Skip to main content
Erschienen in: Clinical and Translational Oncology 12/2019

25.03.2019 | Research Article

Assessment of the effect of the Aquamantys® system on local recurrence after hepatectomy for hepatocellular carcinoma through propensity score matching

verfasst von: M. H. Sui, H. G. Wang, M. Y. Chen, T. Wan, B. Y. Hu, Y. W. Pan, H. Li, H. Y. Cai, C. Cui, S. C. Lu

Erschienen in: Clinical and Translational Oncology | Ausgabe 12/2019

Einloggen, um Zugang zu erhalten

Abstract

Objective

To assess the effect of the intraoperative application of the Aquamantys® system to treat the hepatic resection margin on local and overall recurrence of HCC.

Methods

We retrospectively analyzed 101 patients admitted from November 2016 to June 2018 who underwent hepatectomy using the Aquamantys® as hemostatic device, who were matched with 101 patients (control group) using conventional hemostatic devices through PSM. Univariate and multivariate analyses of recurrence-free survival (RFS) and local recurrence-free survival (LRFS) were performed using the Cox proportional hazard model.

Results

There were no significant differences in baseline data and surgical procedures between the two groups. The Aquamantys® group showed less blood loss (P = 0.005) and a lower blood transfusion rate (P = 0.036), while the incidences of postoperative complications of the two groups showed no difference (P = 0.266). OS rates of the Aquamantys® group and the control group were 82.6% and 84.2%, respectively (P = 0. 446), and RFS rates were 65.5% and 58.2%, respectively (P = 0.153), with no significant differences. The Aquamantys® group and the control group had two cases and 11 cases of local recurrence, respectively, with LRFS rates of 98% and 87.9%, respectively, in the follow-up period, corresponding to a significant difference (P = 0.011). Multivariate analysis showed that microvascular invasion (MVI), tumor diameter > 5 cm, and the control group were independent risk factors for LRFS.

Conclusion

Our results indicate that application of the Aquamantys® system in hepatectomy can reduce local recurrence, but it can neither reduce overall recurrence nor improve OS.
Literatur
1.
Zurück zum Zitat Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2015;65(2):87–108.CrossRef Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2015;65(2):87–108.CrossRef
2.
Zurück zum Zitat European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236.CrossRef European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236.CrossRef
3.
Zurück zum Zitat Maluccio M, Covey A. Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma. CA Cancer J Clin. 2012;62(6):394–9.CrossRef Maluccio M, Covey A. Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma. CA Cancer J Clin. 2012;62(6):394–9.CrossRef
4.
Zurück zum Zitat Nagasue N, Uchida M, Makino Y, Takemoto Y, Yamanoi A, Hayashi T, Chang YC, Kohno H, Nakamura T, Yukaya H. Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology. 1993;105:488–94.CrossRef Nagasue N, Uchida M, Makino Y, Takemoto Y, Yamanoi A, Hayashi T, Chang YC, Kohno H, Nakamura T, Yukaya H. Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology. 1993;105:488–94.CrossRef
5.
Zurück zum Zitat Tabrizian P, Jibara G, Shrager B. Recurrence of hepatocellular cancer after resection: patterns, treatments, and prognosis. Ann Surg. 2015;261(5):947–55.CrossRef Tabrizian P, Jibara G, Shrager B. Recurrence of hepatocellular cancer after resection: patterns, treatments, and prognosis. Ann Surg. 2015;261(5):947–55.CrossRef
6.
Zurück zum Zitat Kumar AM, Fredman ET, Coppa C, El-Gazzaz G, Aucejo FN, Abdel-Wahab M. Patterns of cancer recurrence in localized resected hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int. 2015;14(3):269–75.CrossRef Kumar AM, Fredman ET, Coppa C, El-Gazzaz G, Aucejo FN, Abdel-Wahab M. Patterns of cancer recurrence in localized resected hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int. 2015;14(3):269–75.CrossRef
7.
Zurück zum Zitat Shi M, Guo RP, Lin XJ, Zhang YQ, Chen MS, Zhang CQ, Lau WY, Li JQ. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial. Ann Surg. 2007;245:36–43.CrossRef Shi M, Guo RP, Lin XJ, Zhang YQ, Chen MS, Zhang CQ, Lau WY, Li JQ. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial. Ann Surg. 2007;245:36–43.CrossRef
8.
Zurück zum Zitat Lai EC, Lau WY. The continuing challenge of hepatic cancer in Asia. Surgeon. 2005;3(3):210–5.CrossRef Lai EC, Lau WY. The continuing challenge of hepatic cancer in Asia. Surgeon. 2005;3(3):210–5.CrossRef
9.
Zurück zum Zitat Merican I, Guan R, Amarapuka D, Alexander MJ, Chutaputti A, Chien RN, Hasnian SS, Leung N, Lesmana L, Phiet PH, Sjalfoellah Noer HM, Sollano J, Sun HS, Xu DZ. Chronic hepatitis B virus infection in Asian countries. J Gastroenterol Hepatol. 2000;15(12):1356–61.CrossRef Merican I, Guan R, Amarapuka D, Alexander MJ, Chutaputti A, Chien RN, Hasnian SS, Leung N, Lesmana L, Phiet PH, Sjalfoellah Noer HM, Sollano J, Sun HS, Xu DZ. Chronic hepatitis B virus infection in Asian countries. J Gastroenterol Hepatol. 2000;15(12):1356–61.CrossRef
10.
Zurück zum Zitat Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838–51.CrossRef Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838–51.CrossRef
11.
Zurück zum Zitat Chau GY, Lui WY, Tsay SH, King KL, Loong CC, Chiu JH, Wu CW, P’eng FK. Prognostic significance of surgical margin in hepatocellular carcinoma resection: an analysis of 165 Childs’ A patients. J Surg Oncol. 1997;66(2):122–6.CrossRef Chau GY, Lui WY, Tsay SH, King KL, Loong CC, Chiu JH, Wu CW, P’eng FK. Prognostic significance of surgical margin in hepatocellular carcinoma resection: an analysis of 165 Childs’ A patients. J Surg Oncol. 1997;66(2):122–6.CrossRef
12.
Zurück zum Zitat Makuuchi M, Kokudo N, Arii S. Development of evidence-based clinical guidelines for the diagnosis and treatment of hepatocellular carcinoma in Japan. Hepatol Res. 2008;38(1):37–51.CrossRef Makuuchi M, Kokudo N, Arii S. Development of evidence-based clinical guidelines for the diagnosis and treatment of hepatocellular carcinoma in Japan. Hepatol Res. 2008;38(1):37–51.CrossRef
13.
Zurück zum Zitat Shi M, Zhang CQ, Zhang YQ, Liang XM, Li JQ. Micrometastases of solitary hepatocellular carcinoma and appropriate resection margin. World J Surg. 2004;28:376–81.CrossRef Shi M, Zhang CQ, Zhang YQ, Liang XM, Li JQ. Micrometastases of solitary hepatocellular carcinoma and appropriate resection margin. World J Surg. 2004;28:376–81.CrossRef
14.
Zurück zum Zitat Riediger C, Mueller MW, Geismann F, Lehmann A, Schuster T, Michalski CW, Kuhn K, Friess H. Comparative analysis of different transection techniques in minor and major hepatic resections: a prospective cohort study. Int J Surg. 2013;11(9):826–33.CrossRef Riediger C, Mueller MW, Geismann F, Lehmann A, Schuster T, Michalski CW, Kuhn K, Friess H. Comparative analysis of different transection techniques in minor and major hepatic resections: a prospective cohort study. Int J Surg. 2013;11(9):826–33.CrossRef
15.
Zurück zum Zitat Fischer L, Seiler CM, Broelsch CE, de Hemptinne B, Klempnauer J, Mischinger HJ, Gassel HJ, Rokkjaer M, Schauer R, Larsen PN, Tetens V, Büchler MW. Hemostatic efficacy of TachoSil in liver resection compared with argon beam coagulator treatment: an open, randomized, prospective, multicenter, parallel-group trial. Surgery. 2011;149(1):48–55.CrossRef Fischer L, Seiler CM, Broelsch CE, de Hemptinne B, Klempnauer J, Mischinger HJ, Gassel HJ, Rokkjaer M, Schauer R, Larsen PN, Tetens V, Büchler MW. Hemostatic efficacy of TachoSil in liver resection compared with argon beam coagulator treatment: an open, randomized, prospective, multicenter, parallel-group trial. Surgery. 2011;149(1):48–55.CrossRef
16.
Zurück zum Zitat Wright AS, Lee FT Jr, Mahvi DM. Hepatic microwave ablation with multiple antennae results in synergistically larger zones of coagulation necrosis. Ann Surg Oncol. 2003;10:275–83.CrossRef Wright AS, Lee FT Jr, Mahvi DM. Hepatic microwave ablation with multiple antennae results in synergistically larger zones of coagulation necrosis. Ann Surg Oncol. 2003;10:275–83.CrossRef
17.
Zurück zum Zitat Caruana EJ, Kadlec J, Iyer S, Mani A, Solli P, Scarci M. The Aquamantys(®) system improves haemostasis and pneumostasis in open decortication for thoracic empyema. J Thorac Dis. 2016;8(7):1540–5.CrossRef Caruana EJ, Kadlec J, Iyer S, Mani A, Solli P, Scarci M. The Aquamantys(®) system improves haemostasis and pneumostasis in open decortication for thoracic empyema. J Thorac Dis. 2016;8(7):1540–5.CrossRef
18.
Zurück zum Zitat Grasso G, Giambartino F, Iacopino DG. Hemostasis in brain tumor surgery using the Aquamantys system. Med Sci Monit. 2014;20:538–43.CrossRef Grasso G, Giambartino F, Iacopino DG. Hemostasis in brain tumor surgery using the Aquamantys system. Med Sci Monit. 2014;20:538–43.CrossRef
19.
Zurück zum Zitat Manas DM, Figueras J, Azoulay D, Garcia Valdecasas JC, French J, Dixon E, O’Rourke N, Grovale N, Mazzaferro V. Expert opinion on advanced techniques for hemostasis in liver surgery. Eur J Surg Oncol. 2016;42(10):1597–607.CrossRef Manas DM, Figueras J, Azoulay D, Garcia Valdecasas JC, French J, Dixon E, O’Rourke N, Grovale N, Mazzaferro V. Expert opinion on advanced techniques for hemostasis in liver surgery. Eur J Surg Oncol. 2016;42(10):1597–607.CrossRef
20.
Zurück zum Zitat Takayama T, Sekine T, Makuuchi M, Yamasaki S, Kosuge T, Yamamoto J, Shimada K, Sakamoto M, Hirohashi S, Ohashi Y, Kakizoe T. Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial. Lancet. 2000;356(9232):802–7.CrossRef Takayama T, Sekine T, Makuuchi M, Yamasaki S, Kosuge T, Yamamoto J, Shimada K, Sakamoto M, Hirohashi S, Ohashi Y, Kakizoe T. Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial. Lancet. 2000;356(9232):802–7.CrossRef
21.
Zurück zum Zitat Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F. The ‘50-50 criteria’ on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg. 2005;242(6):824–8.CrossRef Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F. The ‘50-50 criteria’ on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg. 2005;242(6):824–8.CrossRef
22.
Zurück zum Zitat Shi M, Guo RP, Lin XJ, Zhang YQ, Chen MS, Zhang CQ, Lau WY, Li JQ. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial. Ann Surg. 2007;245:36–43.CrossRef Shi M, Guo RP, Lin XJ, Zhang YQ, Chen MS, Zhang CQ, Lau WY, Li JQ. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial. Ann Surg. 2007;245:36–43.CrossRef
23.
