The impact of radiofrequency-assisted transection on local hepatic recurrence after resection of colorectal liver metastases

Abstract

Background: After resection of colorectal liver metastasis, the incidence of local hepatic recurrence (LHER) ranges from 7 to 17% or even higher in some laparoscopic non-anatomical laparoscopic resections in some series. The aim of this study is to determinate if a RF-assisted transection device (RFAT) has any effect on (LHER) compared to conventional technologies. Methods: A study population of 103 patients who had undergone a hepatic surgical resection was analysed. Two groups were considered: RFAT group (n=45) and conventional technique group (n=58). LHER was defined as any growing or enhancing tumour in the margin of hepatic resection during follow-up. Cox proportional models were constructed and variables were eliminated only if p>0.20 to protect against residual confounding. To assess the stability of Cox’s regression model and its internal validity, a bootstrap investigation was also performed. Results: Baseline and operative characteristics were similar in both groups. In patients with positive margins, we demonstrated 0% of LHER in RFAT vs 27% in control group (p=0.03). In the multivariate analysis, factors with significant influence on LHER were: RFAT group, size of the largest metastases, number of resected metastases, positive margin and usage of Pringle-manoeuvre. Conclusion: Parenchymal transection using a RFAT able to create deep thermal lesions may reduce LHER especially in case of margin invasion during transection. This could be especially relevant in some difficult laparoscopic non-anatomical resections.