or to residual parenchyma, or thrombosis of the renal vessels were found. CONCLUSIONS LaparoNewPro is able to deliver coagulation of the resection line effectively and independently of clamping of the vessels both in the open and laparoscopic approaches. Coagulation times are short, the automatism of the generator is reliable, and the open and laparoscopic probes are ergonomic.
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Affiliation(s)
- Piero Rossi
- a Department of General Surgery , University Hospital of Tor Vergata , Rome , Italy
| | - Mauro Montuori
- a Department of General Surgery , University Hospital of Tor Vergata , Rome , Italy
| | - Pierluigi Bove
- b Department of Urology , University Hospital of Tor Vergata , Rome , Italy
| | - Adriano De Majo
- a Department of General Surgery , University Hospital of Tor Vergata , Rome , Italy
| | - Edoardo Ricciardi
- a Department of General Surgery , University Hospital of Tor Vergata , Rome , Italy
| | - Maurizio Mattei
- c Department of Biology STA ; University Hospital of Tor Vergata , Rome , Italy
| | - Roberta Bernardini
- c Department of Biology STA ; University Hospital of Tor Vergata , Rome , Italy
| | - Luigino Calzetta
- d Department of Systems Medicine , University Hospital of Tor Vergata , Rome , Italy
| | | | | | | | - Carlo Chiaramonte
- f Department of Statistics , University Hospital of Tor Vergata , Rome
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Huang KW, Lee PH, Kusano T, Reccia I, Jayant K, Habib N. Impact of cavitron ultrasonic surgical aspirator (CUSA) and bipolar radiofrequency device (Habib-4X) based hepatectomy for hepatocellular carcinoma on tumour recurrence and disease-free survival. Oncotarget 2017; 8:93644-93654. [PMID: 29212179 PMCID: PMC5706825 DOI: 10.18632/oncotarget.21271] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/08/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the oncological outcomes of hepatocellular carcinoma patients undergoing liver resection using cavitron ultrasonic surgical aspirator (CUSA) or radiofrequency (RF) based device Habib-4X.
. STUDY DESIGN We prospectively analyzed the data of 280 patients who underwent liver resection for hepatocellular carcinoma at our institution from 2010-2012 with follow up till August 2016. The CUSA was used in the 163 patients whilst Habib-4X in 117 patients. The end points of analysis were oncological outcomes as disease recurrence, disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method, which has been compared with all other existing literature on the survival study. RESULTS Compared with CUSA the reported incidence of recurrence was significantly lower, in Habib-4X group; p < 0.01. The median DFS was significantly better in Habib-4X group than CUSA group (50.80 vs 45.87 months, p = 0.03). The median OS was better in Habib-4X group than CUSA group (60.57 vs 57.17 months, p = 0.12) though the lesser difference in OS between the groups might be explained by the use of palliative therapies as TACE, percutaneous RFA, etc. in case of recurrence. CONCLUSIONS RF based device Habib-4X, is safe and effective device for resection of hepatocellular carcinoma, in comparison to CUSA with better oncological outcomes, i.e., significantly lesser tumour recurrence and better DFS. This could be explained on the basis of systemic and local immunomodulatory effect involving induction of kupffer cells and effector CD-8 T cells that help in minimizing postoperative complications and bring more advantageous oncological outcomes.
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Affiliation(s)
- Kai-Wen Huang
- Department of Surgery & Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Centre of Mini-invasive Interventional Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Huang Lee
- Department of Surgery & Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Tomokazu Kusano
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Isabella Reccia
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kumar Jayant
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Imperial College London, London, UK
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Reccia I, Kumar J, Kusano T, Zanellato A, Draz A, Spalding D, Habib N, Pai M. A systematic review on radiofrequency assisted laparoscopic liver resection: Challenges and window to excel. Surg Oncol 2017; 26:296-304. [PMID: 28807250 DOI: 10.1016/j.suronc.2017.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/07/2017] [Accepted: 06/13/2017] [Indexed: 12/12/2022]
Abstract
Laparoscopic liver resection has progressively gained acceptance as a safe and effective procedure in the treatment of benign and malignant liver neoplasms. However, blood loss remains the major challenge in liver surgery. Several techniques and devices have been introduced in liver surgery in order to minimize intraoperative haemorrhage during parenchymal transection. Radiofrequency (RF)-assisted liver resection has been shown to be an effective method to minimize bleeding in open and laparoscopic liver resection. A number of RF devices for parenchymal transection have been designed to assist laparoscopic liver resections. Here we have reviewed the results of various RF devices in laparoscopic liver resection. A total 15 article were considered relevant for the evaluation of technical aspects and outcomes of RF-assisted liver resections in laparoscopic procedures. In these studies, 176 patients had laparoscopic liver resection using RF-assisted parenchymal coagulation. Two monopolar and three bipolar devices were employed. Blood loss was limited in most of the studies. The need of blood transfusions was limited to two cases in all the series. Conversion was necessary due to bleeding in 3 cases. Operative and transection times varied between studies. However, RF-assisted resection with bipolar devices appeared to have taken less time in comparison to other RF devices. RF-related complications were minimum, and only one case of in-hospital death due to hepatic failure was reported. Although RF has been used in a small minority of laparoscopic liver resections, laparoscopic RF-assisted liver resection for benign and malignant disease is a safe and feasible procedure associated with reduction in blood loss, low morbidity, and lower hospital mortality rates.
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Affiliation(s)
- Isabella Reccia
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
| | - Jayant Kumar
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Tomokazu Kusano
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Artur Zanellato
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Ahmed Draz
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Duncan Spalding
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Madhava Pai
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
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Karavokyros I, Orfanos S, Angelou A, Meropouli A, Schizas D, Griniatsos J, Pikoulis E. Incidence and Risk Factors for Organ/Space Infection after Radiofrequency-Assisted Hepatectomy or Ablation of Liver Tumors in a Single Center: More than Meets the Eye. Front Surg 2017; 4:17. [PMID: 28439517 PMCID: PMC5384425 DOI: 10.3389/fsurg.2017.00017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/16/2017] [Indexed: 12/29/2022] Open
Abstract
Introduction Surgical site infections (SSIs) and especially organ/space infection (O/SI) after resection or ablation of liver tumors are associated with increased morbidity and mortality. A secondary blood stream infection (BSI) is considered an O/SI but the exact prevalence is unknown. We aimed to investigate the incidence of O/SI and BSIs in a cohort of consecutive patients after liver resection or ablation, to seek for a possible connection between them and to search for potential risk factors. Materials and methods We reviewed all patients who underwent hepatic resection or intraoperative liver ablation between January 2012 and December 2016 in our department. We focused on age, gender, Child–Pugh score, preoperative biliary drainage, indication for surgery, type of resection, resection or ablation of tumor, need for bilioenteric reconstruction, additional procedure to hepatectomy, blood transfusion, operative time, postoperative admission to ICU, and antibiotic chemoprophylaxis. All positive cultures from intra-abdominal fluids and blood were recorded. O/SI and BSIs were diagnosed by the criteria set by Centers for Disease Control. All variables were compared between the group with O/SI and the group without infection. BSIs were associated with these infections also. Results Eighty-one consecutive patients with a mean age of 64 years were enrolled. Fifteen patients presented a positive culture postoperatively: intra-abdominal fluid in eight, blood cultures in six, and both blood and intra-abdominal fluid in one patient. The directly estimated incidence of O/SI amounted to 11.1%. Four blood cultures were secondary to O/SI, and the remaining two secondary to central line catheter. O/SI was diagnosed indirectly, through the BSI in an additional 4.9% of the patients, raising the incidence of SSI to 16%. Among the factors studied, only admission to the ICU was found to be statistically significant as a risk factor for the development of O/SI (p = 0.026). Conclusion O/SI should be actively seeked for after liver surgery including blood cultures. Patients with affected physical status, comorbidities are in greater risk of developing O/SI.
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Affiliation(s)
- Ioannis Karavokyros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Stamatios Orfanos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Anastasios Angelou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Antonia Meropouli
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - John Griniatsos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Emmanouil Pikoulis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Dupré A, Pérol D, Blanc E, Peyrat P, Basso V, Chen Y, Vincenot J, Kocot A, Melodelima D, Rivoire M. Efficacy of high-intensity focused ultrasound-assisted hepatic resection (HIFU-AR) on blood loss reduction in patients with liver metastases requiring hepatectomy: study protocol for a randomized controlled trial. Trials 2017; 18:57. [PMID: 28166812 PMCID: PMC5294714 DOI: 10.1186/s13063-017-1801-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/16/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Liver resection is the only potentially curative treatment for colorectal liver metastases (LM). It is considered a safe procedure, but is often associated with blood loss during liver transection. Blood transfusions are frequently needed, but they are associated with increased morbidity and risk of recurrence. Many surgical devices have been developed to decrease blood loss. However, none of them has proven superior to the standard crushing technique. We developed a new, powerful intra-operative high-intensity focused ultrasound (HIFU) transducer which destroys tissue by coagulative necrosis. We aim to evaluate whether HIFU-assisted liver resection (HIFU-AR) results in reduced blood loss. METHODS This is a prospective, single-centre, randomized (1:1 ratio), comparative, open-label phase II study. Patients with LM requiring a hepatectomy for ≥ 2 segments will be included. Patients with cirrhosis or sinusoidal obstruction syndrome with portal hypertension will be excluded. The primary endpoint is normalized blood loss in millilitres per square centimetre of liver section plane. Secondary endpoints are: total blood loss, transection time, transection time per square centimetre of liver area, haemostasis time, clip density on the liver section area, rate and duration of the Pringle manœuvre, rate of patients needing a blood transfusion, length of hospital stay, morbidity, patients with positive resection margin, and local recurrence. Assuming a blood loss of 7.6 ± 3.7 mL/cm2 among controls, the study will have 85% power to detect a twofold decrease of blood loss in the experimental arm, using a Wilcoxon (Mann-Whitney) rank-sum test with a 0.05 two-sided significance level. Twenty-one randomized patients per arm are required. Considering the risk of contraindications at surgery, up to eight patients may be enrolled in addition to the 42 planned, with an enrolment period of 24 months. Randomization will be stratified by surgeon. DISCUSSION We previously demonstrated the safety and efficacy of intra-operative HIFU in patients operated on for LM. We also demonstrated the efficacy of HIFU-AR in a preclinical study. Participants in the HIFU-AR group of this randomized trial can expect to benefit from reduced blood loss and decreased ischemia of liver parenchyma. TRIAL REGISTRATION Clinicaltrial.gov, NCT02728167 . Registered on 22 March 2016.
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Affiliation(s)
- Aurélien Dupré
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, Lyon, 69008, France. .,Inserm, U1032, LabTau, University of Lyon, Lyon, 69003, France.
