Radiofrequency after liver resection in primary and metastatic liver tumours

Background: Liver resection is currently the standard treatment for patients with both primary and metastatic liver cancer. Recent advances and technologies have reduced significantly morbidity and mortality after liver resection, but bleeding remains a significant factor affecting prognosis. Liver section can be performed with several techniques (i.e. bipolar dissection, hydrodissection with ultrasounds or radiofrequency) and can be associated with Pringle’s maneuver. Patients and Methods: We report the results of the treatment of liver cut surface with radiofrequency (RFA), performed by a cool-tip radiofrequency device, after liver resection for liver malignancies. Forty-two patients with liver malignancies (30 male and 12 female, aged 65.89.5 years) underwent hepatic resections (6 emi-hepatectomies, 22 wedge resections, 11 segmentectomies, 10 plurisegmentectomies) and treatment of the liver cut surface with RFA. Malignancies included 22 primitive tumours (21 hepatocarcinoma, 1 cholangiocarcinoma) and 20 metastatic diseases (19 from colorectal cancer, one from other site). The Charlson comorbidity index of these patients was 3.52.2. Twelve patients (28.5%) were treated also with RFA of hepatic nodules. The duration of the surgical procedure was 22343 minutes. Pringle’s maneuver was never used. Only two (4.8%) patients required red blood cell transfusions after surgery. Results: No biloma was reported in these patients. Main biochemical findings on day 0, 1, and 5 were: (1) hemoglobin 13.51.3, 12.11.6, 11.31.6 g/dL, (2) alanineaminotransferase 37.627.4, 327.4218.2, 82.855.1 U/L, (3) albumin 3.90.4, 2.80.4, 3.20.3 g/dL, (3) international normalized ratio (INR) 1.120.17, 1.240.20, 1.180.23. Histology found positive margins in 5 patients. The median follow-up was 14.36.4 months. Eight patients (two with primitive cancer and 6 with metastatic disease) have progression of the disease. Conclusions: RFA is safe and effective, and our preliminary data suggest that this technique may be useful in reducing bleeding and biliary leaking from the cut surface. Furthermore, it may guarantee a "sterilization" of margins, and no patient with positive margins had local recurrence. RFA after surgical resection allows to preserve liver parenchyma, regulating the necrosis on the liver cut surface. References: Weber JC et al. New technique for liver resection using heat coagulative necrosis. Ann Surg 236: 560-563, 2002.