Assessing the impact and benefits of radiofrequency-assisted parenchymal sparing liver resection on post hepatectomy liver failure

Abstract

Background: Post-hepatectomy liver failure is a feared complication of liver surgery. Many devices have help in reducing its occurrence while allowing parechymal preserving resection. In this study, we reviewed the technical subtleties of radiofrequency (RF)assisted liver resections, analysing perioperative variables focusing on post-hepatectomy liver failure (PHLF) and its impact on morbidity and mortality. Methods: We retrospectively reviewed 857 cases of RF assisted liver resection (with Habib 4X) for malignant tumours between 2001 and 2015. We evaluated intraoperative blood loss, blood transfusions, and need for vascular inflow control. Postoperative complications, PHLF, 30-days mortality, intensive care unit and hospital stay were also analysed. Results: 857 RF-based liver resections were performed for primary and secondary liver tumours. Median intraoperative blood loss was 130 ml with 9.8% of patients received blood transfusion. Major liver resection was performed in only 34% of the patients. The incidence of post-hepatectomy liver failure was 1.5% (n=13) with single directly related mortality (0.1%). Conclusion: RF based liver resection is safe and feasible with low incidence of PHLF and related mortality. This may be explained by reducing blood loss, blood transfusion, minimal use of vascular inflow control,and maximum preservation of functional liver parenchyma. Thus, development of Habib 4X and its ease in application has further strengthen the role of RF based devices in liver surgery.