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J Surg Res. 2014 Apr;187(2):471-83. doi: 10.1016/j.jss.2013.10.055. Epub 2013 Oct 31.

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

Author information

1
Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
2
Department of General Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
3
Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. Electronic address: lisq@medmail.com.cn.

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.

KEYWORDS:

Clamp-crush liver resection; Meta-analysis; Radiofrequency-assisted liver resection; Systematic review

PMID:
24290429
DOI:
10.1016/j.jss.2013.10.055
[Indexed for MEDLINE]
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