Morbidity and mortality of laparoscopic vs. open radiofrequency ablation for hepatic malignancies

AimsSurgical radiofrequency ablation (RFA) of hepatic malignancies is associated with superior oncological outcome as compared to percutaneous RFA. The aim of this prospective non-randomized cohort study was to compare morbidity and mortality of laparoscopic (LRFA) vs. open (ORFA) radiofrequency ablation of liver cancer.MethodsBetween October 1999 and November 2006, RFA was performed in 154 consecutive patients (percutaneous 12, LRFA 93, ORFA 49) for a total of 291 hepatic tumours (HCC 81, colorectal metastases 157, other 53). Seventy-four patients simultaneously underwent additional surgery. Laparoscopic RFA was performed in 45/54 patients with HCC, and in 44/54 patients with cirrhosis. Laparotomy was performed in 14/22 patients who underwent simultaneous colorectal resection, and in 12/22 patients with hepatic resection.ResultsPostoperative complications occurred in 25 patients with subsequent mortality in 2. As compared with LRFA, ORFA was associated with significantly (p < 0.01) higher intra-operative blood loss (median 20 (range 0–1700) vs. 10 (0–900) ml), longer duration of surgery (180 (25–440) vs. 75 (30–390) min), more postoperative complications (17 vs. 8), and longer postoperative hospital stay (8 (1–127) vs. 4 (1–51) d). According to the therapy-oriented severity grading system (TOSGS) classification, postoperative complications in the ORFA-group were more severe than those in the LRFA-group (p < 0.01). These findings were consistent in patients without simultaneous colorectal and/or hepatic resection and in patients with liver tumours measuring 3 cm or less. In univariate analysis the following factors were significantly (p < 0.01) related to the presence of postoperative complications: simultaneous colorectal resection, laparotomy, duration of surgery, tumour location in right liver, liver segment 7 (p = 0.01), absence of cirrhosis (p = 0.02), liver segment 8 (p = 0.03), and metastatic liver cancer (p = 0.04).ConclusionLRFA for hepatic malignancies seems preferable above ORFA, provided good patient selection, surgical expertise, and long-term oncological control.