title: A critical analysis of postoperative morbidity and mortality after laparoscopic radiofrequency ablation of liver tumors.
abstract: BACKGROUND
  Although the laparoscopic approach provides certain advantages over the percutaneous radiofrequency thermal ablation (RFA), the morbidity needs to be defined. The aim of this study is to analyze the morbidity and underlying risk factors after laparoscopic RFA of liver tumors.
  
  
  METHODS
  Between 1996 and 2012, 910 patients underwent 1,207 RFA procedures for malignant liver tumors in a tertiary academic center. The 90-day morbidity and mortality were extracted from a prospective IRB-approved database. Statistical analyses were performed using regression, t, and χ (2) tests.
  
  
  RESULTS
  Complications occurred in 50 patients (4 %) and were gastrointestinal in 13 patients (1.1 %), infections in 10 (0.8 %), hemorrhagic in 9 (0.7 %), urinary in 7 (0.6 %), cardiac in 4 (0.3 %), pulmonary in 3 (0.3 %), hematologic in 2 (0.2 %), and neurologic in 2 (0.2 %). The complication rates for an RFA done alone (5 %) versus concomitantly with ancillary procedure (6 %) were similar (p = .6). In all patients who developed postoperative bleeding from the liver, the ablations had been performed on lesions located in the right posterior sector. Of 9 patients with bleeding, 5 (55 %) required a laparotomy. Also, 60 % of liver abscesses occurred in patients with a prior bilioenteric anastomosis (BEA). The 90-day mortality was 0.4 % (n = 5). Hospital stay was 1.2 ± 0.1 days and was prolonged to 4.4 ± 0.3 days in case of complications.
  
  
  CONCLUSIONS
  This study describes the morbidity and mortality to be expected after a laparoscopic RFA procedure. Our results show that additional caution should be used to prevent bleeding complications in patients with tumors located in the right posterior sector and infections in patients with a history of BEA.
authors: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors: Onur
authors: O
authors: Birsen
authors: Shamil
authors: S
authors: Aliyev
authors: Erol
authors: E
authors: Aksoy
authors: Halit E
authors: HE
authors: Taskin
authors: Muhammet
authors: M
authors: Akyuz
authors: Koray
authors: K
authors: Karabulut
authors: Allan
authors: A
authors: Siperstein
authors: Eren
authors: E
authors: Berber
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology; D017115:Catheter Ablation / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000401:mortality; D007902:Length of Stay; D008100:Liver Abscess / Q000209:etiology*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology*; D014570:Urologic Diseases / Q000209:etiology