| | - David Pérol
- Department of Clinical Research (DRCI), Centre Léon Bérard, Lyon, 69008, France
| | - Ellen Blanc
- Department of Clinical Research (DRCI), Centre Léon Bérard, Lyon, 69008, France
| | - Patrice Peyrat
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, Lyon, 69008, France
| | - Valéria Basso
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, Lyon, 69008, France
| | - Yao Chen
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, Lyon, 69008, France
| | - Jérémy Vincenot
- Inserm, U1032, LabTau, University of Lyon, Lyon, 69003, France
| | - Anthony Kocot
- Inserm, U1032, LabTau, University of Lyon, Lyon, 69003, France
| | | | - Michel Rivoire
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, Lyon, 69008, France.,Inserm, U1032, LabTau, University of Lyon, Lyon, 69003, France
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El Shobary M, Salah T, El Nakeeb A, Sultan AM, Elghawalby A, Fathy O, Wahab MA, Yassen A, Elmorshedy M, Elkashef WF, Shiha U, Elsadany M. Spray Diathermy Versus Harmonic Scalpel Technique for Hepatic Parenchymal Transection of Living Donor. J Gastrointest Surg 2017; 21:321-329. [PMID: 27798785 DOI: 10.1007/s11605-016-3312-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/13/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Liver parenchymal transection is the most invasive and challenging part in the living donor operation. The study was planned to compare the safety, efficacy, and outcome of harmonic scalpel versus spray diathermy as a method of parenchymal liver transection in donor hepatectomy. PATIENT AND METHOD Eighty consecutive patients, who were treated by living donor liver transplantation (LDLT), were included in the study. The study population was divided into two groups according to the method of liver transection: group A by harmonic scalpel (HS) and group B by spray diathermy (SD). The primary outcome was the volume of blood loss during transection. Secondary outcomes were time of transection, number of ligatures needed during transection, pathological changes at cut surface, postoperative morbidities, cost, and hospital stay RESULTS: Blood loss during overall liver transection and in each zone was significantly less in the SD than in the HS group (P = 0.015). The number of ligatures was significantly less in the SD than in the HS group (P = 0.0001). The SD group had significantly higher level of serum bilirubin, serum glutamic pyruvic transaminase (SGPT), and international normalized ratio (INR) levels on postoperative day 3 than the HS group. Lateral tissue coagulation and hepatic necrosis are significantly less in HS group. The overall incidence of postoperative morbidities was the same in both groups. The cost was higher in HS group than SD group (US$760 vs. US$40 P = 0.0001). CONCLUSION Spray diathermy is an effective method of parenchymal transection with significantly lower blood loss and lower cost compared to HS with no increase in morbidity. HS is associated with earlier recovery of liver functions.
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Affiliation(s)
- Mohamed El Shobary
- Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt
| | - Tarek Salah
- Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt
| | - Ayman El Nakeeb
- Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt.
| | - Ahmad M Sultan
- Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt
| | - Ahmed Elghawalby
- Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt
| | - Omar Fathy
- Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt
| | - Mohamed Abdel Wahab
- Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt
| | - Amro Yassen
- Anesthesia and Intensive Care Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt
| | - Mohamed Elmorshedy
- Anesthesia and Intensive Care Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt
| | - Wagdi F Elkashef
- Pathology Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt
| | - Usama Shiha
- Radiology Department, Gastroenterology Surgical Center, Mansoura University, Daqahlia, Egypt
| | - Mohamed Elsadany
- Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt
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Morel P, Jung M, Cornateanu S, Buehler L, Majno P, Toso C, Buchs NC, Rubbia-Brandt L, Hagen ME. Robotic versus open liver resections: A case-matched comparison. Int J Med Robot 2017; 13. [PMID: 28058770 DOI: 10.1002/rcs.1800] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 10/12/2016] [Accepted: 11/15/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Most hepatic resections are currently performed using an open approach. Robotic surgery might enable the transition of these procedures to minimally invasive surgery. METHODS Pre-, peri- and post-operative data of all patients who underwent a liver resection from 2009/2012 to 2001/2015, were collected prospectively. All robotic resection patients were matched 1:1 to patients who underwent open surgery. Pre- and perioperative data, up to 30 days, were analyzed. RESULTS Sixteen robotic and open hepatic resections were identified. Fewer complication events and shorter lengths of stay (LOS, 7.9 versus 11 days, P = 0.0603) were observed for robotic resections. Length of stay in the intermediate care unit (IMC) was shorter after the robotic procedure (10 h vs 16.6 h, P = 0.0699). Operating room (OR) time was significantly longer in the robotic resection cohort (352.8 vs 239.6 min, P = 0.0215). All tumor margins were negative. CONCLUSIONS This preliminary comparison demonstrates the general feasibility of minor robotic liver resection in selected cases.
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Affiliation(s)
- Philippe Morel
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Minoa Jung
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Sorina Cornateanu
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Leo Buehler
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Pietro Majno
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Nicolas C Buchs
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Division of Pathology, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Monika E Hagen
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
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Poupalou A, Kontos M, Felekouras E, Papalois A, Kavantzas N, Agrogiannis G, Yagoubi F, Tomos P. Open versus Thoracoscopic RFA-Assisted Lung Resection. J INVEST SURG 2016; 30:403-409. [PMID: 27875060 DOI: 10.1080/08941939.2016.1240272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to evaluate Radio Frequency Ablation (RFA)-assisted lung parenchymal transection through thoracotomy and thoracoscopy. Twelve domestic pigs underwent RFA-assisted lingulectomy: six through thoracotomy (group A), and six with thoracoscopy (group B). There was no mortality, no bleeding, or air leak intra- or postoperatively in either of the groups, and no conversion to open thoracotomy in group B. Group A had longer operating period and more pleural adhesions. A barotrauma, a skin burn, and a localized infection were observed in this group. Histopathology confirmed a sharply demarcated area of coagulation necrosis without damage to adjacent structures. RFA-assisted lung resection through thoracotomy bears the inherent problems of an open approach, and the use of RFA device does not add to morbidity. The thoracoscopic use of RFA probe by experienced surgeons is considered safe, maintaining the advantages of key-hole surgery.
