Abstract
BackgroundThe aim of this study was to evaluate the oncological outcomes of hepatocellular carcinoma patients undergoing liver resection using cavitron ultrasonic surgical aspirator (CUSA) or radiofrequency (RF) based device Habib-4X. Study DesignWe prospectively analyzed the data of 280 patients who underwent liver resection for hepatocellular carcinoma at our institution from 2010–2012 with follow up till August 2016. The CUSA was used in the 163 patients whilst Habib-4X in 117 patients. The end points of analysis were oncological outcomes as disease recurrence, disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan–Meier method, which has been compared with all other existing literature on the survival study.ResultsCompared with CUSA the reported incidence of recurrence was significantly lower, in Habib-4X group; p < 0.01. The median DFS was significantly better in Habib-4X group than CUSA group (50.80 vs 45.87 months, p = 0.03). The median OS was better in Habib-4X group than CUSA group (60.57 vs 57.17 months, p = 0.12) though the lesser difference in OS between the groups might be explained by the use of palliative therapies as TACE, percutaneous RFA, etc. in case of recurrence.ConclusionsRF based device Habib-4X, is safe and effective device for resection of hepatocellular carcinoma, in comparison to CUSA with better oncological outcomes, i.e., significantly lesser tumour recurrence and better DFS. This could be explained on the basis of systemic and local immunomodulatory effect involving induction of kupffer cells and effector CD-8 T cells that help in minimizing postoperative complications and bring more advantageous oncological outcomes.
Highlights
Hepatocellular carcinoma (HCC) has been reported as the fifth most common malignancy and considered as one of the aggressive cancer of mankind
The median overall survival (OS) was better in Habib-4X group than cavitron ultrasonic surgical aspirator (CUSA) group (60.57 vs 57.17 months, p = 0.12) though the lesser difference in OS between the groups might be explained by the use of palliative therapies as TACE, percutaneous RFA, etc. in case of recurrence
RF based device Habib-4X, is safe and effective device for resection of hepatocellular carcinoma, in comparison to CUSA with better oncological outcomes, i.e., significantly lesser tumour recurrence and better disease-free survival (DFS). This could be explained on the basis of systemic and local immunomodulatory effect involving induction of kupffer cells and effector CD-8 T cells that help in minimizing postoperative complications and bring more advantageous oncological outcomes
Summary
Hepatocellular carcinoma (HCC) has been reported as the fifth most common malignancy and considered as one of the aggressive cancer of mankind. The initial prototype technique of liver resection is clamp crush or finger fracture is associated with high incidence of intraoperative bleeding during parenchymal transection and is the major obstacle to surgical success [4]. Excessive blood loss and blood transfusions have further ratified the perioperative morbidity, infections and mortality. It is associated with an increased risk of HCC recurrence [5, 6]. To limit the blood flow during parenchymal transection an infamous hepatic vascular inflow occlusion technique or Pringle manoeuvre has been introduced into the practice its applicability is limited in patients with underlying liver disease owing to an increase risk of ischemic reperfusion injury and inability to control backflow bleed from hepatic veins [7, 8]. The aim of this study was to evaluate the oncological outcomes of hepatocellular carcinoma patients undergoing liver resection using cavitron ultrasonic surgical aspirator (CUSA) or radiofrequency (RF) based device Habib-4X
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