Usefulness of intraoperative radiofrequency thermoablation of liver tumours associated or not with hepatectomy

doi:10.1053/ejso.2000.1000

European Journal of Surgical Oncology (EJSO)

Volume 26, Issue 8, December 2000, Pages 763-769

https://doi.org/10.1053/ejso.2000.1000 Get rights and content

Abstract

Introduction A probe emitting radiofrequency (RF) waves is able to destroy tumour tissue by thermal ablation. The purpose of this study was to undertake a prospective estimation of the benefit of RF thermoablation of liver tumours during hepatic and extrahepatic resections aimed at obtaining an R0 status in patients in whom disease is notoriously considered unresectable. Method Twenty-one patients underwent surgery between January 1997 and September 1999. In 17 cases, RF was associated with a hepatectomy and in nine of these cases with resection of extrahepatic lesions. In two cases, extensive resection of extrahepatic lesions was associated with RF to treat liver metastases, and in two cases RF was ultimately performed alone. The mean number of liver metastases was 6.2±4.3 (range 1–15) per patient. A total of 32 lesions were treated with RF. The mean size of the 33 RF-thermoablated tumours was 13.6±9.7 mm (range 5–52 mm), and in all but one case, a Pringle manoeuvre was performed during the RF procedure. Results: A probable R0-resection was obtained in 18 cases. No operative deaths or any RF-related complications occurred. If we exclude the case in which it was clearly impossible to destroy liver metastases intraoperatively, only one local recurrence occurred (3%) among the 32 thermoablated lesions after a mean follow-up of 17.3 months. The 2-year overall and disease-free survival rates for this initially unresectable population were 94.7% and 22%, respectively. Conclusion: Intraoperative use of RF to destroy unresectable liver tumours increases the rate of curative resections. Future progress in RF technology and adequate vascular clamping during RF should increase this rate.

