Clamp–crush technique vs. radiofrequency-assisted liver resection for primary and metastatic liver neoplasms

Background: Several techniques for liver resection have been developed. We compared radiofrequency-assisted (RF) and clamp–crush (CC) liver resection (LR) in terms of blood loss, operating time and short-term outcomes in primary and metastatic tumour resection.

Methods: From 2002 to 2007, 196 consecutive patients with primary or metastatic hepatic tumours underwent RF-LR (n= 109; group 1) or CC-LR (n= 87; group 2) in our unit. Primary endpoints were intraoperative blood loss (and blood transfusion requirements) and total operative time. Secondary endpoints included postoperative complications, mortality and intensive care unit (ICU) and hospital stay. Data were collected retrospectively on all patients with primary or secondary liver lesions.

Results: Blood loss was similar (P= 0.09) between the two groups of patients with the exception of high MELD score (>9) cirrhotic patients, in whom blood loss was lower when RF-LR was used (P < 0.001). Total operative time and transection time were shorter in the CC-LR group (P= 0.04 and P= 0.01, respectively), except for high MELD score (>9) cirrhotic patients, in whom total operation and transection times were shorter when RF-LR was used (P= 0.04). Rates of bile leak and abdominal abscess formation were higher after RF-LR (P= 0.04 for both).

Conclusions: Clamp–crush LR is reliable and results in the same amount of blood loss and a shorter operating time compared with RF-LR. Radiofrequency-assisted LR is a unique, simple and safe method of resection, which may be indicated in cirrhotic patients with high MELD scores.