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Abstract
BackgroundWhereas the usefulness of radiofrequency (RF) energy as haemostatic method in liver surgery has become well established in the last decades, its intentional application on resection margins with the aim of reducing local recurrence is still debatable. Our goal was to compare the impact of an additional application of RF energy on the top of the resection surface, namely additional margin coagulation (AMC), on local recurrence (LR) when subjected to a subcentimeter margin. MethodsWe retrospectively analyzed 185 patients out of a whole cohort of 283 patients who underwent radical hepatic resection with subcentimetric margin. After propensity score adjustment, patients were classified into two balanced groups according to whether RF was applied or not. ResultsNo significant differences were observed within groups in baseline characteristics after PSM adjustment. The LR rate was significantly higher in the Control than AMC Group: 12 patients (14.5%) vs. 4 patients (4.8%) (p = 0.039). The estimated 1, 3, and 5-year LR-free survival rates of patients in the Control and AMC Group were: 93.5%, 86.0%, 81.0% and 98.8%, 97.2%, 91.9%, respectively (p = 0.049). Univariate Cox analyses indicated that the use of the RF applicator was significantly associated with lower LR (HR = 0.29, 95% confidence interval 0.093–0.906, p = 0.033). The Control Group showed smaller coagulation widths than the AMC group (p < 0.001). ConclusionsAn additional application of RF on the top of the resection surface is associated with less local hepatic recurrence than the use of conventional techniques.
Highlights
Liver resection remains the standard for the curative treatment of most primary and metastatic liver tumors
Local recurrence is a common cause of early liver tumour recurrence after an hepatectomy due to the persistence of tumour cells close to the resection margin, which could subsequently favour the tumour recurrence and somehow challenge the quality of surgical performance
On the basis of the argument that these remaining malignant cells in the hepatic remnant are responsible for tumour relapse, we aimed to demonstrate that additional coagulation of the hepatic surface with an efficient RF-based device successfully achieved hemostasis and had a favorable effect on local recurrence
Summary
Liver resection remains the standard for the curative treatment of most primary and metastatic liver tumors. As the presence of positive margins in the remaining liver after surgical resection is known to be a significant factor correlated with both local recurrence and overall survival [1], surgical margin width often raises concern in surgeons, as being the only factor in which prognosis might be influenced by surgical performance. Whereas the usefulness of radiofrequency (RF) energy as haemostatic method in liver surgery has become well established in the last decades, its intentional application on resection margins with the aim of reducing local recurrence is still debatable. Our goal was to compare the impact of an additional application of RF energy on the top of the resection surface, namely additional margin coagulation (AMC), on local recurrence (LR) when subjected to a subcentimeter margin. Conclusions: An additional application of RF on the top of the resection surface is associated with less local hepatic recurrence than the use of conventional techniques
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