Randomized clinical trial of radiofrequency-assisted versus clamp-crushing liver resection.
BACKGROUND
Surgical resection remains the treatment of choice for primary and secondary liver cancer. Complications are mainly related to blood loss. Radiofrequency-assisted liver resection (RF-R) has been proposed for parenchymal division as an alternative to clamp crushing in order to reduce blood loss.


METHODS
Fifty patients (median age 62 (range 30-82) years) undergoing hepatectomy were randomized to RF-R (24 patients) or the clamp-crushing method (26). In the RF-R group the resection plane was precoagulated by multiple insertion of a planar triple-cooled radiofrequency ablation needle, and then the parenchyma was sectioned using a scalpel.


RESULTS
The two groups were well matched in terms of age, sex, liver disease and type of resection. There were no deaths. Eight in the RF-R group developed complications (abscess in six, biliary fistula in three and biliary stenosis in one) compared with none of those who had resection by the crush method (P < 0.001). Two patients with cirrhosis in each group developed decompensation. Blood transfusion was required in eight of 24 patients in the RF-R group and 13 of 26 in the clamp-crushing group (P = 0.079).


CONCLUSIONS
RF-R allows parenchymal resection in a clean surgical field but is associated with a higher rate of postoperative complications than the clamp-crushing technique.
Lupo
L
L
Department of Emergency and Organ Transplantation, Institute of General Surgery and Liver Transplantation, University of Bari, piazza Giulio Cesare 12, 70124 Bari, Italy. lupo@clichiru.uniba.it
Gallerani
A
A
Panzera
P
P
Tandoi
F
F
Di Palma
G
G
Memeo
V
V
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D017115:Catheter Ablation; D003250:Constriction; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome