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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2014

01-06-2014 | Hepatobiliary Tumors

A Critical Analysis of Postoperative Morbidity and Mortality After Laparoscopic Radiofrequency Ablation of Liver Tumors

Authors: Onur Birsen, MD, Shamil Aliyev, MD, Erol Aksoy, MD, Halit E. Taskin, MD, Muhammet Akyuz, MD, Koray Karabulut, MD, Allan Siperstein, MD, Eren Berber, MD

Published in: Annals of Surgical Oncology | Issue 6/2014

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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.
Literature
1.
Abdalla EK. The truth about radiofrequency ablation and laparoscopic liver resection. Ann Surg. 2011;253:841–2.PubMedCrossRef
2.
Berber E, Rogers S, Siperstein A. Predictors of survival after laparoscopic radiofrequency thermal ablation of hepatocellular cancer: a prospective study. Surg Endosc. 2005;19:710–4.PubMedCrossRef
3.
Berber E, Pelley R, Siperstein AE. Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: a prospective study. J Clin Oncol. 2005;23:1358–64.PubMedCrossRef
4.
Asahina Y, Nakanishi H, Izumi N. Laparoscopic radiofrequency ablation for hepatocellular carcinoma. Dig Endosc. 2009;21:67–72.PubMedCrossRef
5.
Tzanis D, Shivathirthan N, Laurent A, Abu Hilal M, Soubrane O, Kazaryan AM, et al. European experience of laparoscopic major hepatectomy. J Hepatobiliary Pancreat Sci. 2013; 20:120–4.
6.
Kong WT, Zhang WW, Qiu YD, Zhou T, Qiu JL, Zhang W, et al. Major complications after radiofrequency ablation for liver tumors: analysis of 255 patients. World J Gastroenterol. 2009;15:2651–6.PubMedCentralPubMedCrossRef
7.
Buscarini E, Buscarini L. Radiofrequency thermal ablation with expandable needle of focal liver malignancies: complication report. Eur Radiol. 2004;14:31–7.PubMedCrossRef
8.
Livraghi T, Meloni F, Di Stasi M, Rolle E, Solbiati L, Tinelli C, et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice? Hepatology. 2008;47:82–9.PubMedCrossRef
9.
Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003;226:441–51.PubMedCrossRef
10.
Wood TF, Rose DM, Chung M, Allegra DP, Foshag LJ, Bilchik AJ. Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations, and complications. Ann Surg Oncol. 2000;7:593–600.PubMedCrossRef
11.
12.
Zagoria RJ, Chen MY, Shen P, Levine EA. Complications from radiofrequency ablation of liver metastases. Am Surg. 2002;68:204–9.PubMed
13.
Berber E, Ari E, Herceg N, Siperstein A. Laparoscopic radiofrequency thermal ablation for unusual hepatic tumors: operative indications and outcomes. Surg Endosc. 2005;19:1613–7.PubMedCrossRef
14.
Siperstein A, Garland A, Engle K, Rogers S, Berber E, String A, et al. Laparoscopic radiofrequency ablation of primary and metastatic liver tumors. Technical considerations. Surg Endosc. 2000;14:400–5.PubMedCrossRef
15.
Berber E, Flesher N, Siperstein AE. Laparoscopic radiofrequency ablation of neuroendocrine liver metastases. World J Surg. 2002;26:985–90.PubMedCrossRef
16.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.PubMedCrossRef
17.
Mulier S, Mulier P, Ni Y, Miao Y, Dupas B, Marchal G, et al. Complications of radiofrequency coagulation of liver tumours. Br J Surg. 2002;89:1206–22.PubMedCrossRef
18.
19.
Wong J, Lee KF, Lee PS, Ho SS, Yu SC, Ng WW, et al. Radiofrequency ablation for 110 malignant liver tumours: preliminary results on percutaneous and surgical approaches. Asian J Surg. 2009;32:13–20.PubMedCrossRef
20.
Schumacher G, Eisele R, Spinelli A, Neuhaus P. The surgical approach for radiofrequency ablation of liver tumors. Recent Results Cancer Res. 2006;167:53–68.PubMedCrossRef
21.
Decadt B, Siriwardena AK. Radiofrequency ablation of liver tumours: systematic review. Lancet Oncol. 2004;5:550–60.PubMedCrossRef
22.
Bleicher RJ, Allegra DP, Nora DT, Wood TF, Foshag LJ, Bilchik AJ. Radiofrequency ablation in 447 complex unresectable liver tumors: lessons learned. Ann Surg Oncol. 2003;10:52–8.PubMedCrossRef
