Salvage hepatic resection after incomplete interstitial therapy for primary and secondary liver tumours.
BACKGROUND
When the response to percutaneous ablation therapy (PAT) of liver tumours is incomplete, surgery may be undertaken as a salvage therapy. To validate the safety and effectiveness of salvage hepatectomy, patients who had undergone PAT or no treatment before hepatectomy were compared.


METHODS
Of 137 patients who had hepatectomy for primary and secondary tumours, 21 had undergone PAT and 116 had surgery as primary treatment. Tumour features and the incidence of liver cirrhosis were similar in the two groups.


RESULTS
Peroperative mortality and major morbidity rates were zero and 5 per cent (one of 21) respectively among patients who had PAT before surgery, and 0.9 per cent (one of 116) and zero in those who did not. Duration of operation (mean 495 versus 336 min; P<0.001), clamping time (mean 81 versus 53 min; P<0.001), blood loss (mean 519 versus 286 ml; P=0.004), need for blood transfusion (six of 21 patients versus nine of 116; P=0.001), and rates of thoracophrenolaparotomy (eight of 21 versus 14 of 116; P<0.001) and resection of other tissues (six of 21 versus nine of 116; P<0.001) were significantly higher in the PAT group.


CONCLUSIONS
Hepatectomy after incomplete PAT is safe and effective, but more extensive procedures are necessary. The effect of salvage hepatectomy on long-term outcome is still unclear.
Torzilli
G
G
Third Department of Surgery, University School of Medicine, Istituto Clinico Humanitas, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy. guido.torzilli@unimi.it
Del Fabbro
D
D
Palmisano
A
A
Marconi
M
M
Makuuchi
M
M
Montorsi
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional