Colorectal cancer liver metastases: laparoscopic and open radiofrequency-assisted surgery.

INTRODUCTION: The liver is the most common site of colorectal metastases (colorectal liver metastases - CLM). Surgical treatment in combination with oncological therapy is the only potentially curative method. Unfortunately, only 10-25% of patients are suitable for surgery. Traditionally, open liver resection (OLR) is usually performed. However, laparoscopic liver resection (LLR) has become popular worldwide in the last two decades. AIM: To evaluate the effectiveness and benefits of radiofrequency minor LLR of CLM in comparison with OLR. MATERIAL AND METHODS: The indication for surgery was CLM and the possibility to perform minor laparoscopic or OLR not exceeding two hepatic segments according to Couinaud's classification. RESULTS: Sixty-six minor liver resections for CLM were performed. Twenty-five (37.9%) patients underwent a laparoscopic approach and 41 (62.1%) patients underwent OLR. The mean operative time was 166.4 min for LLR and 166.8 min for OLR. Average blood loss was 132.3 ±218.0 ml during LLR and 149.5 ±277.5 ml during OLR. Length of hospital stay was 8.4 ±2.0 days for LLR and 10.5 ±5.8 days for OLR. All resections were R0. There was no case of mortality. Postoperative complications were recognized in 9 (13.6%) patients: 8 in the group of OLR patients and 1 in the LLR group. The median survival time for LLR was 70.5 months and for OLR 61.9 months. The 5-year overall survival rate was higher for LLR vs. OLR - 82.1% vs. 69.8%. The average length of disease-free interval after LLR was greater (52.2 months) in comparison with OLR (49.4%). The 5-year disease-free interval was 63.2% for LLR and 58% for OLR. CONCLUSIONS: Outcomes and oncological radicality of minor laparoscopic liver resections of CLM are comparable to outcomes of OLR.

Technical development of a new semispherical radiofrequency bipolar device (RONJA): ex vivo and in vivo studies.

The aim of this study is to inform about the development of a new semispherical surgical instrument for the bipolar multielectrode radiofrequency liver ablation. Present tools are universal; however they have several disadvantages such as ablation of healthy tissue, numerous needle punctures, and, therefore, longer operating procedure. Our newly designed and tested semispherical surgical tool can solve some of these disadvantages. By conducting an in vivo study on a set of 12 pigs, randomly divided into two groups, we have compared efficiency of the newly developed instrument with the commonly used device. Statistical analysis showed that there were no significant differences between the groups. On average, the tested instrument RONJA had shorter ablation time in both liver lobes and reduced the total operating time. The depth of the thermal alteration was on average 4 mm larger using the newly tested instrument. The new radiofrequency method described in this study could be used in open liver surgery for the treatment of small liver malignancies (up to 2 cm) in a single application with the aim of saving healthy liver parenchyma. Further experimental studies are needed to confirm these results before clinical application of the method in the treatment of human liver malignancies.

Radiofrequency-assisted liver resections: comparison of open and laparoscopic techniques.

BACKGROUND/AIMS: After the first reported laparoscopic liver resection (LLR) twenty years ago, liver surgery still remains one of the last areas of resistance to the offensive of laparoscopy. Radiofrequency assisted laparoscopic liver resection has been recently developed technique for treatment of primary and secondary liver tumors. METHODOLOGY: Over a 5-year period, a total of 134 laparoscopic and open radiofrequency assisted operations were performed in a single institution. LLR was done in 47 patients, and open liver resection (OLR) in 87 patients. RESULTS: The study selection criteria were fulfilled by 134 patients. The mean blood loss for LLR was 68.7 mL, the difference between the groups was significant with lower median of blood loss using laparoscopy (p=0.046). The mean of length of hospital stay in LLR was 7.5 days versus 8.7 days in OLR (p=0.071). The 5-year survival rate was 67.0% after LLR and 63.8% after OLR. The 5-year disease-free survival rate was 59.4% after LLR, and 62.2% after OLR. The difference between groups was not statistically significant. CONCLUSIONS: Laparoscopic liver resection is safe and feasible procedure. The hand-assisted laparoscopic radiofrequency technique can be applied effectively for selected patients. Preliminary oncological results suggest non-inferiority of laparoscopic to open procedures.