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.
Highlights
A central tenet to liver surgery lies in the complete oncological resection with minimal morbidity [1,2]
The development of non-surgical treatment modalities such as chemotherapy regimens, trans-arterial chemoembolisation (TACE), percutaneous radiofrequency ablation (RFA), microwave ablation, electroporation and cryotherapy could serve as an adjunct to the surgical management and produce a positive impact on the survival of liver cancer patients [15,16,17,18,19,20]
Attention has turned towards liver resection owing to its ability to achieve oncological clearance; that comes with the price of several procedure-specific complications and increased perioperative morbidity, which may influence the disease-specific survival rates [21,22]
Summary
A central tenet to liver surgery lies in the complete oncological resection with minimal morbidity [1,2]. Life-span [6,7,8,9] This improvement can be attributed to a number of factors including, increased use of Cancers 2018, 10, 428; doi:10.3390/cancers10110428 www.mdpi.com/journal/cancers. Cancers 2018, 10, 428 parenchyma-sparing resections, lower intraoperative central venous pressure, better patient selection, ipsilateral portal vein embolization, staged resections in advanced diseases, the advent of newer devices for parenchymal transection, further improvements in perioperative patient management, and so forth [10,11,12,13,14]. The foundation of liver resection surgery is the clamp-crush (CC) technique, which is regarded as a gold standard method of liver parenchymal transection, albeit that the post-resection outcomes are often limited by excessive bleeding, massive blood transfusions, bile leak and increased postoperative morbidity and mortality [23,24]
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