Sherief A Saber, MD1, Gamal I Moussa, PhD1, Ossama H Elkhadrawy, PhD1, Tarek M Ibrahim, PhD2, Hamdy S Abd Alla, PhD1, Mohamad H Abo-Raya, PhD1, Ahmad A Alshoora, MD1, Sherief M Algarf, MSc1, Ahmad Swilum, MSc1, Tamer Almahdy, MSc1, Ahmad Abd Alrahman, MSc1, Mahmoud A Eissa, MSc1, Mostaffa Allam, MSc1, Amre S Ghoraba, MSc1. 1Faculty of medicine, Tanta university Hospital, 2National Liver Inistitute, Menofiya University, Egypt
Introduction: Hepatocellular carcinoma (HCC) is the 5th most common malignancy worldwide with a high prevalence in Nile Delta associated with HCV infection. Anatomical liver resection is poorly tolerated in cirrhotic patients. Various devices are used to control bleeding during parenchymal transection. Of these, Harmonic Scalpel and Habib™ 4x sealer are in common use.
Patients and Methods: This study involved 50 patients with HCC managed by non-anatomical liver resection at the National Liver Institute, Menoufiya University and Gastro-intestinal Surgery Department, Tanta University, Egypt during the period from March 2011 to December 2013. All patients were of child class A, had resectable HCCs and with a good performance status. Patients were randomly divided into 2 equal groups, Group (A) underwent non-anatomical liver resection using Habib™ 4x sealer (RITA Medical Systems Inc, Freemont, California) and Group (B) underwent non-anatomical liver resection using Harmonic Scalpel (Johnson and Johnson Medical, Ethicon, Cincinnati, OH, USA).
Results: The two study groups were matched regarding demographics, clinical presentation, hepatitis virus status, preoperative imaging, laboratory data and previous therapeutic interventions. Three patients (12%) in group (A) required other haemostatic techniques during parenchymal transection, while all patients (100%) in group (B) required these techniques (P<0.0001). The estimated intraoperative blood loss in group (A) was 327.5±184.6 ml vs 662.0±355.7 ml in group (B) (p<0.001). The operative time was 163.2±28.8 min in group (A) vs 188.6±43.0 min in group (B) (P<0.018). Postoperatively, 20 patients (80%) in group (A) needed ICU admission (2.56±2.1 days) vs 23 patients (92%) in group (B) (3.24±2.9 days) (P<0.526). The mean hospital stay was 13.2±4.2 days in group (A) vs 15.3±5.1 days in group (B) (P<0.308). Resection margins were –ve in all patients in group (A) while +ve in 2 patients (8%) in group B. Post-operative liver functions developed marked affection in group (A) in comparison to group (B). In group (A), 3 patients (12%) developed intra-abdominal collections vs 3, 2, 5 and 1 patients developed postoperative intra-abdominal bleeding, bile leakage, intra-abdominal collections and portal vein thrombosis respectively in group (B). The 6-month recurrence rate was 6/25 patients (24%) in group (A) vs 9/25 patients (36%) in group (B) (P<0.452). The 6-months mortality rate was 3/25 patients (12%) in group (A) vs 4/25 patients (16%) in group (B) (P<0.387).
Conclusions: Despite the small sample size, using Habib™ 4x sealer for parenchymal transection in non-anatomical resection of hepatocellular carcinoma in cirrhotic patients seems to be superior to Harmonic scalpel
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80019
Program Number: P472
Presentation Session: Poster (Non CME)
Presentation Type: Poster
