Mustafa TURAN, Metin ŞEN, Kürşat KARADAYI, Mustafa KOÇ

The effect of radiofrequency-assisted liver resection on liver function

Amaç. Bu araştırmada kolon kaynaklı karaciğer metastazlarında Radyofrekans (RF) yardımlıkaraciğer reseksiyonunun karaciğer fonksiyonlarına etkisi irdelenmiştir. Yöntemler. Buaraştırmaya kolorektal karaciğer metastazlarında RF yardımlı karaciğer rezeksiyonugerçekleştirilen 15 hasta dahil edilmiştir. Hastaların ameliyat öncesi, ve ameliyat sonrası 1. ve 8.günlerde karaciğer fonksiyon testleri çalışılmıştır. Bulgular. Hastaların Aspartateaminotransferase (AST) ve Alanine transaminase (ALT) düzeylerinin ameliyat sonrası 1. gündeistatistiksel olarak anlamlı oranda arttığı görüldü. Ancak bu değerlerin ameliyat sonrası 8. gündenormal değerlerine ulaştığı tespit edildi. Hastaların ameliyat sonrası bilirubine, alkalinephosphatase (ALP) ve Gamma-glutamyl transpeptidase (GGT) serum düzeylerinde ise ameliyatöncesi değerlerine göre anlamlı bir değişiklik görülmedi. Sonuç. Kolorektal karaciğermetastazlarında radyofrekans yardımlı karaciğer rezeksiyonu etkili bir yöntemdir. Ancak RFuygulaması sonrası karaciğer yetmezliğiyle karşılaşmamak için uygun hasta seçimi önemlidir.

Radyof rekans yardımlı karaciğer reseksiyonunun karaciğer fonksiyonlarına etkisi

Aim. To investigate the effects of Radiofrequency (RF)-assisted liver parenchyma dissectiontechnique for the treatment of colorectal metastatic liver tumors in liver parenchymal function.Methods. Fifteen patients with colorectal hepatic metastases underwent radiofrequency assistedhepatic resection. Preoperative and postoperative (1stday and 8thday) liver function tests wereeveluated. Results. Aspartate aminotransferase (AST) and Alanine transaminase (ALT) wasincreased in 100% of patients on the day after RF. However, 8 days after surgery ALT and ASTlevels have almost fully recovered. Serum bilirubine, alkaline phosphatase (ALP) and Gamma- glutamyl transpeptidase (GGT), levels were not increased in postoperative period. Conclusion.Hepatic parenchymal transection with RF device is an effective method to resect colorectal hepaticmetastases. Careful patient selection will help to minimize the incidence of liver failure which mayoccur after RFA.

PDF

___

1. Matsumata T, Ikeda Y, Hayashi H, Kamakura T, Taketomi A, Sugimachi K. The association between transfusion and cancer-free survival after curative resection for hepatocellular carcinoma. Cancer 1993; 72: 1866-71.
2. Shimada M, Matsumata T, Akazawa K, Kamakura T, Itasaka H, Sugimachi K, Nose Y. Estimation of risk of major complications after hepatic resection. Am J Surg 1994; 167: 399-403.
3. Kooby DA, Stockman J, Ben-Porat L, Gonen M, Jarnagin WR, Dematteo RP, Tuorto S, Wuest D, Blumgart LH, Fong Y. Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg 2003; 237: 860-9.
4. Weber JC, Navarra G, Jiao LR, Nicholls JP, Jensen SL, Habib NA. New technique for liver resection using heat coagulative necrosis. Ann Surg 2002; 236: 560-3.
5. Milicevic M, Bulajic P, Zuvela M, Dervenis C, Basaric D, Galun D. A Radiofrequency-Assisted Minimal Blood Loss Liver Parenchyma Dissection Technique. Dig Surg 2007. 24:306-13.
6. Lavergne T, Sebag C, Ollitrault J, Chouari S, Copie X, Le Heuzey JY, Guize L. Radiofrequency ablation: physical bases and principles. Arch Mal Coeur Vaiss 1996; 89: 57-63.
7. Delis S, Bakoyiannis A, Tassopoulos N, Athanassiou K, Papailiou J, Brountzos EN, Madariaga J, Papakostas P, Dervenis C. Clamp-crush technique vs. radiofrequency-assisted liver resection for primary and metastatic liver neoplasms. HPB (Oxford) 2009; 11: 339-44.
8. Kong WT, Zhang WW, Qiu YD, Zhou T, Qiu JL, Zhang W, Ding YT. Major complications after radiofrequency ablation for liver tumors: Analysis of 255 patients. World J Gastroenterol 2009; 15: 2651-6.
9. Ohnishi T, Yasuda I, Nishigaki Y, Hayashi H, Otsuji K, Mukai T, Enya M, Omar S, Soehendra N, Tomita E, Moriwaki H. Intraductal chilled saline perfusion to prevent bile duct injury during percutaneous radiofrequency ablation for hepatocellular carcinoma. J Gastroenterol Hepatol 2008; 23: e410-5.
10. Navarra G, Lorenzini C, Currò G, Basaglia E, Habib NH. Early results after radiofrequency-assisted liver resection. Tumori 2004; 90: 32-5.
11. Stippel DL, Bangard C, Kasper HU, Fischer JH, Hölscher AH, Gossmann A. Experimental bile duct protection by intraductal cooling during radiofrequency ablation. Br J Surg 2005; 92: 849-55.
12. Hering J, Garrean S, Saied A, Helton WS, Espat NJ. Use of radiofrequency hepatic parenchymal transection device in hepatic hemangioma resection: early experience and lessons learned. HPB (Oxford) 2007; 9: 319-23.
13. Bowles BJ, Machi J, Limm WM, Severino R, Oishi AJ, Furumoto NL, Wong LL, Oishi RH. Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors. Arch Surg 2001; 136: 864-9.
14. Jansen MC, van Duijnhoven FH, van Hillegersberg R, Rijken A, van Coevorden F, van der Sijp J, Prevoo W, van Gulik TM. Adverse effects of radiofrequency ablation of liver tumours in the Netherlands. Br J Surg 2005; 92: 1248-54.
15. Koda M, Ueki M, Maeda Y, Mimura KI, Okamoto K, Matsunaga Y, Kawakami M, Hosho K, Murawaki Y. The influence on liver parenchymal function and complications of radiofrequency ablation or the combination with transcatheter arterial embolization for hepatocellular carcinoma. Hepatol Res 2004; 29: 18-23.
16. Hoshida Y, Shiratori Y, Koike Y, Obi S, Hamamura K, Teratani T, Shiina S, Omata M. Hepatic volumetry to predict adverse events in percutaneous ablation of hepatocellular carcinoma. Hepatogastroenterology 2002; 49: 451-5.
17. Yıldırım AE, Altun R, Kaya DF, Öcal S, Akbaş E, Korkmaz M, Selçuk H, Yılmaz U. Radyofrekans ablasyon sonrası gelişen iki nadir komplikasyon. Endoskopi 2012; 3: 1302.