Zurück zum Zitat Mullen JT, Ribero D, Reddy SK, Donadon M, Zorzi D, Gautam S, Abdalla EK, Curley SA, Capussotti L, Clary BM, Vauthey JN. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg. 2007;204:854–62.CrossRef Mullen JT, Ribero D, Reddy SK, Donadon M, Zorzi D, Gautam S, Abdalla EK, Curley SA, Capussotti L, Clary BM, Vauthey JN. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg. 2007;204:854–62.CrossRef
24.
Zurück zum Zitat Makuuchi M, Hasegawa H, Yamazaki S. Developmenton segmentectomy and subsegmentectomy of the liver due to introduction of ultrasonography. Nihon Geka Gakkai Zasshi. 1983;84:913–7.PubMed Makuuchi M, Hasegawa H, Yamazaki S. Developmenton segmentectomy and subsegmentectomy of the liver due to introduction of ultrasonography. Nihon Geka Gakkai Zasshi. 1983;84:913–7.PubMed
25.
Zurück zum Zitat Menon KV, Al-Mukhtar A, Aldouri A, Prasad RK, Lodge PA, Toogood GJ. Outcomes after major hepatectomy in elderly patients. J Am Coll Surg. 2006;203:677–83.CrossRef Menon KV, Al-Mukhtar A, Aldouri A, Prasad RK, Lodge PA, Toogood GJ. Outcomes after major hepatectomy in elderly patients. J Am Coll Surg. 2006;203:677–83.CrossRef
26.
Zurück zum Zitat Gorisch W, Boergen KP. Heat-induced contraction of blood vessels. Lasers Surg Med. 1982;2:1–13.CrossRef Gorisch W, Boergen KP. Heat-induced contraction of blood vessels. Lasers Surg Med. 1982;2:1–13.CrossRef
27.
Zurück zum Zitat Pawlik TM, Delman KA, Vauthey JN. Tumor size predicts vascular invasion and histologic grade: implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl. 2005;11(9):1086–92.CrossRef Pawlik TM, Delman KA, Vauthey JN. Tumor size predicts vascular invasion and histologic grade: implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl. 2005;11(9):1086–92.CrossRef
28.
Zurück zum Zitat Sasaki K, Matsuda M, Ohkura Y, Kawamura Y, Hashimoto M, Ikeda K, Kumada H, Watanabe G. Minimum resection margin should be based on tumor size in hepatectomy for hepatocellular carcinoma in hepatoviral infection patients. Hepatol Res. 2013;43(12):1295–303.CrossRef Sasaki K, Matsuda M, Ohkura Y, Kawamura Y, Hashimoto M, Ikeda K, Kumada H, Watanabe G. Minimum resection margin should be based on tumor size in hepatectomy for hepatocellular carcinoma in hepatoviral infection patients. Hepatol Res. 2013;43(12):1295–303.CrossRef
29.
Zurück zum Zitat Ng IO, Guan XY, Poon RT, Fan ST, Lee JM. Determination of the molecular relationship between multiple tumour nodules in hepatocellular carcinoma differentiates multicentric origin from intrahepatic metastasis. J Pathol. 2003;199(3):345–53.CrossRef Ng IO, Guan XY, Poon RT, Fan ST, Lee JM. Determination of the molecular relationship between multiple tumour nodules in hepatocellular carcinoma differentiates multicentric origin from intrahepatic metastasis. J Pathol. 2003;199(3):345–53.CrossRef
30.
Zurück zum Zitat Frank SM, Wasey JO, Dwyer IM, Gokaslan ZL, Ness PM, Kebaish KM. Radiofrequency bipolar hemostatic sealer reduces blood loss, transfusion requirements, and cost for patients undergoing multilevel spinal fusion surgery: a case control study. J Orthop Surg Res. 2014;9:50.CrossRef Frank SM, Wasey JO, Dwyer IM, Gokaslan ZL, Ness PM, Kebaish KM. Radiofrequency bipolar hemostatic sealer reduces blood loss, transfusion requirements, and cost for patients undergoing multilevel spinal fusion surgery: a case control study. J Orthop Surg Res. 2014;9:50.CrossRef
31.
Zurück zum Zitat Patrizi A, Jezequel C, Sulpice L, Meunier B, Rayar M, Boudjema K. Disposable bipolar irrigated sealer (Aquamantys(®)) for liver resection: use with caution. Updates Surg. 2016;68(2):171–7.CrossRef Patrizi A, Jezequel C, Sulpice L, Meunier B, Rayar M, Boudjema K. Disposable bipolar irrigated sealer (Aquamantys(®)) for liver resection: use with caution. Updates Surg. 2016;68(2):171–7.CrossRef
Metadaten
Titel
Assessment of the effect of the Aquamantys® system on local recurrence after hepatectomy for hepatocellular carcinoma through propensity score matching
verfasst von
M. H. Sui
H. G. Wang
M. Y. Chen
T. Wan
B. Y. Hu
Y. W. Pan
H. Li
H. Y. Cai
C. Cui
S. C. Lu
Publikationsdatum
25.03.2019
Verlag
Springer International Publishing
Erschienen in
Clinical and Translational Oncology / Ausgabe 12/2019
Print ISSN: 1699-048X
Elektronische ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-019-02092-0

Weitere Artikel der Ausgabe 12/2019

Clinical and Translational Oncology 12/2019 Zur Ausgabe

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.