Combined ultrasonic aspiration and saline-linked radiofrequency precoagulation: a step toward bloodless liver resection without the need of liver inflow occlusion: analysis of 313 consecutive patients

World Journal of Surgical Oncology

Satvinder Mudan⁴  Emmanouel Pikoulis⁵  Ferdinando Cananzi⁴  Jessamy Bagenal³  Alexandros Giakoustidis¹  Kyriakos Neofytou⁴  Athanasios Petrou²  Evangelos Felekouras⁵ 

[1] The London Clinic, 20 Devonshire Pl, London W1G 6BW, UK;Nicosia Surgical Department, Division of Hepatobiliary Pancreatic Surgery, Nicosia General Hospital, Palaios Dromos Lefkosias - Lemesou, 215, 2029 Strovolos, Nicosia, Cyprus;Bristol Heart Institute, Severn School of Surgery, Bristol, UK;Department of Academic Surgery, Upper GI/HPB Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK;First Department of Surgery, University of Athens Medical School, Laikon Teaching Hospital, Αγ. Θωμά 17, Goudi, Athens, Greece

关键词: Radiofrequency;    Ultrasonic aspiration;    Complications;    Pringle;    Blood loss;    Liver resection;   

Others  :  1147159
DOI  :  10.1186/1477-7819-12-357

 received in 2014-04-06, accepted in 2014-10-29,  发布年份 2014

【 摘 要 】

Background

Hemorrhage is undoubtedly one of the main factors contributing to morbidity and mortality in liver resections. Vascular occlusion techniques are effective in controlling intraoperative bleeding, but they cause liver damage due to ischemia. We evaluated the effectiveness and safety of using a combined technique for hepatic parenchymal transection without liver inflow occlusion.

Methods

Three hundred and thirteen consecutive patients who underwent liver resection in four hepato-pancreato-biliary units. Hepatic parenchymal transection was carried out using a combined technique of saline-linked radiofrequency precoagulation and ultrasonic aspiration without liver inflow occlusion.

Results

During the study period 114 minor and 199 major hepatic resections were performed. The mean amount of intraoperative blood loss was 377 ml (SD 335 ml, range 50 to 2,400 ml) and the blood transfusion rate was 10.5%. The median amount of blood loss during parenchymal transection and parenchymal transection time was 222 ml (SD 224 ml, range 40 to 2,100 ml) and 61 minutes (range 12 to 150 minutes) respectively. There were two postoperative deaths (0.6%). Complications occurred in 84 patients (26.8%) and most complications were minor.

Conclusions

Combined technique of saline-linked radiofrequency ablation and ultrasonic aspiration for liver resection is a safe method for both major and minor liver resections. The method is associated with decreased blood loss, reduced postoperative morbidity, and minimal mortality rates. We believe that this combined technique is comparable to other techniques and should be considered as an alternative.

