title: Minor hepatic resection for hepatocellular carcinoma in cirrhotic patients: Kelly clamp crushing resection versus heat coagulative necrosis with bipolar radiofrequency device.
abstract: Hemorrhage and postoperative liver insufficiency are frequent and serious complications of hepatic resection in cirrhotic patients. The aim of this study was to assess retrospectively whether the surgical techniques using Kelly clamp crushing resection or heat coagulative necrosis with  a bipolar radiofrequency device can reduce the incidence of the above complications and an eventual recurrence of neoplasia on the liver slice. We retrospectively reviewed the results of 35 patients who had undergone resection for monofocal hepatocellular carcinoma at our center. Thirteen  patients (Group A) had undergone liver resection with Kelly clamp crushing resection, 22 patients (Group B) had had liver resection assisted with a bipolar radiofrequency device. Radiofrequency-assisted liver resection was associated with diminished blood loss (P < 0.0001), a lower  blood transfusion rate (P < 0.005), reduced operative time (P < 0.0001), and better postoperative serum albumin levels (P < 0.03). This nonrandomized retrospective study suggests that radiofrequency-assisted liver resection is associated with better results than  the Kelly clamp crushing resection technique in cirrhotic patients with focal hepatocellular carcinoma and preserved liver function. These results should now be assessed prospectively in a randomized clinical trial.
authors.affiliation: Department of Oncology, Division of General and Oncological Surgery, Interdepartmental Unit for Hepatic Neoplastic Disease, University of Palermo, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Sandonato
authors.forename: Maurizio
authors.initials: M
authors.lastname: Soresi
authors.forename: Calogero
authors.initials: C
authors.lastname: Cipolla
authors.forename: Tommaso V
authors.initials: TV
authors.lastname: Bartolotta
authors.forename: Lydia
authors.initials: L
authors.lastname: Giannitrapani
authors.forename: Michela
authors.initials: M
authors.lastname: Antonucci
authors.forename: Massimo
authors.initials: M
authors.lastname: Galia
authors.forename: Mario A
authors.initials: MA
authors.lastname: Latteri
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007813:Laparotomy; D008099:Liver / Q000473:pathology* / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D009336:Necrosis; D012189:Retrospective Studies; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome