Elias D, Goharin A, El Otmany A, Taieb J, Duvillard P, Lasser P, de Baere T
Departments of Surgical Oncology, Interventional Radiology, and Pathology, Institut Gustave Roussy, Comprehensive Cancer Center, Villejuif Cedex, 94805, France.
Eur J Surg Oncol. 2000 Dec;26(8):763-9. doi: 10.1053/ejso.2000.1000.
A probe emitting radiofrequency (RF) waves is able to destroy tumour tissue by thermal ablation. The purpose of this study was to undertake a prospective estimation of the benefit of RF thermoablation of liver tumours during hepatic and extrahepatic resections aimed at obtaining an R0 status in patients in whom disease is notoriously considered unresectable.
Twenty-one patients underwent surgery between January 1997 and September 1999. In 17 cases, RF was associated with a hepatectomy and in nine of these cases with resection of extrahepatic lesions. In two cases, extensive resection of extrahepatic lesions was associated with RF to treat liver metastases, and in two cases RF was ultimately performed alone. The mean number of liver metastases was 6.2+/-4.3 (range 1-15) per patient. A total of 32 lesions were treated with RF. The mean size of the 33 RF-thermoablated tumours was 13.6+/-9.7 mm (range 5-52 mm), and in all but one case, a Pringle manoeuvre was performed during the RF procedure.
A probable R0-resection was obtained in 18 cases. No operative deaths or any RF-related complications occurred. If we exclude the case in which it was clearly impossible to destroy liver metastases intraoperatively, only one local recurrence occurred (3%) among the 32 thermoablated lesions after a mean follow-up of 17.3 months. The 2-year overall and disease-free survival rates for this initially unresectable population were 94.7% and 22%, respectively.
Intraoperative use of RF to destroy unresectable liver tumours increases the rate of curative resections. Future progress in RF technology and adequate vascular clamping during RF should increase this rate.
发射射频（RF）波的探头能够通过热消融破坏肿瘤组织。本研究的目的是对肝肿瘤射频热消融在肝切除和肝外切除术中的益处进行前瞻性评估，旨在使被认为无法切除的疾病患者获得R0状态。
1997年1月至1999年9月期间，21例患者接受了手术。17例中，射频与肝切除术联合应用，其中9例与肝外病变切除术联合应用。2例中，肝外病变广泛切除与射频联合用于治疗肝转移瘤，2例最终单独进行了射频治疗。每位患者肝转移瘤的平均数量为6.2±4.3个（范围1 - 15个）。总共32个病变接受了射频治疗。33个经射频热消融的肿瘤平均大小为13.6±9.7毫米（范围5 - 52毫米），除1例病例外，所有病例在射频过程中均进行了Pringle手法。
18例获得了可能的R0切除。未发生手术死亡或任何与射频相关的并发症。如果排除术中明显无法破坏肝转移瘤的病例，在平均随访17.3个月后，32个经热消融的病变中仅发生1例局部复发（3%）。该最初无法切除人群的2年总生存率和无病生存率分别为94.7%和22%。
术中使用射频破坏无法切除的肝肿瘤可提高根治性切除率。射频技术的未来进展以及射频过程中适当的血管钳夹应会提高这一比率。