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Affiliation(s)
- Anna Poupalou
- a Department of Pediatric Surgery , Hopital Universitaire Des Enfants Reine Fabiola (IRIS Group), CHU St Pierre , Brussels , Belgium
| | - Michael Kontos
- b 1st Department of Surgery , University of Athens , Athens , Greece
| | | | | | | | | | | | - Periklis Tomos
- f 2nd Department of Propaedeudic Surgery , University of Athens , Athens , Greece
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Precoagulation-assisted parenchyma-sparing laparoscopic liver surgery: rationale and surgical technique. Surg Endosc 2016; 31:1354-1360. [PMID: 27444829 DOI: 10.1007/s00464-016-5120-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/12/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND For the treatment of both primary and metastatic liver tumors, laparoscopic parenchyma-sparing surgery is advocated to reduce postoperative liver failure and facilitate reoperation in the case of recurrence. However, atypical and wedge resections are associated with a higher amount of intraoperative bleeding than are anatomical resections, and such bleeding is known to affect short- and long-term outcomes. Beyond the established role of radiofrequency and microwave ablation in the setting of inoperable liver tumors, the application of thermoablative energy along the plane of the liver surface to be transected results in a zone of coagulative necrosis, possibly minimizing bleeding of the cut liver surface during parenchymal transection. METHODS From January 2013 to March 2016, a total of 20 selected patients underwent laparoscopic ultrasound-guided liver resection with thermoablative precoagulation of the transection line. RESULTS During a period of 38 months, 50 laparoscopic thermoablative procedures were performed. Colorectal liver metastases were the most frequent diagnosis. Seventy-two percent of the nodules were removed using parenchymal transection with radiofrequency-precoagulation, while microwave-precoagulation was performed for 20 % of the resected nodules. The remaining 8 % of the nodules were treated by thermoablation alone. The hepatic pedicle was intermittently clamped in six patients. The mean blood loss was 290 mL, and four patients required perioperative transfusions. CONCLUSIONS Precoagulation-assisted parenchyma-sparing laparoscopic liver surgery can get minimal blood loss during parenchymal transection and lower the need for perioperative transfusions, providing a nonquantifiable margin of oncological safety on the remaining liver. Additional results from larger series are advocated to confirm these preliminary data.
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Ito F, Evans SS. Pre-resectional Radiofrequency Ablation as a Neoadjuvant in situ Tumor Vaccine. JOURNAL OF VACCINES & VACCINATION 2016; 7:310. [PMID: 28944091 PMCID: PMC5606234 DOI: 10.4172/2157-7560.1000310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A lack of effective immune response against cancer is one of the major risk factors for developing local recurrence and distant metastases after curative resectional surgery. Prior studies revealed that systemic antitumor immunity is elicited by radiofrequency ablation (RFA) of tumor lesions, which is mainly considered a palliative procedure for unresectable tumors or for inoperable patients. Recently, we discovered an oncological benefit that depends on the adaptive arm of the antitumor immune response when RFA is performed in a neoadjuvant setting prior to surgical resection in preclinical murine models.
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Affiliation(s)
- Fumito Ito
- Center for Immunotherapy, Roswell Park Cancer Institute, Buffalo, New York, USA
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Sharon S Evans
- Department of Immunology, Roswell Park Cancer Institute, Buffalo, New York, USA
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Chen JY, Luo YK, Cai SW, Ji WB, Yao M, Jiang K, Dong JH. Ultrasound-guided radiofrequency ablation of the segmental Glissonian pedicle: A new technique for anatomic liver resection. Surgery 2016; 159:802-9. [DOI: 10.1016/j.surg.2015.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 12/22/2022]
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Worhunsky DJ, Dua MM, Tran TB, Siu B, Poultsides GA, Norton JA, Visser BC. Laparoscopic hepatectomy in cirrhotics: safe if you adjust technique. Surg Endosc 2016; 30:4307-14. [PMID: 26895906 DOI: 10.1007/s00464-016-4748-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/11/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Minimally invasive liver surgery is a growing field, and a small number of recent reports have suggested that laparoscopic liver resection (LLR) is feasible even in patients with cirrhosis. However, parenchymal transection of the cirrhotic liver is challenging due to fibrosis and portal hypertension. There is a paucity of data regarding the technical modifications necessary to safely transect the diseased parenchyma. METHODS Patients undergoing LLR by a single surgeon between 2008 and 2015 were reviewed. Patients with cirrhosis were compared to those without cirrhosis to examine differences in surgical technique, intraoperative characteristics, and outcomes (including liver-related morbidity and general postoperative complication rates). RESULTS A total of 167 patients underwent LLR during the study period. Forty-eight (29 %) had cirrhosis, of which 43 (90 %) had hepatitis C. Most had Child-Pugh class A disease (85 %). Compared to noncirrhotics, patients with cirrhosis were older, had more comorbidities, and were more likely to have hepatocellular carcinoma. Precoagulation before parenchymal transection was used more frequently in cirrhotics (65 vs. 15 %, P < 0.001), and mean portal triad clamping time was longer (32 vs. 22 min, P = 0.002). There were few conversions to open surgery, though hand-assisted laparoscopy was used as an alternative to converting to open in three patients with cirrhosis. Blood loss was relatively low for both groups. Although there were more postoperative complications among cirrhotics (38 vs. 13 %, P = 0.001), this was almost entirely due to a higher rate of minor (Clavien-Dindo I or II) complications. Liver-related morbidity, major complications, and mortality rates were similar. CONCLUSIONS LLR is safe for selected patients with cirrhosis. The added complexity associated with the division of diseased liver parenchyma may be overcome with some form of technique modification, including more liberal use of precoagulation, portal triad clamping, or a hand-assist port.
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Affiliation(s)
- David J Worhunsky
- Division of Surgical Oncology, Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive, Suite H3680C, Stanford, CA, 94305, USA
| | - Monica M Dua
- Division of Surgical Oncology, Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive, Suite H3680C, Stanford, CA, 94305, USA
| | - Thuy B Tran
- Division of Surgical Oncology, Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive, Suite H3680C, Stanford, CA, 94305, USA
| | - Bernard Siu
- Division of Surgical Oncology, Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive, Suite H3680C, Stanford, CA, 94305, USA
| | - George A Poultsides
- Division of Surgical Oncology, Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive, Suite H3680C, Stanford, CA, 94305, USA
| | - Jeffrey A Norton
- Division of Surgical Oncology, Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive, Suite H3680C, Stanford, CA, 94305, USA
| | - Brendan C Visser
- Division of Surgical Oncology, Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive, Suite H3680C, Stanford, CA, 94305, USA.
