Clinical and Translational Oncology

, Volume 21, Issue 12, pp 1634–1643 | Cite as

Assessment of the effect of the Aquamantys® system on local recurrence after hepatectomy for hepatocellular carcinoma through propensity score matching

  • M. H. Sui
  • H. G. Wang
  • M. Y. Chen
  • T. Wan
  • B. Y. Hu
  • Y. W. Pan
  • H. Li
  • H. Y. Cai
  • C. Cui
  • S. C. LuEmail author
Research Article



To assess the effect of the intraoperative application of the Aquamantys® system to treat the hepatic resection margin on local and overall recurrence of HCC.


We retrospectively analyzed 101 patients admitted from November 2016 to June 2018 who underwent hepatectomy using the Aquamantys® as hemostatic device, who were matched with 101 patients (control group) using conventional hemostatic devices through PSM. Univariate and multivariate analyses of recurrence-free survival (RFS) and local recurrence-free survival (LRFS) were performed using the Cox proportional hazard model.


There were no significant differences in baseline data and surgical procedures between the two groups. The Aquamantys® group showed less blood loss (P = 0.005) and a lower blood transfusion rate (P = 0.036), while the incidences of postoperative complications of the two groups showed no difference (P = 0.266). OS rates of the Aquamantys® group and the control group were 82.6% and 84.2%, respectively (P = 0. 446), and RFS rates were 65.5% and 58.2%, respectively (P = 0.153), with no significant differences. The Aquamantys® group and the control group had two cases and 11 cases of local recurrence, respectively, with LRFS rates of 98% and 87.9%, respectively, in the follow-up period, corresponding to a significant difference (P = 0.011). Multivariate analysis showed that microvascular invasion (MVI), tumor diameter > 5 cm, and the control group were independent risk factors for LRFS.


Our results indicate that application of the Aquamantys® system in hepatectomy can reduce local recurrence, but it can neither reduce overall recurrence nor improve OS.


Hepatocellular carcinoma Hepatectomy Margin Recurrence Aquamantys 



This study was supported by funds from National Key R & D Program of China; National Natural Science Foundation of China.