23.
Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Ierace T, Solbiati L, et al. Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology. 2000;214:761–8.PubMedCrossRef
24.
Bowles BJ, Machi J, Limm WM, Severino R, Oishi AJ, Furumoto NL, et al. Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors. Arch Surg. 2001;136:864–9.PubMedCrossRef
25.
Berber E, Siperstein AE. Perioperative outcome after laparoscopic radiofrequency ablation of liver tumors: an analysis of 521 cases. Surg Endosc. 2007;21:613–8.PubMedCrossRef
26.
Rhim H, Yoon KH, Lee JM, Cho Y, Cho JS, Kim SH, et al. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. Radiographics. 2003;23:123–34; discussion 134–6.PubMedCrossRef
27.
Curley SA, Marra P, Beaty K, Ellis LM, Vauthey JN, Abdalla EK et al. Early and late complications after radiofrequency ablation of malignant liver tumors in 608 patients. Ann Surg. 2004;239:450–8.PubMedCentralPubMedCrossRef
28.
Curley SA, Izzo F, Ellis LM, Nicolas Vauthey J, Vallone P. Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis. Ann Surg. 2000;232:381–91.PubMedCentralPubMedCrossRef
29.
de Sio I, Castellano L, De Girolamo V, di Santolo SS, Marone A, Del Vecchio Blanco C, et al. Tumor dissemination after radiofrequency ablation of hepatocellular carcinoma. Hepatology. 2001;34:609–10; author reply 610–1.PubMedCrossRef
30.
Rodriguez J, Tellioglu G, Siperstein A, Berber E. Myoglobinuria after laparoscopic radiofrequency ablation of liver tumors. J Gastrointest Surg. 2010;14:664–7.PubMedCrossRef
31.
Choi H, Loyer EM, DuBrow RA, Kaur H, David CL, Huang S, et al. Radio-frequency ablation of liver tumors: assessment of therapeutic response and complications. Radiographics. 2001;21 Spec No:S41–54.PubMedCrossRef
32.
Risse O, Sengel C, Penillon S, Arvieux C, Voirin D, Letoublon C. Radiofrequency ablation of malignant hepatic tumors. Preliminary experience apropos of 25 cases. Ann Chir. 2001;126:118–26.PubMedCrossRef
33.
Gillams AR, Lees WR. Radio-frequency ablation of colorectal liver metastases in 167 patients. Eur Radiol. 2004;14:2261–7.PubMedCrossRef
34.
Burdio F, Mulier S, Navarro A, Figueras J, Berjano E, Poves I, et al. Influence of approach on outcome in radiofrequency ablation of liver tumors. Surg Oncol. 2008;17:295–9.PubMedCrossRef
35.
Karabulut K, Aucejo F, Akyildiz HY, Siperstein A, Berber E. Resection and radiofrequency ablation in the treatment of hepatocellular carcinoma: a single-center experience. Surg Endosc. 2012;26:990–7.PubMedCrossRef
36.
de Baere T, Risse O, Kuoch V, Dromain C, Sengel C, Smayra T, et al. Adverse events during radiofrequency treatment of 582 hepatic tumors. AJR Am J Roentgenol. 2003;181:695–700.PubMedCrossRef
37.
Navarra G, Ayav A, Weber JC, Jensen SL, Smadga C, Nicholls JP, et al. Short- and-long term results of intraoperative radiofrequency ablation of liver metastases. Int J Colorectal Dis. 2005;20:521–8.PubMedCrossRef
38.
Tepel J, Hinz S, Klomp HJ, Kapischke M, Kremer B. Intraoperative radiofrequency ablation (RFA) for irresectable liver malignancies. Eur J Surg Oncol. 2004;30:551–5.PubMedCrossRef
39.
Pearson AS, Izzo F, Fleming RY, Ellis LM, Delrio P, Roh MS, et al. Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies. Am J Surg. 1999;178:592–9.PubMedCrossRef
40.
Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371:1007–16.PubMedCentralPubMedCrossRef
Metadata
Title
A Critical Analysis of Postoperative Morbidity and Mortality After Laparoscopic Radiofrequency Ablation of Liver Tumors
Authors
Onur Birsen, MD
Shamil Aliyev, MD
Erol Aksoy, MD
Halit E. Taskin, MD
Muhammet Akyuz, MD
Koray Karabulut, MD
Allan Siperstein, MD
Eren Berber, MD
Publication date
01-06-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 6/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3526-8

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