title: Intraoperative radiofrequency ablation for hepatocellular carcinoma in 112 patients with cirrhosis: a surgeon's view.
abstract: OBJECTIVE
  This retrospective study was an investigation of overall survival (OS), disease-free survival (DFS) and prognostic factors affecting OS and DFS in cirrhotic patients who received intraoperative radiofrequency ablation (IORFA).
  
  
  METHODS
  Between April 2009 and November 2013, 112 patients (94 men, 84%; 18 women, 16%) underwent IORFA for 185 cases of hepatocellular carcinomas (HCC). Repeat IORFA was done in 9 patients during the same period (total of 121 treatments).
  
  
  RESULTS
  All patients were followed-up for at least 12 months (mean follow-up, 32 months). Surgical resection combined with IORFA was performed in 20 patients. The technical effectiveness at 1 week was 91.78% (111 of 121). Readmission was 9.1% (11 of 121) and the most common cause was ventral hernia. Procedure-related mortality was 2.7% (3 of 112) and continued fatal biliary leakage was 1.8% (2 of 112). Local recurrence developed in 10 patients (8.9%). Most recurrence was intrahepatic. Cumulative survival was assessed in 33 patients who received IORFA as primary treatment (naive patients) and 79 non-naive patients. The cumulative DFS and OS rate at l and 3 years was 54% and 24%, and 87% and 66%, respectively. Moderate ascites (P = 0.001), tumor located segment I (P = 0.001), portal vein thrombosis (P = 0.001) had poor survival were significant factors by multivariate analysis.
  
  
  CONCLUSIONS
  IORFA alone or in combination with surgical resection extends the spectrum of liver surgery. A fundamental understanding of RFA, additional comorbidities, and postablation complication are necessary to maximize the safety and efficacy of IORFA for treating HCC with cirrhosis.
authors.affiliation: Department of Surgery, Dong-A University College of Medicine, Pusan, Korea.
authors.forename: Jung Yeon
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Surgery, Dong-A University College of Medicine, Pusan, Korea.
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Surgery, Dong-A University College of Medicine, Pusan, Korea.
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Roh
authors.affiliation: Department of Surgery, Dong-A University College of Medicine, Pusan, Korea.
authors.forename: Kyung Bin
authors.initials: KB
authors.lastname: Roh
authors.affiliation: Department of Surgery, Dong-A University College of Medicine, Pusan, Korea.
authors.forename: Kwan Woo
authors.initials: KW
authors.lastname: Kim
authors.affiliation: Department of Surgery, Dong-A University College of Medicine, Pusan, Korea.
authors.forename: Sung Hwa
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Dong-A University College of Medicine, Pusan, Korea.
authors.forename: Yang Hyun
authors.initials: YH
authors.lastname: Baek
authors.affiliation: Department of Internal Medicine, Dong-A University College of Medicine, Pusan, Korea.
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Dong-A University College of Medicine, Pusan, Korea.
authors.forename: Sang Young
authors.initials: SY
authors.lastname: Han
authors.affiliation: Department of Radiology, Dong-A University College of Medicine, Pusan, Korea.
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Kwon
authors.affiliation: Department of Radiology, Dong-A University College of Medicine, Pusan, Korea.
authors.forename: Jin Han
authors.initials: JH
authors.lastname: Cho
keywords: Hepatocellular carcinoma; Intraoperative; Radiofrequency ablation