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HR cohort demonstrated significantly less local recurrence rate and better 3- and 5-year disease-free (DFS) and overall survival (OS) compared to MWA and RFA cohorts. HR cohort included significantly younger patients and with significantly lower preoperative carcinoembryonic antigen (CEA) by 10.28 ng/mL compared to RFA cohort. Subgroup analysis of local recurrence and OS of solitary and ≤ 3 cm CRLMs did not demonstrate any discrepancies when compared with the whole sample.
For resectable CRLM the treatment of choice still remains HR. MWA and RFA can be used as a single or adjunct treatment in patients with unresectable CRLM and/or prohibitive comorbidities.
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This study aimed to compare the outcomes of combined hepatic resection (HR) plus intraoperative radiofrequency ablation (RFA) and transarterial embolization (TAE) for Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) in case-controlled patient groups using the propensity score.
A total of 179 patients with multifocal HCC treated with HR plus RFA (n = 26) or TAE (n = 153) were retrospectively studied. All patients were classified as BCLC stage B and Child–Pugh class A. Analyses were performed over all participants as well as for propensity score-matched (1:3) patients to adjust for baseline differences. Cumulative overall survival (OS) and time to progression (TTP) were compared between the two groups using the Kaplan–Meier method, and independent predictors were identified by multivariate Cox regression analysis.
Patients treated with HR plus RFA had better OS and longer TTP than those with TAE (p = 0.011 and p < 0.001, respectively). Multivariate Cox regression analysis showed that combined therapy (hazard ratio 0.31; 95% confidence interval (CI), 0.12–0.78; p = 0.013), BCLC substage B2 (hazard ratio 1.82; 95% CI, 1.13–2.92; p = 0.013) and alpha-fetoprotein ≥ 400 ng/ml (hazard ratio 1.85; 95% CI, 1.12-3.05; p = 0.016) were independent factors associated with OS. After propensity score matching, combined therapy was the significant factor associated with OS and TTP by univariate and multivariate analyses.
Combined HR plus RFA may provide survival advantage compared to TAE in patients with BCLC stage B HCC.
Parenchymal sparing surgery for colorectal liver metastases: The need for a common definition
2017, European Journal of Surgical Oncology
The definition of parenchymal sparing surgery (PSS) for colorectal liver metastases (CRLM) diverges requiring a clarification of the concept.
A consecutive series of patients were treated by PSS for their CRLMs, either by resection or intra-operative ablation (IOA), whenever possible a one-stage surgery and minimal usage of portal vein embolization. Post-operative complications were the primary endpoint with a special focus on post-operative liver failure.
Three hundred and eighty-seven patients underwent a PSS out of which 328 patients received a median of 9 pre-operative cycles of chemotherapy. One hundred and twenty-eight patients had a major resection, combined with IOA in 137 patients and IOA alone in 50 cases. The 5yr-overall survival was 50.3%. There was no difference in post-operative complications between minor and major resections, validating our PSS definition based on the Tumor burden/Healthy liver ratio and not just the retrieved volume.
PSS is defined as a high ratio of tumoral burden per specimen retrieved while favoring one-stage surgery approach. Our series, using combined resections and IOAs, matches this definition well. Furthermore, complications were correlated neither to chemotherapy nor to liver-induced toxicities, contrary to extended hepatectomies.
The impact of expanded indications on short-term outcomes for resection of malignant tumours of the liver over a 30 year period
2017, HPB
There are two philosophical approaches to planning liver resection for malignancy: one strives towards zero postoperative mortality by stringent selection of candidates, thus inherently limiting patients selected; the other, accepts a low yet definite postoperative mortality rate, and offers surgery to all those with potential gain in survival. The aim of this study was to retrospectively analyse an alternative and evolving strategy, and its impact on short-term outcomes.
3118 consecutive hepatectomies performed in 2627 patients over 3 decades (1980–2011) were analysed. Patient demographics, tumour characteristics, operative details, and postoperative outcomes were analysed.
1528 patients (58%) were male. Colorectal liver metastases (1221 patients, 47%) and hepatocellular carcinoma (584 patients, 22%) were the most common diagnoses. Anatomical resections were performed in 2045 (66%), some form of vascular clamping was used in 2385 (72%), and blood transfusion was required in 1130 (36%) patients. Use of preoperative techniques to increase feasibility and safety of complex liver resections allowed expansion of indications to include sicker patients with larger tumours in the later period of the study. Overall morbidity and mortality rates were 31% and 3% respectively. During the first vs. second half of the study period the postoperative morbidity and mortality were 19% vs. 36% (p < 0.001) and 2% vs. 4% (p = 0.006) respectively.
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Intraoperative radiofrequency ablation (IRFA) is added to surgery to obtain hepatic clearance of liver metastases. Complications occurring in IRFA should differ from those associated with wedge or anatomic liver resection.
Patients with liver metastases treated with IRFA from 2000 to 2010 were retrospectively analysed. Postoperative outcomes are reported according to the Clavien–Dindo system of classification.
A total of 151 patients underwent 173 procedures for 430 metastases. Of these, 97 procedures involved IRFA plus liver resection and 76 involved IRFA only. The median number of lesions treated by IRFA was two (range: 1–11). A total of 123 (71.1%) procedures were carried out in patients who had received preoperative chemotherapy. The mortality rate was 1.2%. Thirty (39.5%) IRFA-only patients and 45 (46.4%) IRFA-plus-resection patients presented complications. Immediate complications (n = 4) were associated with IRFA plus resection. American Society of Anesthesiologists (ASA) class, previous abdominal surgery or hepatic resection, body mass index, number of IRFA procedures, portal pedicle clamping, total vascular exclusion and preoperative chemotherapy were not associated with a greater number of complications of Grade III or higher severity. Length of surgery >4 h [odds ratio (OR) 2.67, 95% confidence interval (CI) 1.1–6.3; P < 0.05] and an associated contaminating procedure (OR 3.72, 95% CI 1.53–9.06; P < 0.005) led to a greater frequency of complications of Grade III or higher.
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Bilobar hepatocellular carcinoma (HCC) is not rare and curative resection often cannot be achieved. However, the long-term results of nonsurgical treatments remain unsatisfactory. This study investigates the safety, efficacy, and long-term outcome of hepatic resection (HR) and resection combined with radiofrequency ablation (RFA) in treating patients with bilobar HCC.
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The median follow-up time was 28 mo (range, 3–84 mo). The 1-, 3-, 5-y overall survival rates were better after HR and resection combined with RFA than those of patients after TACE, that is, 78.9%, 49.4%, and 34.4%; 70.7%, 40.7%, and 22.3%; and 47.2%, 17.4%, and 8.6%, respectively (P < 0.001). Overall survival and recurrence-free survival rates were comparable between the two surgical groups. Child–Pugh stage, liver cirrhosis, and tumor number were identified as significant prognostic factors for overall survival by using the multivariate Cox model.
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^☆: Correspondence to: Dr Dominique Elias, Institut Gustave Roussy, Comprehensive Cancer Center, Rue Camille Desmoulins, 94805 Villejuif Cedex, France. Fax: + 33 01 42 11 52 56; E-mail: [email protected]

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Regular ArticleUsefulness of intraoperative radiofrequency thermoablation of liver tumours associated or not with hepatectomy☆

Abstract

Am J Surg

Tissue ablation with radiofrequency: effects of probe size, gauge, duration, and temperature on lesion volume

Acad Radiol

Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode

AJR

Large-volume tissue ablation with radiofrequency by using a clustered, internally cooled electrode technique: laboratory and clinical experience in liver metastases

Radiology

Radiofrequency ablation of porcine liver in vivo. Effects of blood flow and treatment time on lesion size

Ann Surg

Intraoperative use of radiofrequency treatment allows an increase in the rate of curative liver resection

J Surg Oncol

Prolonged intermittent clamping of the portal triad during hepatectomy

Br J Surg

Regular Article
Usefulness of intraoperative radiofrequency thermoablation of liver tumours associated or not with hepatectomy☆