Takahashi Hideo, Akyuz Muhammet, Aksoy Erol, Karabulut Koray, Berber Eren
Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.
Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
J Surg Oncol. 2017 Jun;115(7):830-834. doi: 10.1002/jso.24599. Epub 2017 Mar 20.
The aims of this study were to determine the incidence of Local recurrence (LR) in patients at long-term follow-up after laparoscopic RFA (LRFA) and also to determine the risk factors for LR from a contemporary series.
Patients undergoing LRFA between 2005 and 2014 by a single surgeon were reviewed. Demographic and perioperative data were analyzed from a prospective database.
LRFA was performed on 316 patients with 901 lesions. Median follow-up was 25 months, with 76% of whom completed at least one year of follow-up. The LR rate was 18.4%. The LR in patients followed for less than 12 months was 13.8%, 20.3% for 12 months, and 19.7% for 18 months (P = 0.02). One-fourth of the LRs developed after the 1st year. Morbidity was 8.9% and mortality 0.3%. Tumor type, size, ablation margin, and surgeon experience affected LR, with tumor type, size, and ablation margin being independent.
This study shows that 14% of malignant liver tumors will develop LR within a year after LRFA. Additional 4% of the lesions will demonstrate recurrence within 1 cm of the ablation zone, mostly as part of a multifocal recurrence. Ablation margin is the only parameter that the surgeon can manipulate to decrease LR.
本研究的目的是确定接受腹腔镜射频消融术（LRFA）的患者在长期随访中的局部复发（LR）发生率，并从当代系列病例中确定LR的危险因素。
回顾了2005年至2014年间由单一外科医生实施LRFA的患者。从前瞻性数据库中分析人口统计学和围手术期数据。
对316例患者的901个病灶进行了LRFA。中位随访时间为25个月，其中76%的患者完成了至少一年的随访。LR率为18.4%。随访时间少于12个月的患者LR率为13.8%，12个月时为20.3%，18个月时为19.7%（P = 0.02）。四分之一的LR发生在第1年之后。发病率为8.9%，死亡率为0.3%。肿瘤类型、大小、消融边缘和外科医生经验影响LR，其中肿瘤类型、大小和消融边缘是独立因素。
本研究表明，14%的恶性肝肿瘤在LRFA后一年内会发生LR。另外4%的病灶将在消融区1厘米内复发，大多为多灶性复发的一部分。消融边缘是外科医生可以操作以降低LR的唯一参数。
