The impact of additional margin coagulation with radiofrequency in liver resections with subcentimetric margin: can we improve the oncological results? A propensity score matching study.


Journal

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
ISSN: 1532-2157
Titre abrégé: Eur J Surg Oncol
Pays: England
ID NLM: 8504356

Informations de publication

Date de publication:
Jan 2022
Historique:
received: 29 03 2021
revised: 09 05 2021
accepted: 02 06 2021
pubmed: 22 6 2021
medline: 22 2 2022
entrez: 21 6 2021
Statut: ppublish

Résumé

Whereas the usefulness of radiofrequency (RF) energy as haemostatic method in liver surgery has become well established in the last decades, its intentional application on resection margins with the aim of reducing local recurrence is still debatable. Our goal was to compare the impact of an additional application of RF energy on the top of the resection surface, namely additional margin coagulation (AMC), on local recurrence (LR) when subjected to a subcentimeter margin. We retrospectively analyzed 185 patients out of a whole cohort of 283 patients who underwent radical hepatic resection with subcentimetric margin. After propensity score adjustment, patients were classified into two balanced groups according to whether RF was applied or not. No significant differences were observed within groups in baseline characteristics after PSM adjustment. The LR rate was significantly higher in the Control than AMC Group: 12 patients (14.5%) vs. 4 patients (4.8%) (p = 0.039). The estimated 1, 3, and 5-year LR-free survival rates of patients in the Control and AMC Group were: 93.5%, 86.0%, 81.0% and 98.8%, 97.2%, 91.9%, respectively (p = 0.049). Univariate Cox analyses indicated that the use of the RF applicator was significantly associated with lower LR (HR = 0.29, 95% confidence interval 0.093-0.906, p = 0.033). The Control Group showed smaller coagulation widths than the AMC group (p < 0.001). An additional application of RF on the top of the resection surface is associated with less local hepatic recurrence than the use of conventional techniques.

Sections du résumé

BACKGROUND BACKGROUND
Whereas the usefulness of radiofrequency (RF) energy as haemostatic method in liver surgery has become well established in the last decades, its intentional application on resection margins with the aim of reducing local recurrence is still debatable. Our goal was to compare the impact of an additional application of RF energy on the top of the resection surface, namely additional margin coagulation (AMC), on local recurrence (LR) when subjected to a subcentimeter margin.
METHODS METHODS
We retrospectively analyzed 185 patients out of a whole cohort of 283 patients who underwent radical hepatic resection with subcentimetric margin. After propensity score adjustment, patients were classified into two balanced groups according to whether RF was applied or not.
RESULTS RESULTS
No significant differences were observed within groups in baseline characteristics after PSM adjustment. The LR rate was significantly higher in the Control than AMC Group: 12 patients (14.5%) vs. 4 patients (4.8%) (p = 0.039). The estimated 1, 3, and 5-year LR-free survival rates of patients in the Control and AMC Group were: 93.5%, 86.0%, 81.0% and 98.8%, 97.2%, 91.9%, respectively (p = 0.049). Univariate Cox analyses indicated that the use of the RF applicator was significantly associated with lower LR (HR = 0.29, 95% confidence interval 0.093-0.906, p = 0.033). The Control Group showed smaller coagulation widths than the AMC group (p < 0.001).
CONCLUSIONS CONCLUSIONS
An additional application of RF on the top of the resection surface is associated with less local hepatic recurrence than the use of conventional techniques.

Identifiants

pubmed: 34148824
pii: S0748-7983(21)00570-9
doi: 10.1016/j.ejso.2021.06.008
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

82-88

Informations de copyright

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest FB declares that he is co-inventor of the US Patent 8.303.584 which corresponds to Coolinside and Coolingbis devices employed in the AMC Group. The other authors have no conflict of interests or financial ties to disclose.

Auteurs

María Villamonte (M)

Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain.

Fernando Burdío (F)

Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain; Hospital del Mar Medical ResearchInstitute (IMIM), Barcelona, Spain. Electronic address: fburdio@psmar.cat.

Eva Pueyo (E)

Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain.

Ana Andaluz (A)

Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain.

Xavier Moll (X)

Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain.

Enrique Berjano (E)

BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain.

Aleksander Radosevic (A)

Department of Radiology, Hospital del Mar, Barcelona, Spain.

Luís Grande (L)

Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain.

Miguel Pera (M)

Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain.

Benedetto Ielpo (B)

Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain.

Patricia Sánchez-Velázquez (P)

Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain; Hospital del Mar Medical ResearchInstitute (IMIM), Barcelona, Spain.

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