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Civil O, Kement M, Okkabaz N, Haksal M, Gezen C, Oncel M. The Feasibility of Hepatic Resections Using a Bipolar Radiofrequency Device (Habib®). Indian J Surg 2015; 77:276-82. [PMID: 26702234 DOI: 10.1007/s12262-015-1295-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/26/2015] [Indexed: 11/29/2022] Open
Abstract
The bipolar radiofrequency device (Habib®) has been recently introduced in order to reduce intraoperative bleeding for a safe hepatic resection as an alternative to the conventional tools. However, indications, perioperative findings, and outcome of the device for hepatic resections remain and deserve to be analyzed. The current study aims to analyze the feasibility of the bipolar radiofrequency device (Habib®) for hepatic resections. Information of the patients that underwent hepatic resection using with the Habib® device between 2007 and 2011 was abstracted. Patient, disease, and operation-related findings and perioperative data were investigated. A total of 71 cases (38 [53.5 %] males, mean age was 56.8 ± 11.9) were analyzed. Metastatic disease (n = 55; 77.5 %) was the leading indication followed by primary liver and biliary malignancies (n = 7; 9.9 %), hemangioma (n = 5; 7 %), hydatid disease (n = 3; 2.8 %), and hepatic gunshot trauma (n = 1; 1.4 %). Metastasectomy was the most commonly performed procedure (n = 31; 56.3 %), but in 24 (77.4 %) cases, it was performed in addition to extended resections. Other procedures in the study patients include segmentectomy in 17, bisegmentectomy in 19, trisegmentectomy in 17, right or left hepatectomy in 8, and extended right/left hepatectomy in 3. The mean (±SD) operation time was 241.7 ± 78.2 min. The median amount of bleeding was 300 cc (range 25-2500), and 23 (32.4 %) cases required perioperative transfusion. The median hospitalization period was 5 days (range 1-47). Lengthened drainage (n = 9, 12.7 %) and intraabdominal abscess (n = 8, 11.23 %) were the most common problems. Hepatic resections using the Habib® device seem to be feasible in cases with primary and metastatic hepatic lesions and benign liver masses and even those with hepatic trauma. It may lessen the amount of intraoperative hemorrhage, although lengthened drainage and intraabdominal abscess were the major postoperative problems in these cases.
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Affiliation(s)
- Osman Civil
- Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey
| | - Metin Kement
- Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey
| | - Nuri Okkabaz
- Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Haksal
- Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey
| | - Cem Gezen
- Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Oncel
- Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey ; Department of General Surgery, Medipol University Hospital, Istanbul, Turkey
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Guo R, Feng X, Xiao S, Yan J, Xia F, Ma K, Li X. Short- and long-term outcomes of hepatectomy with or without radiofrequency-assist for the treatment of hepatocellular carcinomas: a retrospective comparative cohort study. Biosci Trends 2015; 9:65-72. [PMID: 25787911 DOI: 10.5582/bst.2014.01142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The objective of this study was to compare the short- and long-term outcomes of radiofrequency-assisted liver resection (RFLR) and conventional clamp-crushing liver resection (CCLR) and to evaluate the safety and efficiency of RFLR. Between January 2008 and December 2012, a total of 597 patients with hepatocellular carcinoma (HCC) who underwent curative hepatectomy were identified. A total of 272 patients underwent RFLR, and 325 patients received CCLR. The short- and long-term outcomes were compared. The patients in the RFLR and CCLR groups showed similar baseline characteristics. The RFLR group showed less intraoperative blood loss (485.5 vs. 763.2 mL, p = 0.003), a lower transfusion requirement rate (19.1 vs. 31.7%, p ≤ 0.01), shorter surgery duration (211 vs. 296 min, p ≤ 0.01) and a lower vascular inflow occlusion rate (25.7 vs. 33.8%, p = 0.032). No significant postoperative changes in bilirubin or liver enzymes were observed in the two groups. The degree of postoperative complications and morbidity did not significantly differ between the two groups. There were no significant differences in the 1-, 2- and 3-year overall survival rates (73.8%, 58.5%, and 55.7% vs. 80.8%, 65.8%, and 56.2%, respectively) or disease-free rates (51.9%, 47.2%, and 46.0% vs. 54.5%, 44.9%, and 38.5%, respectively) between the RFLR and CCLR groups. These results suggested RFLR was a safe and efficient method for patients with HCC. RFLR was associated with decreased blood loss, fewer blood transfusions, shorter surgery times and less vascular inflow occlusion application. The RFLR group did not show increased liver injury or postoperative morbidity or mortality.
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Affiliation(s)
- Rui Guo
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University
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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. World J Gastroenterol 2015; 21:10159-10165. [PMID: 26401080 PMCID: PMC4572796 DOI: 10.3748/wjg.v21.i35.10159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/27/2015] [Accepted: 04/17/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the efficiency and safety of radiofrequency-assisted 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 vs 50, P = 0.10). Overall, the rate of postoperative complications was roughly the same in these two groups (28.0% vs 17.7%, P = 0.11) except that post hepatectomy liver failure was far more common in the RF+ group than in the RF- group (6% vs 0%, P = 0.04).
CONCLUSION: 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 liver failure.
