Advertisement

Annals of Surgical Oncology

, Volume 21, Issue 6, pp 1834–1840 | Cite as

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

  • Onur Birsen
  • Shamil Aliyev
  • Erol Aksoy
  • Halit E. Taskin
  • Muhammet Akyuz
  • Koray Karabulut
  • Allan Siperstein
  • Eren Berber
Hepatobiliary 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.

Keywords

Liver Abscess Laparoscopic Liver Resection Cardiopulmonary Complication Posterior Sector Postoperative Liver Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Abdalla EK. The truth about radiofrequency ablation and laparoscopic liver resection. Ann Surg. 2011;253:841–2.PubMedCrossRefGoogle Scholar
  2. 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.PubMedCrossRefGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. 4.
    Asahina Y, Nakanishi H, Izumi N. Laparoscopic radiofrequency ablation for hepatocellular carcinoma. Dig Endosc. 2009;21:67–72.PubMedCrossRefGoogle Scholar
  5. 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.Google Scholar
  6. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Buscarini E, Buscarini L. Radiofrequency thermal ablation with expandable needle of focal liver malignancies: complication report. Eur Radiol. 2004;14:31–7.PubMedCrossRefGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 11.
    Razafindratsira T, Isambert M, Evrard S. Complications of intraoperative radiofrequency ablation of liver metastases. HPB (Oxford). 2011;13:15–23.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Zagoria RJ, Chen MY, Shen P, Levine EA. Complications from radiofrequency ablation of liver metastases. Am Surg. 2002;68:204–9.PubMedGoogle Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. 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.PubMedCrossRefGoogle Scholar
  15. 15.
    Berber E, Flesher N, Siperstein AE. Laparoscopic radiofrequency ablation of neuroendocrine liver metastases. World J Surg. 2002;26:985–90.PubMedCrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 18.
    Minami Y, Kudo M. Radiofrequency ablation of hepatocellular carcinoma: a literature review. Int J Hepatol. 2011;2011:104685.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 21.
    Decadt B, Siriwardena AK. Radiofrequency ablation of liver tumours: systematic review. Lancet Oncol. 2004;5:550–60.PubMedCrossRefGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 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.PubMedCrossRefGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 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.PubMedCrossRefGoogle Scholar
  30. 30.
    Rodriguez J, Tellioglu G, Siperstein A, Berber E. Myoglobinuria after laparoscopic radiofrequency ablation of liver tumors. J Gastrointest Surg. 2010;14:664–7.PubMedCrossRefGoogle Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. 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.PubMedCrossRefGoogle Scholar
  33. 33.
    Gillams AR, Lees WR. Radio-frequency ablation of colorectal liver metastases in 167 patients. Eur Radiol. 2004;14:2261–7.PubMedCrossRefGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 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.PubMedCrossRefGoogle Scholar
  36. 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.PubMedCrossRefGoogle Scholar
  37. 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.PubMedCrossRefGoogle Scholar
  38. 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.PubMedCrossRefGoogle Scholar
  39. 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.PubMedCrossRefGoogle Scholar
  40. 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.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Onur Birsen
    • 1
  • Shamil Aliyev
    • 1
  • Erol Aksoy
    • 1
  • Halit E. Taskin
    • 1
  • Muhammet Akyuz
    • 1
  • Koray Karabulut
    • 1
  • Allan Siperstein
    • 1
  • Eren Berber
    • 1
  1. 1.Department of Endocrine SurgeryCleveland ClinicClevelandUSA

Personalised recommendations