Ablation approach for primary liver tumors: Peri-operative outcomes

作者：Berger Nicholas G; Herren Josi L; Liu Chrissy; Burrow Robert H; Silva Jack P; Tsai Susan; Christians Kathleen K; Gamblin T Clark^*

来源：Journal of Surgical Oncology, 2018, 117(7): 1493-1499.

DOI：10.1002/jso.25019

• hepatocellular carcinoma
• intrahepatic cholangiocarcinoma
• radiofrequency ablation

Background and ObjectivesAblation is a common treatment modality for malignant primary liver tumors(PLTs), outcomes following laparoscopic (LA) versus open ablation (OA) are ill-defined. This project compares peri-procedural outcomes of LA versus OA for PLTs.
Materials and MethodsPatients with PLTs undergoing radiofrequency ablation were queried from ACS NSQIP Database (2005-2013) using CPT codes. Patients undergoing percutaneous ablation or hepatic resection were excluded. Multivariable logistic regression analyses determined the association of ablation approach with 30-day morbidity and mortality.
ResultsOf 5747 with PLTs, 655 (11.4%) ablations were identified: 177 (27.0%) underwent OA, 478 (73.0%) underwent LA. Patients undergoing LA had lower mortality (1.9% vs 5.1%, P=0.026), lower minor morbidity (2.3% vs 5.7%, P=0.031), and lower major morbidity (4.2% vs 17.0%, P<0.001). Adjusting for demographics, disease-specific variables (preoperative ascites, total bilirubin, platelet count, albumin, and INR), 30-day mortality (OR 3.85, 95%CI: 1.38-10.80, P=0.010), minor morbidity (OR 2.98, 95%CI: 1.16-7.67, P=0.024), and major morbidity (OR 4.59 95%CI: 2.41-8.76, P<0.001) were statistically lower in LA. OA demonstrated increased length of stay(LOS) (5 vs 2 days, P<0.001), and longer operative time (152 vs 112min, P<0.001).
ConclusionLA offers decreased peri-procedural morbidity, mortality, and reduced LOS. LA should be the preferred method for hepatic ablation.

• 出版日期2018-6-1