Radiofrequency-assisted versus clamp-crush liver resection: a systematic review and meta-analysis

• Published in: The Journal of surgical research Vol. 187; no. 2; pp. 471 - 483
• Main Authors: Xiao, Wei-Kai, MD, Chen, Dong, MD, PhD, Hu, An-Bin, MD, PhD, Peng, Bao-Gang, MD, PhD, Guo, Yi-Zhan, MD, Fu, Shun-Jun, MD, Liang, Li-Jian, MD, Li, Shao-Qiang, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2014
• Subjects: Catheter Ablation - methods; Clamp-crush liver resection; Hemostasis, Surgical - methods; Hepatectomy - instrumentation; Hepatectomy - methods; Humans; Liver Diseases - surgery; Liver Neoplasms - surgery; Meta-analysis; Radiofrequency-assisted liver resection; Randomized Controlled Trials as Topic; Surgery; Surgical Instruments; Systematic review; Clamp-crush liver resection; Systematic review; Radiofrequency-assisted liver resection; Meta-analysis
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2013.10.055

Abstract Background Conflicting results were found between radiofrequency-assisted liver resection (RF-LR) and clamp-crush liver resection (CC-LR) during liver surgery. We conducted a systematic review and meta-analysis that included randomized controlled trials (RCTs) and non-RCTs to compare the effectiveness and safety of RF-LR versus CC-LR during liver surgery. Methods Articles comparing RF-LR and CC-LR that were published before December 2012 were retrieved and subjected to a systematic review and meta-analysis. Data synthesis and statistical analysis were carried out by Review Manager Version 5.2 software. Results In all, four RCTs and five nonrandomized studies evaluating 728 patients were included. Compared with CC-LR, the RF-LR group had significantly reduced total intraoperative blood loss (weighted mean difference [WMD] = −187 mL; 95% confidence interval [CI] = −312, −62; data on 628 patients), and blood loss during liver transection (WMD = −143.7 mL; 95% CI = −200, −87; data on 190 patients). However, RF-LR is associated with a higher rate of intra-abdominal abscess than the clamp-crushing method (odds ratio = 3.61; 95% CI = 1.26, 10.32; data on 366 patients). No significant difference was observed between both the groups for the incidence of both blood transfusion and bile leak. Conclusions There is currently not sufficient evidence to support or refute the use of RF-LR in liver surgery. RF-LR has advantages in terms of reducing blood loss. However, RF-LR may increase the rates of both bile leak and abdominal abscess. So, the safety of RF-LR has not been established. Future well-designed RCTs are awaited to further investigate the efficacy and safety of RF devices in liver resection.