Compliance with ethical standards

Conflict of interest

All the authors declare that there is no conflict of interest in this work.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the hospital ethics committee and conducted in accordance with medical ethics regulations.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2015;65(2):87–108.CrossRefGoogle Scholar
  2. 2.
    European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236.CrossRefGoogle Scholar
  3. 3.
    Maluccio M, Covey A. Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma. CA Cancer J Clin. 2012;62(6):394–9.CrossRefGoogle Scholar
  4. 4.
    Nagasue N, Uchida M, Makino Y, Takemoto Y, Yamanoi A, Hayashi T, Chang YC, Kohno H, Nakamura T, Yukaya H. Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology. 1993;105:488–94.CrossRefGoogle Scholar
  5. 5.
    Tabrizian P, Jibara G, Shrager B. Recurrence of hepatocellular cancer after resection: patterns, treatments, and prognosis. Ann Surg. 2015;261(5):947–55.CrossRefGoogle Scholar
  6. 6.
    Kumar AM, Fredman ET, Coppa C, El-Gazzaz G, Aucejo FN, Abdel-Wahab M. Patterns of cancer recurrence in localized resected hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int. 2015;14(3):269–75.CrossRefGoogle Scholar
  7. 7.
    Shi M, Guo RP, Lin XJ, Zhang YQ, Chen MS, Zhang CQ, Lau WY, Li JQ. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial. Ann Surg. 2007;245:36–43.CrossRefGoogle Scholar
  8. 8.
    Lai EC, Lau WY. The continuing challenge of hepatic cancer in Asia. Surgeon. 2005;3(3):210–5.CrossRefGoogle Scholar
  9. 9.
    Merican I, Guan R, Amarapuka D, Alexander MJ, Chutaputti A, Chien RN, Hasnian SS, Leung N, Lesmana L, Phiet PH, Sjalfoellah Noer HM, Sollano J, Sun HS, Xu DZ. Chronic hepatitis B virus infection in Asian countries. J Gastroenterol Hepatol. 2000;15(12):1356–61.CrossRefGoogle Scholar
  10. 10.
    Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838–51.CrossRefGoogle Scholar
  11. 11.
    Chau GY, Lui WY, Tsay SH, King KL, Loong CC, Chiu JH, Wu CW, P’eng FK. Prognostic significance of surgical margin in hepatocellular carcinoma resection: an analysis of 165 Childs’ A patients. J Surg Oncol. 1997;66(2):122–6.CrossRefGoogle Scholar
  12. 12.
    Makuuchi M, Kokudo N, Arii S. Development of evidence-based clinical guidelines for the diagnosis and treatment of hepatocellular carcinoma in Japan. Hepatol Res. 2008;38(1):37–51.CrossRefGoogle Scholar
  13. 13.
    Shi M, Zhang CQ, Zhang YQ, Liang XM, Li JQ. Micrometastases of solitary hepatocellular carcinoma and appropriate resection margin. World J Surg. 2004;28:376–81.CrossRefGoogle Scholar
  14. 14.
    Riediger C, Mueller MW, Geismann F, Lehmann A, Schuster T, Michalski CW, Kuhn K, Friess H. Comparative analysis of different transection techniques in minor and major hepatic resections: a prospective cohort study. Int J Surg. 2013;11(9):826–33.CrossRefGoogle Scholar
  15. 15.
    Fischer L, Seiler CM, Broelsch CE, de Hemptinne B, Klempnauer J, Mischinger HJ, Gassel HJ, Rokkjaer M, Schauer R, Larsen PN, Tetens V, Büchler MW. Hemostatic efficacy of TachoSil in liver resection compared with argon beam coagulator treatment: an open, randomized, prospective, multicenter, parallel-group trial. Surgery. 2011;149(1):48–55.CrossRefGoogle Scholar
  16. 16.
    Wright AS, Lee FT Jr, Mahvi DM. Hepatic microwave ablation with multiple antennae results in synergistically larger zones of coagulation necrosis. Ann Surg Oncol. 2003;10:275–83.CrossRefGoogle Scholar
  17. 17.
    Caruana EJ, Kadlec J, Iyer S, Mani A, Solli P, Scarci M. The Aquamantys(®) system improves haemostasis and pneumostasis in open decortication for thoracic empyema. J Thorac Dis. 2016;8(7):1540–5.CrossRefGoogle Scholar
  18. 18.
    Grasso G, Giambartino F, Iacopino DG. Hemostasis in brain tumor surgery using the Aquamantys system. Med Sci Monit. 2014;20:538–43.CrossRefGoogle Scholar
  19. 19.
    Manas DM, Figueras J, Azoulay D, Garcia Valdecasas JC, French J, Dixon E, O’Rourke N, Grovale N, Mazzaferro V. Expert opinion on advanced techniques for hemostasis in liver surgery. Eur J Surg Oncol. 2016;42(10):1597–607.CrossRefGoogle Scholar
  20. 20.
    Takayama T, Sekine T, Makuuchi M, Yamasaki S, Kosuge T, Yamamoto J, Shimada K, Sakamoto M, Hirohashi S, Ohashi Y, Kakizoe T. Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial. Lancet. 2000;356(9232):802–7.CrossRefGoogle Scholar
  21. 21.
    Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F. The ‘50-50 criteria’ on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg. 2005;242(6):824–8.CrossRefGoogle Scholar
  22. 22.
    Shi M, Guo RP, Lin XJ, Zhang YQ, Chen MS, Zhang CQ, Lau WY, Li JQ. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial. Ann Surg. 2007;245:36–43.CrossRefGoogle Scholar
  23. 23.
    Mullen JT, Ribero D, Reddy SK, Donadon M, Zorzi D, Gautam S, Abdalla EK, Curley SA, Capussotti L, Clary BM, Vauthey JN. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg. 2007;204:854–62.CrossRefGoogle Scholar
  24. 24.
    Makuuchi M, Hasegawa H, Yamazaki S. Developmenton segmentectomy and subsegmentectomy of the liver due to introduction of ultrasonography. Nihon Geka Gakkai Zasshi. 1983;84:913–7.PubMedGoogle Scholar
  25. 25.
    Menon KV, Al-Mukhtar A, Aldouri A, Prasad RK, Lodge PA, Toogood GJ. Outcomes after major hepatectomy in elderly patients. J Am Coll Surg. 2006;203:677–83.CrossRefGoogle Scholar
  26. 26.
    Gorisch W, Boergen KP. Heat-induced contraction of blood vessels. Lasers Surg Med. 1982;2:1–13.CrossRefGoogle Scholar
  27. 27.
    Pawlik TM, Delman KA, Vauthey JN. Tumor size predicts vascular invasion and histologic grade: implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl. 2005;11(9):1086–92.CrossRefGoogle Scholar
  28. 28.
    Sasaki K, Matsuda M, Ohkura Y, Kawamura Y, Hashimoto M, Ikeda K, Kumada H, Watanabe G. Minimum resection margin should be based on tumor size in hepatectomy for hepatocellular carcinoma in hepatoviral infection patients. Hepatol Res. 2013;43(12):1295–303.CrossRefGoogle Scholar
  29. 29.
    Ng IO, Guan XY, Poon RT, Fan ST, Lee JM. Determination of the molecular relationship between multiple tumour nodules in hepatocellular carcinoma differentiates multicentric origin from intrahepatic metastasis. J Pathol. 2003;199(3):345–53.CrossRefGoogle Scholar
  30. 30.
    Frank SM, Wasey JO, Dwyer IM, Gokaslan ZL, Ness PM, Kebaish KM. Radiofrequency bipolar hemostatic sealer reduces blood loss, transfusion requirements, and cost for patients undergoing multilevel spinal fusion surgery: a case control study. J Orthop Surg Res. 2014;9:50.CrossRefGoogle Scholar
  31. 31.
    Patrizi A, Jezequel C, Sulpice L, Meunier B, Rayar M, Boudjema K. Disposable bipolar irrigated sealer (Aquamantys(®)) for liver resection: use with caution. Updates Surg. 2016;68(2):171–7.CrossRefGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  1. 1.Medical School of Chinese PLABeijingChina
  2. 2.Department of Hepatobiliary SurgeryChinese PLA General HospitalBeijingChina
  3. 3.NanKai UniversityTianjinChina

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