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Pai M, Habib N, Senturk H, Lakhtakia S, Reddy N, Cicinnati VR, Kaba I, Beckebaum S, Drymousis P, Kahaleh M, Brugge W. Endoscopic ultrasound guided radiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors. World J Gastrointest Surg 2015; 7:52-9. [PMID: 25914783 PMCID: PMC4390891 DOI: 10.4240/wjgs.v7.i4.52] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 02/11/2015] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To outline the feasibility, safety, adverse events and early results of endoscopic ultrasound (EUS)-radiofrequency ablation (RFA) in pancreatic neoplasms using a novel probe. METHODS This is a multi-center, pilot safety feasibility study. The intervention described was radiofrequency ablation (RF) which was applied with an innovative monopolar RF probe (1.2 mm Habib EUS-RFA catheter) placed through a 19 or 22 gauge fine needle aspiration (FNA) needle once FNA was performed in patients with a tumor in the head of the pancreas. The Habib™ EUS-RFA is a 1 Fr wire (0.33 mm, 0.013") with a working length of 190 cm, which can be inserted through the biopsy channel of an echoendoscope. RF power is applied to the electrode at the end of the wire to coagulate tissue in the liver and pancreas. RESULTS Eight patients [median age of 65 (range 27-82) years; 7 female and 1 male] were recruited in a prospective multicenter trial. Six had a pancreatic cystic neoplasm (four a mucinous cyst, one had intraductal papillary mucinous neoplasm and one a microcystic adenoma) and two had a neuroendocrine tumors (NET) in the head of pancreas. The mean size of the cystic neoplasm and NET were 36.5 mm (SD ± 17.9 mm) and 27.5 mm (SD ± 17.7 mm) respectively. The EUS-RFA was successfully completed in all cases. Among the 6 patients with a cystic neoplasm, post procedure imaging in 3-6 mo showed complete resolution of the cysts in 2 cases, whilst in three more there was a 48.4% reduction [mean pre RF 38.8 mm (SD ± 21.7 mm) vs mean post RF 20 mm (SD ± 17.1 mm)] in size. In regards to the NET patients, there was a change in vascularity and central necrosis after EUS-RFA. No major complications were observed within 48 h of the procedure. Two patients had mild abdominal pain that resolved within 3 d. CONCLUSION EUS-RFA of pancreatic neoplasms with a novel monopolar RF probe was well tolerated in all cases. Our preliminary data suggest that the procedure is straightforward and safe. The response ranged from complete resolution to a 50% reduction in size.
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Reich DJ. Liver resection after thermal ablation of parenchymal transection margin using microwave energy. Clin Liver Dis (Hoboken) 2015; 5:25-28. [PMID: 31040942 PMCID: PMC6490457 DOI: 10.1002/cld.450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- David J. Reich
- Division of Multiorgan Transplantation and Hepatobiliary Surgery and Department of SurgeryDrexel University College of MedicineHahnemann University HospitalPhiladelphiaPA
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Radiofrequency ablation-assisted liver resection: a step toward bloodless liver resection. Hepatobiliary Pancreat Dis Int 2015; 14:69-74. [PMID: 25655293 DOI: 10.1016/s1499-3872(14)60304-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Liver resection is currently the most efficient curative approach for a wide variety of liver tumors. The application of modern techniques and new surgical devices has improved operative outcomes. Radiofrequency ablation is used more often for liver parenchymal transection. This study aimed to assess the efficacy and safety of radiofrequency ablation-assisted liver resection. METHODS A retrospective study of 145 consecutive patients who underwent radiofrequency ablation-assisted liver resection was performed. Intraoperative blood loss, need for transfusion or intraoperative Pringle maneuver, the duration of liver parenchymal transection, perioperative complications, and postoperative morbidity and mortality were all evaluated. RESULTS Fifty minor and ninety-five major liver resections were performed. The mean intraoperative blood loss was 251 mL, with a transfusion rate of 11.7%. The Pringle maneuver was necessary in 12 patients (8.3%). The mean duration for parenchymal transection was 51.75 minutes. There were 47 patients (32.4%) with postoperative complications. There is no mortality within 30 days after surgery. CONCLUSIONS Radiofrequency ablation-assisted liver resection permits both major and minor liver resections with minimal blood loss and without occlusion of hepatic inflow. Furthermore it decreases the need for blood transfusion and reduces morbidity and mortality.
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Abstract
As the number of liver resections in the United States has increased, operations are more commonly performed on older patients with multiple comorbidities. The advent of effective chemotherapy and techniques such as portal vein embolization, have compounded the number of increasingly complex resections taking up to 75% of healthy livers. Four potentially devastating complications of liver resection include postoperative hemorrhage, venous thromboembolism, bile leak, and post-hepatectomy liver failure. The risk factors and management of these complications are herein explored, stressing the importance of identifying preoperative factors that can decrease the risk for these potentially fatal complications.
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Affiliation(s)
- Maria C Russell
- Division of Surgical Oncology, Department of Surgery, Emory University Hospital, 550 Peachtree Street Northeast, 9th Floor MOT, Atlanta, GA 30308, USA.
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42
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Radiofrequency pancreatic ablation and section of the main pancreatic duct does not lead to necrotizing pancreatitis. Pancreas 2014; 43:931-7. [PMID: 24977335 DOI: 10.1097/mpa.0000000000000156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether radiofrequency ablation (RFA) of the pancreas and subsequent transection of the main pancreatic duct may avoid the risk of both necrotizing pancreatitis and postoperative pancreatic fistula (POPF) formation. METHODS Thirty-two rats were subjected to RFA and section of the pancreas over their portal vein. Animals were killed at 3, 7, 15, and 21 days (groups 0-3, respectively). Two additional control groups (sham operation and user manipulation only, respectively) of 15 days of postoperative period were considered. Postoperative complications, histological changes (including morphometric and immunohistochemical analysis), and incidence of POPF were evaluated. RESULTS A significant increase in serum amylase levels (P < 0.05) on the third postoperative day, which return to baseline levels in the following weeks, was noted in groups 0 to 3. Those groups showed a rapid atrophy of the distal pancreas by apoptosis with no signs of necrotizing pancreatitis or POPF. The distal pancreas in groups 1 to 3 compared with group 0 and control groups showed a significant increase of small islets (<1000 µm). CONCLUSIONS The rapid acinar atrophy of the distal pancreas after RFA and section of the pancreatic ducts in this model does not lead to necrotizing pancreatitis.