【 授权许可】

   
2014 Felekouras et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Fortner JG, Silva JS, Golbey RB, Cox EB, Maclean BJ: Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. Ann Surg 1984, 199:306-316.
• [2]Rosen CB, Nagorney DM, Taswell HF, Helgeson SL, Ilstrup DM, van Heerden JA, Adson MA: Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma. Ann Surg 1992, 216:493-504.
• [3]Castaing D, Kanstlinger F, Habib N: Intraoperative ultrasonographic study of liver. Methods and anatomic results. Am J Surg 1985, 149(5):676-682.
• [4]Nagasue N, Yukaya H, Ogawa Y, Hirose S, Okita M: Segmental and subsegmental resections of the cirrhotic liver under hepatic inflow and outflow occlusion. Br J Surg 1981, 72:565-568.
• [5]Buell JF, Rosen S, Yoshida A, Labow D, Limsrichamrern S, Cronin DC, Bruce DS, Wen M, Michelassi F, Millis JM, Posner MC: Hepatic resection: effective treatment for primary and secondary tumors. Surgery 2000, 128(4):686-693.
• [6]Matsumata T, Ikeda Y, Hayashi H, Kamakura T, Taketomi A, Sugimachi K: The association between transfusion and cancer-free survival after curative resection for hepatocellular carcinoma. Cancer 1993, 72:1866-1871.
• [7]Yamamoto J, Kosuge T, Takayama T, Shimada K, Yamasaki S, Ozaki H, Yamaguchi N, Mizuno S, Makuuchi M: Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery 1994, 115:303-309.
• [8]Poon RT, Fan ST, Lo CM, Ng IO, Liu CL, Lam CM, Wong J: Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 2001, 234:63-70.
• [9]Nagorney DM, van Heerden JA, Ilstrup DM, Adson MA: Primary hepatic malignancy: surgical management and determinants of survival. Surgery 1989, 106:740-749.
• [10]Shimada M, Matsumata T, Akazawa K, Kamakura T, Itasaka H, Sugimachi K, Nose Y: Estimation of risk of major complications after hepatic resection. Am J Surg 1994, 167:399-403.
• [11]Makuuchi M, Takayama T, Gunvén P, Kosuge T, Yamazaki S, Hasegawa H: Restrictive versus liberal blood transfusion policy for hepatectomies in cirrhotic patients. World J Surg 1989, 13(5):644-648.
• [12]de Boer MT, Molenaar IQ, Porte RJ: Impact of blood loss on outcome after liver resection. Dig Surg 2007, 24:259-264.
• [13]Asahara T, Katayama K, Itamoto T, Yano M, Hino H, Okamoto Y, Nakahara H, Dohi K, Moriwaki K, Yuge O: Perioperative blood transfusion as a prognostic indicator in patients with hepatocellular carcinoma. World J Surg 1999, 23(7):676-680.
• [14]Hanazaki K, Kajikawa S, Shimozawa N, Matsushita A, Machida T, Shimada K, Yazawa K, Koide N, Adachi W, Amano J: Perioperative blood transfusion and survival following curative hepatic resection for hepatocellular carcinoma. Hepatogastroenterology 2005, 52:524-529.
• [15]Abdalla EK, Noun R, Belghiti J: Hepatic vascular occlusion: which technique? Surg Clin North Am 2004, 84(2):563-585.
• [16]Smyrnitotis V, Farantos C, Kostopanagiotou G, Arkadopoulos N: Vascular control during hepatectomy: review of methods and results. World J Surg 2005, 29(11):1384-1396.
• [17]Lai PB, Lee KF, Wong J, Li AK: Techniques for liver resection: a review. Surgeon 2007, 5(3):166-174.
• [18]Pringle JH: Notes on the arrest of hepatic haemorrhage due to trauma. Ann Surg 1908, 48(4):541-549.
• [19]Makuuchi M, Hasegawa H, Yamazaki S: Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 1985, 161(4):346-350.
• [20]Grace PA: Ischaemia-reperfusion injury. Br J Surg 1994, 81(5):637-647.
• [21]Smyrniotis VE, Kostopanagiotou GG, Gamaletsos EL, Vassiliou JG, Voros DC, Fotopoulos AC, Contis JC: Total versus selective hepatic vascular exclusion in major liver resections. Am J Surg 2002, 183:173-178.
• [22]Smyrniotis VE, Kostopanagiotou GG, Contis JC, Farantos CI, Voros DC, Kannas DC, Koskinas JS: Selective hepatic vascular exclusion versus Pringle maneuver in major liver resections: prospective study. World J Surg 2003, 27:765-769.
• [23]Torzilli G, Makuuchi M, Midorikawa Y, Sano K, Inoue K, Takayama T, Kubota K: Liver resection without total vascular exclusion: hazardous or beneficial. An analysis of our experience. Ann Surg 2001, 233(2):167-175.
• [24]Wu CC, Hwang CR, Liu TJ, P’eng FK: Effects and limitations of prolonged intermittent ischaemia for hepatic resection of the cirrhotic liver. Br J Surg 1996, 83(1):121-124.
• [25]van der Bilt JD, Livestro DP, Borren A, van Hillegersberg R, Borel Rinkes IH: European survey on the application of vascular clamping in liver surgery. Dig Surg 2007, 24(6):423-435.
• [26]Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F: The ‘50-50 criteria’ on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 2005, 242(6):824-828.
• [27]Makuuchi M, Mori T, Gunvén P, Yamazaki S, Hasegawa H: Safety of hemihepatic vascular occlusion during resection of the liver. Surg Gynecol Obstet 1987, 164(2):155-158.
• [28]Clavien PA, Yadav S, Sindram D, Bentley RC: Protective effects of ischaemic preconditioning for liver resection performed under inflow occlusion in humans. Ann Surg 2000, 232(2):155-162.
• [29]Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, Corvera C, Weber S, Blumgart LH: Improvement in perioperative outcome after hepatic resection: analysis of 1803 consecutive cases over the past decade. Ann Surg 2002, 236(4):397-407.
• [30]Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O: Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 2000, 191(1):38-46.
• [31]Ercolani G, Ravaioli M, Grazi GL, Cescon M, Del Gaudio M, Vetrone G, Zanello M, Pinna AD: Use of vascular clamping in hepatic surgery: lessons learned from 1260 liver resections. Arch Surg 2008, 143(4):380-387. Discussion 8. Epub 2008/04/23
• [32]Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C, Wong J: Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 2004, 240(4):698-708. Discussion 10
• [33]Feng ZQ, Huang ZQ, Xu LN, Liu R, Zhang AQ, Huang XQ, Zhang WZ, Dong JH: Liver resection for benign hepatic lesions: a retrospective analysis of 827 consecutive cases. World J Gastroenterol 2008, 14(47):7247-7251.
• [34]Huang ZQ, Xu LN, Yang T, Zhang WZ, Huang XQ, Cai SW, Zhang AQ, Feng YQ, Zhou NX, Dong JH: Hepatic resection: an analysis of the impact of operative and perioperative factors on morbidity and mortality rates in 2008 consecutive hepatectomy cases. Chin Med J (Engl) 2009, 122(19):2268-2277.
• [35]Pai M, Frampton AE, Mikhail S, Resende V, Kornasiewicz O, Spalding DR, Jiao LR, Habib NA: Radiofrequency assisted liver resection: analysis of 604 consecutive cases. Eur J Surg Oncol 2012, 38(3):274-280.
• [36]Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, Takayama T, Makuuchi M: One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 2003, 138(11):1198-1206.