| Research background:Hepatocellular carcinoma(HCC)is one of the most common malignant tumors all over the world.The incidence ranks fifth and the third most common cause of cancer-related death.China is one of the highest incidence areas.The incidence and the mortality are respectively 30.3/100,000?20.4/100,000.China accounts for 18.8% of all cancer related death and more than 50% of world's HCC patients.In the last 20 years,the mortality of HCC is increasing,and it can be seen in our country,the high incidence and high mortality of HCC.So the situation is very severe.The surgery resection is main treatment for HCC.Liver transplantation may be the most effective treatment for HCC patients with cirrhosis,because it can also solve two problems of liver cancer and liver cirrhosis.However,there is a worldwide shortage of liver transplant donors,as well as the expensive cost limits the clinical use of the program.At present,liver resection remains the preferred treatment for patients with early-stage HCC,according to the American Association for the study of liver diseases and the Association for the study of the European Association for liver diseases.Although liver resection is a high difficulty and high risk operation,with the development of surgical technique,liver anatomy,anesthesia management and perioperative nursing,the complications and mortality of liver resection have been improved obviously.Massive bleeding is still the most important risk for hepatectomy,but it is also the key factor to affect the incidence of postoperative complications and mortality.In addition,blood transfusion is an independent risk factor leaded to tumor recurrence for patients with HCC.Therefore,a variety of techniques and strategies including resection of liver parenchyma transections,vascular control and low central venous pressure anesthesia in order to reduce intraoperative blood loss and blood transfusions,are used in liver resection.Especially on liver parenchymal transection techniques emerging out of a variety of surgical instruments and equipment,such as CUSA,Liga Sure,water jet,ultrasonic scalpel and radio and other.Among them,radiofrequency-assisted liver resection devices have been developed that employ a bipolar needle and utilize the RF energy to pre-coagulate the liver transection plane.The heat produced by microwaves seals the vessels and enables the bloodless resection of parenchyma transection.In recent years,some studies have indicated that radiofrequency-assisted liver resection reduced the amount of blood loss and blood transfusions.However,there is still controversy about the application of radiofrequency ablation.Because a small amount of literature reported that the device will increase the incidence of postoperative complications,especially biliary fistula,liver abscess,bile duct stricture and liver failure.Liver failure is one of the most common causes leading to death after liver resection,especially for patients with cirrhosis.In our country,there are more than 95% of for HCC with chronic hepatitis B,and even cirrhosis.Objective:The perioperative and postoperative follow-up results were compared and analyzed between the radiofrequency-assisted liver resection and the clamp-crushing liver resection,demonstrated radiofrequency-assisted liver resection are safe and effective surgery for HCC with cirrhosis.Methods:697 cases of HCC patients were treated by liver resection in Department of hepatobiliary surgery of the Southwest Hospital of the Third Military Medical University Between January 1,2011 and December 31,2012.According to the inclusion criteria,386 cases were included.Radiofrequency-assisted liver resection had 189 cases.The clamp-crushing liver resection had 197.Postoperative assessment of the outcomes was conducted by follow-ups through telephone calls and clinical visits at the Clinical Research Center of Hepatobiliary Surgery,Southwest Hospital of the Third Military Medical University.Re-examination involved liver function testing,AFP measurement,and abdominal ultrasound examination.Patients with suspected recurrence underwent enhanced CT scanning of the upper abdomen,ultrasound contrast examination or MRI for clarity.Those diagnosised patients were treated by a second liver resection,RFA and TACE according to the size,site,and number of lesions.Re-examination was performed once every 3 months in the first postoperative year,once every 4 months in the second postoperative year,and once every 6 months after the third postoperative year.The preoperative,intraoperative,postoperative and follow-up data were collected,including general information:age,sex,Child-Pugh,liver function,liver function,liver function,ICG-R15,tumor location and size.Operation data: the scope of the liver,operation time,blood loss,blood transfusion rate,blood transfusion volume,the first hepatic portal block rate and the average blocking time.Postoperative related parameters: postoperative complications,mortality,postoperative hospital stay,postoperative liver function.The follow-up data: recurrence time,postoperative time of death,and the recurrence solution and results.Data were analyzed using SPSS 19.0 statistical software(IBM SPSS,Somers,NY,USA).Measurement data were described as mean ± standard deviation and subjected to the t-test or the Wilcoxon rank-sum test.Count data were analyzed using the ?2 or Fisher's exact test.Survival curves were plotted using the Kaplan–Meier method.Patient survival was compared between the two groups using the log-rank test.The P value of <0.05 was considered statistically significant.Results1.There was no significant difference in gender,age,hepatitis B,AFP,ICG-R15,liver function,tumor size and tumor location between the two groups(P > 0.05).2.RF-LR group and CC-LR group after operation had 9 and 7 cases death respectively for multiple organ dysfunction syndrome.The rest of complications in the RF-LR group including 7 cases abdominal infection,14 cases bile leakage,13 cases liver failure,15 cases pulmonary infection,12 cases pleural effusion,16 cases ascites,7 cases wound infection,1 cases ileus,1 cases portal vein thrombosis,2 cases abdominal bleeding,3 cases respiratory failure,3 cases renal failure,6 cases multiple organ failure.The incidence of liver failure(6.9% vs.4.6%;P = 0.095),the total complication rate(33.3% vs.28.9%;P = 0.351)and mortality(4.8% vs.3.6%;P = 0.552),was no significant different between the two groups.There were statistically significant differences between the two groups of patients in the operation time(241.3± 79.7vs267.0±108.1min;P=0.008),blood loss(484.6±472.7 vs770.1±973.6ml;P=0.005),blood transfusion rate(16.9%vs33.0%,P =0.000)and proportion of first hepatic portal inflow occlusion(52.9% vs65.5%;P=0.012).There were no statistically significant differences between the two groups of inflow occlusion time(23.6 ± 24.3vs28.2 ± 23.0 min,P = 0.078).The SICU time(1.6±1.4vs1.5±1.5days;P=0.445)and postoperative hospital stay(16.6±8.1vs 17.1±8.4 days;P=0.591)were no statistically significant differences between the two groups.The peak values of ALT(494 + 466 vs.448.4 426.2;P = 0.331),TB(33.7 42.8 vs.30.4,34.2;P= 0.897),were not statistically significant.3.The 1-and-3 years overall survival rates of RF-LR group and CC-LR group were 76.6%vs.80.1%,49.5%vs.58.1%,respectively,with no statistically significant differences between the groups(P = 0.197).The corresponding 1-and 3-year disease-free survival rates were 50.1%vs.56.4%,37.6%vs.42.1%,respectively,with no statistically significant differences between the groups(P = 0.285).Conclusions1.Compared to clamp-crushing liver resection,Radiofrequency-assisted liver resection is advantageous with shortened operation time,decreased the volume of blood loss,resulted in fewer blood transfusions and reduced proportion of first hepatic portal inflow occlusion.2.The study showed that radiofrequency-assisted liver resection did not either worsen liver function or increase morbidity or mortality rate.Especially important,our study indicated that the radiofrequency-assisted liver resection is safe and effective for HCC with cirrhosis.Compared to CC-LR group,the 1-and-3 years overall survival and disease-free survival rates of RF-LR group was no statistically significant differences between the groups.But further are necessary to evaluate large-sample,multicenter,randomized and controlled study are necessary to evaluate the long-time effects of radiofrequency-assisted liver resection. |
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