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Yada K, Ishibashi H, Mori H, Shimada M. Laparoscopic resection of hepatoblastoma: report of a case. Asian J Endosc Surg 2014; 7:267-70. [PMID: 25131326 DOI: 10.1111/ases.12106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 02/19/2014] [Accepted: 03/05/2014] [Indexed: 11/26/2022]
Abstract
Despite the increasing number of recent reports on laparoscopic resection of malignant liver tumors in adults, there have been few reports involving children. In this paper we discuss the laparoscopic resection of a hepatoblastoma in a 1-year-old boy. The CT scan revealed an exophytic hepatic tumor on S5 measuring 6 × 5 × 4 cm after preoperative chemotherapy. The operation time was 225 min with an estimated blood loss of about 38 mL; intraoperative transfusion was not required. Radiofrequency-assisted precoagulation was performed. The patient had an uncomplicated recovery and started postoperative chemotherapy on postoperative day 12. Our literature search revealed only five reported cases of laparoscopic resection of hepatoblastoma in which there was no postoperative complication or recurrence. Laparoscopic resection of a hepatoblastoma in a selected subgroup of patients can be safe and feasible.
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Affiliation(s)
- Keigo Yada
- Department of Surgery, University of Tokushima, Tokushima, Japan
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44
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Xiao WK, Chen D, Hu AB, Peng BG, Guo YZ, Fu SJ, Liang LJ, Li SQ. Radiofrequency-assisted versus clamp-crush liver resection: a systematic review and meta-analysis. J Surg Res 2014; 187:471-83. [DOI: 10.1016/j.jss.2013.10.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/21/2013] [Accepted: 10/25/2013] [Indexed: 12/20/2022]
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Hasegawa Y, Nitta H, Sasaki A, Takahara T, Ito N, Fujita T, Kanno S, Nishizuka S, Wakabayashi G. Laparoscopic left lateral sectionectomy as a training procedure for surgeons learning laparoscopic hepatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 20:525-30. [PMID: 23430054 DOI: 10.1007/s00534-012-0591-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Laparoscopic liver resection remains limited to a relatively small number of institutions because of insufficient hepatic and laparoscopic surgical experience and few training opportunities. The aim of this study was to assess the feasibility and safety of an improved laparoscopic left lateral sectionectomy technique as a training procedure for new surgeons. METHODS Twenty-four laparoscopic left lateral sectionectomies (LLLSs) were retrospectively reviewed. Patients were divided into 3 groups with 8 patients in each: those undergoing surgery by expert surgeons prior to 2008 (Group A); those undergoing surgery by expert surgeons after 2008, when a standardized LLLS technique was adopted (Group B); and those undergoing LLLS by junior surgeons being trained (Group C). RESULTS The median operative time was significantly shorter for Group B (103 min; range, 99-109 min) and C (107 min; range, 85-135 min) patients than for Group A (153 min; range, 95-210 min) patients. There were no significant differences in blood loss or hospital stay. In Groups B and C, no conversions to open laparotomy or complications occurred. CONCLUSION The standardized LLLS procedure was both safe and feasible as a technique for training surgeons in laparoscopic hepatectomy.
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Affiliation(s)
- Yasushi Hasegawa
- Department of Surgery, Iwate Medical University School of Medicine, 19-1, Uchimaru, Morioka city, Iwate 020-8505, Japan
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Rossi P, Bove P, Montuori M, De Majo A, Ricciardi E, Mattei M, Bernardini R, Calzetta L, Mauti P, Intini L, Quattrini V, Chiaramonte C, Vespasiani G. Partial nephrectomy using radiofrequency incremental bipolar generator with multi electrode probe: experimental study in bench pig kidneys. BMC Urol 2014; 14:7. [PMID: 24410789 PMCID: PMC4029438 DOI: 10.1186/1471-2490-14-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/11/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The aim of this research project was the realization of an incremental bipolar radiofrequency generator with inline 4-electrode probe for partial renal resection without clamping of the vessels. METHODS The experimentation was carried out across two phases: the preliminary realization of a specific generator and an inline multielectrode probe for open surgery (Phase 1); system testing on 27 bench kidneys for a total of 47 partial resection (Phase 2). The parameters evaluated were: power level, generator automatisms, parenchymal coagulation times, needle caliber, thickness of the coagulated tissue "slice", charring, ergonomy, feasibility of the application of "bolster" stitches. RESULTS The analysis of the results referred to the homogeneity and thickness of coagulation, energy supply times with reference to the power level and caliber of the needles. The optimal results were obtained by using needles of 1.5 mm caliber at power level 5, and with coagulation times of 54 seconds for the first insertion and 30 seconds for the second. CONCLUSIONS The experimentation demonstrated that the apparatus, consisting of a generator named "LaparoNewPro" and fitted with a dedicated probe for open surgery, is able to carry out a coagulation of the line of resection of the renal parenchyma in a homogeneous manner, in short times, without tissue charring, and with the possibility of stitching both on coagulated tissue and the caliceal system. The generator automatism based on the flow of the current supplied by each electrode is reliable, and the cessation of energy supply coincides with optimal coagulation.
