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Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1782
Percivale A. 1, Griseri G. 2, Gastaldo A. 3, Benasso M. 4, Serafini G. 5, Pellici R. 1
1 Department of Surgery, Hepatobiliary Unit Santa Corona Hospital, Pietra Ligure, Savona, Italy;
2 Department of Surgery, Hepatobiliary Unit San Paolo Hospital, Savona, Italy;
3 Department of Radiology, Advanced Biotechnologies Unit San Paolo Hospital, Savona, Italy;
4 Department of Medicine, Medical Oncology San Paolo Hospital, Savona, Italy;
5 Department of Radiology Radiology and Interventional Radiology Unit Santa Corona Hospital, Pietra Ligure, Italy
AIM: The goal of hepatectomy for primary and metastatic hepatic tumors remains the resection with no residual disease on the transection line. Perioperative blood transfusion and post operative morbidity are today considered as independent predictors of survival emphasizing the importance of procedure dedicated to minimize the intraoperative blood loss. Final end point of the present report was to evaluate the operative strategy for resection of malignant tumors addressing the key components on blood loss and need for peri operative blood transfusion, optimal pathologic margin and evaluation of recurrence on resection margin by computed tomography (CT) morphology during long term follow up.
METHODS: Between June 2003 and February 2009, 68 radiofrequency (RF) assisted liver resection were performed patients using the RF Cool Tip device and Habib Sealer 4x in the Department of General and Hepatobiliary Surgery of Santa Corona Community Hospital. The most frequent indication for RF assisted liver resection were represented by colorectal metastatic liver cancer, while there were patients with hepatocellular carcinoma, breast cancer liver metastasis and other type of liver metastatic tumors.
RESULTS: We perform a total of 68 hepatic resections: 48 patients had a solitary tumor while 20 patients had more than one neoplastic lesion in the liver. Surgery procedure range from wedge resection to right hepatectomy. Minor hepatectomy were performed in 48 patients while major hepatectomies including three or more segmentectomies were performed in 20 patients. Median intraoperative blood loss, estimated by the aspiration tube device, was 123 ml: there was no need for intraoperative blood transfusion. In all cases RF assisted liver resection allow us to obtain a negative margin of resection: mean safety margin measured by the pathologist was 0.5 cm (range 0.1 to 3.2 cm). We performed at one months from procedure an hepatic contrast enhanced CT scan in order to evaluate the morphology of the necrotic tissue on the resection line and the presence of line transection recurrences: during the follow up no patients presented recurrences on the resection margin. The same CT study was done at 6, 12 and 24 months.
CONCLUSION: In conclusion the technique applied, even if the current study was not designed to compare the RF assisted liver resection to others transection technique, shows us good results in terms of statement for best oncological practice: RF assisted liver resection should be considered a good options for the hepatobiliary surgeon being an additional methods to perform safe oncological hepatic resection.