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Affiliation(s)
- Piero Rossi
- Department of General Surgery, University Hospital of Tor Vergata, Rome, Italy
| | - Pierluigi Bove
- Department of Urology, University Hospital of Tor Vergata, Rome, Italy
| | - Mauro Montuori
- Department of General Surgery, University Hospital of Tor Vergata, Rome, Italy
| | - Adriano De Majo
- Department of General Surgery, University Hospital of Tor Vergata, Rome, Italy
| | - Edoardo Ricciardi
- Department of General Surgery, University Hospital of Tor Vergata, Rome, Italy
| | - Maurizio Mattei
- Department of Biology STA, University Hospital of Tor Vergata, Rome, Italy
| | - Roberta Bernardini
- Department of Biology STA, University Hospital of Tor Vergata, Rome, Italy
| | - Luigino Calzetta
- Laboratory of Systems Approaches and Non-Communicable Diseases, San Raffaele Pisana Hospital, IRCCS, Rome, Italy
| | | | | | | | - Carlo Chiaramonte
- Department of Statistics, University Hospital of Tor Vergata, Rome, Italy
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Schirmang TC, Dupuy DE. Image-guided thermal ablation of nonresectable hepatic tumors using the Cool-Tip™ radiofrequency ablation system. Expert Rev Med Devices 2014; 4:803-14. [DOI: 10.1586/17434440.4.6.803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Riediger C, Mueller MW, Geismann F, Lehmann A, Schuster T, Michalski CW, Kuhn K, Friess H. Comparative analysis of different transection techniques in minor and major hepatic resections: a prospective cohort study. Int J Surg 2013; 11:826-33. [PMID: 23994002 DOI: 10.1016/j.ijsu.2013.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 08/01/2013] [Accepted: 08/20/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND In liver surgery different transection techniques are available without clear evidence regarding indication and advantage for each technique. The aim of this study was to identify the most superior liver transection technique between the different techniques (stapler, water-jet and electrocautery). Comparative analyses were performed for minor and major hepatectomies. METHODS In a single-center study, all liver resections performed between July 2007 and July 2012 were prospectively recorded and analysed. RESULTS 366 liver resections were included according to predefined eligibility criteria. No clear benefit for one particular technique in minor or major hepatectomy could be shown. Cost-effectiveness analysis revealed disadvantages for stapler-hepatectomies. However, minor hepatectomies were performed with significantly lower morbidity (p < 0.001), lower operating time (p = 0.001), fewer need of transfusion (p < 0.0001) and shorter ICU stay (p = 0.001) than major hepatectomies. CONCLUSIONS If possible, minor hepatectomies should be chosen. Competing techniques, selected according to surgeon's preference, revealed no significant differences in primary outcome measures.
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Affiliation(s)
- Carina Riediger
- Department of Surgery, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
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49
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Alexiou VG, Tsitsias T, Mavros MN, Robertson GS, Pawlik TM. Technology-Assisted Versus Clamp-Crush Liver Resection. Surg Innov 2013; 20:414-428. [DOI: 10.1177/1553350612468510] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Objective. To review the published evidence on technology-assisted liver resection regarding operative time, intraoperative bleeding, mortality, hospital stay, postoperative bile leak, and other outcomes. Method. A systematic review of clinical studies comparing liver resection using vessel sealing systems (VSSs—LigaSure), Cavitron Ultrasonic Surgical Aspirator (CUSA), or radiofrequency dissecting sealer (RFDS) with the conventional clamp-crushing technique (CC) was performed. Data for each modality were synthesized and individually compared with CC with the methodology of meta-analysis. Result. In all, 8 randomized controlled trials (RCTs) and 7 nonrandomized studies evaluating 1539 patients were included. Compared with CC, the VSS group (3 RCTs and 3 nonrandomized studies) had significantly lower blood loss by a mean of 109 mL (weighted mean difference [WMD] = −109; 95% confidence interval [CI] = −192, −26; data on 494 patients), lower risk for postoperative bile leak by 63% (odds ratio [OR] = 0.37; CI = 0.17, 0.78; 559 patients), and shorter total hospital stay by 2 days (WMD = −2.04; CI = −3.08, −1; 340 patients); no difference was noted for liver parenchyma transection time and mortality. No difference was noted between CUSA (4 RCTs and 1 nonrandomized study) or RFDS (3 RCTs and 3 nonrandomized studies) versus CC for any of the studied outcomes. Conclusion. Of the 3 modalities used in liver resection (VSS, CUSA, and RFDS), only VSS appeared to offer significant benefit over standard CC. However, the generalization of our findings is limited by the scarcity and clinical heterogeneity of the published studies. Large, well-designed and implemented RCTs are warranted to further investigate the usefulness of novel modalities used in liver resection.
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Affiliation(s)
- Vangelis G. Alexiou
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
- University Hospitals of Leicester, Leicester, UK
| | | | - Michael N. Mavros
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
- John Hopkins University School of Medicine, Baltimore, MD, USA
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Ihnát P, Ihnát Rudinská L, Zonča P. Radiofrequency energy in surgery: state of the art. Surg Today 2013; 44:985-91. [PMID: 23728491 DOI: 10.1007/s00595-013-0630-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 04/30/2013] [Indexed: 12/30/2022]
Abstract
Over a period of more than 100 years, radiofrequency energy has been introduced in many fields and applications in medicine. At present, radiofrequency constitutes the basis of numerous medical devices employed in almost all medical specialties. It is particularly applicable and valuable in various minimally invasive procedures for its locally focused effects. Radiofrequency energy is a technical term established to describe high-frequency alternating electrical currents (with a frequency ranging from 300 kHz to 3 MHz) and their impact on biological tissue. The application of RF energy causes controlled tissue heating with consequent cell protein denaturation and desiccation, which leads to cell death and tissue destruction. The primary principle of radiofrequency is that the generated heat can be used to cut, coagulate or induce metabolic processes in the target tissue. The authors of this paper offer a comprehensive and compact review of the definition, history, physics, biological principles and applications of radiofrequency energy in current surgery.
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Affiliation(s)
- Peter Ihnát
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic,
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