Study to evaluate the immunomodulatory effects of radiofrequency ablation compared to surgical resection for liver cancer

How Can We Improve the Survival of Patients with Colorectal Liver Metastases Using Thermal Ablation?

Thermal ablation has been widely used for patients with small colorectal liver metastases (CRLMs), even for resectable cases; however, solid evidence has been scarce. (1) Thermal ablation versus liver resection. Some propensity-score matching studies using patients with balanced baseline characteristics have confirmed less invasiveness and the comparable survival benefits of thermal ablation to liver resection. A more recent pivotal randomized controlled trial comparing thermal ablation and liver resection was presented during the American Society of Clinical Oncology 2024 meeting. Diameter ≤ 3 cm, ten or fewer resectable and ablatable CRLMs were assigned to thermal ablation or liver resection. No differences were observed in the overall survival and local and distant progression-free survival with less morbidity. (2) Combination of thermal ablation and liver resection. Four matching studies demonstrated comparable data between the combination and liver resection alone groups in the long-term survival and recurrence rates without increasing the postoperative complication rates. The selection of the two approaches depends primarily on the number, size, and location of the CRLMs. (3) Chemotherapy in combination with thermal ablation. A propensity-score matching study comparing thermal ablation ± neoadjuvant chemotherapy was conducted. The addition of neoadjuvant chemotherapy was an independent predictive factor for good progression-free survival without increasing morbidity. Two randomized controlled trials demonstrated that additional thermal ablation to systemic chemotherapy can improve the overall survival for initially unresectable CRLMs. (4) Conclusions. Thermal ablation can provide survival benefits for patients with CRLMs in various situations, keeping adequate indications.

A Comparative Study of Antitumor Immunity Induced by Radiofrequency Microwave and Cryoablation in Hepatocellular Carcinoma

PURPOSE

This study aimed to compare the immune responses induced by microwave ablation (MWA), radiofrequency ablation (RFA), and cryoablation (CRYO) in hepatocellular carcinoma (HCC) and identify differences in immune responses and the timing of immune changes.

MATERIALS AND METHODS

A bilateral subcutaneous model was established in C57 mice, and the successfully modeled mice were divided into the microwave (n = 15), radiofrequency (n = 15), CRYO (n = 15), control (n = 9), and blank groups (n = 3). Mice in the control group were dissected before ablation, whereas mice in the three ablation groups underwent ultrasound-guided ablation of one axillary tumor. Three mice were sacrificed and dissected at 1-4 weeks after ablation. After tissue processing, flow cytometry was used to detect the levels of CD8 + T and regulatory T (Treg) cells in the tissue, and western blotting was used to assess the level of programmed cell death ligand 1 (PD-L1) protein in the tumor tissue.

RESULTS

The pattern of immune changes after the three types of ablation was consistent, with immune changes occurring at 3-4 weeks. CRYO induced the most significant increase in the percentage of CD8 + T cells. There were no significant differences in the levels of Treg cells and the level of PD-L1 protein among the three types of ablation (p > 0.05), but the decline in Treg cells and PD-L1 protein level caused by CRYO was the most pronounced.

CONCLUSION

In the HCC mouse model, the immune changes following the three types of ablation were consistent, with immune changes occurring at 3-4 weeks. Among them, CRYO elicited the strongest adaptive immune response, and RFA outperformed MWA.

Contribution of immune cells in synergistic anti-tumor effect of ablation and immunotherapy

Thermal ablation results in the damage of tumor tissue, which leads to localized necrosis and incites a significant inflammatory response, accompanied by the infiltration of numerous immune cells. Nevertheless, depending solely on the singular approach of thermal ablation frequently is difficult in eliciting a robust anti-tumor response. Research suggests that integrating immune modulators into conventional ablation techniques has the potential to enhance the elicited immune response, finally initiating synergistic effect without significantly elevated risk profiles. This article comprehensively analyses the immunological effects resulting from post-ablation alone and its synergy with immunotherapies, and accentuates the heterogeneous alterations noted in immune cells across distinct malignancies. Collectively, the article delves into the theoretical framework and advancements in clinical trials concerning the combined thermal ablation and immunotherapy for treating malignant tumors.

CSTB accelerates the progression of hepatocellular carcinoma via the ERK/AKT/mTOR signaling pathway

Hepatocellular carcinoma (HCC) is a significant contributor to global cancer-related deaths, leading to high mortality rates. However, the pathogenesis of HCC remains unclear. In this research, by the bioinformatics data analysis, we found that elevated CSTB expression correlated with advanced disease and predicted diminished overall survival (OS) in HCC patients. We subsequently verified the oncogenic role of CSTB as well as the potential underlying mechanisms in HCC through a series of in vitro experiments, such as CCK-8 assays, cloning assays, flow cytometry, Transwell assays, and western blotting. Our findings illustrated that the silencing of CSTB effectively suppressed cellular proliferation by inducing cell cycle arrest in the G2 phase and impaired HCC cell invasion and migration by stimulating epithelial-mesenchymal transition (EMT). Additionally, we analyzed the pathways enriched in HCC using RNA sequencing and found that the ERK/AKT/mTOR signaling pathway was related to increased CSTB expression in HCC. Finally, we confirmed the tumorigenic role of CSTB via in vivo experiments. Thus, our findings revealed that silencing CSTB inhibited the HCC progression via the ERK/AKT/mTOR signaling pathway, highlighting new perspectives for investigating the mechanisms of HCC.

How Biology Guides the Combination of Locoregional Interventional Therapies and Immunotherapy for Hepatocellular Carcinoma: Cytokines and Their Roles

As most patients with hepatocellular carcinoma (HCC) are diagnosed at the intermediate or advanced stage and are no longer eligible for curative treatment, the overall survival rate of HCC remains unsatisfactory. Locoregional interventional therapies (LITs), and immune checkpoint inhibitor (ICI)-based immunotherapy, focus on treating HCC, but the efficacy of their individual application is limited. Therefore, the purpose of this review was to discuss the biological roles of cytokines and their therapeutic potential in the combination therapy of LITs and ICI-based immunotherapy. The two common techniques of LITs are ablative and transarterial therapies. Whether LITs are complete or incomplete can largely affect the antitumor immune response and tumor progression. Cytokines that induce both local and systemic responses to LITs, including interferons, interleukins, chemokines, TNF-α, TGF-β, VEGF, and HGF, and their roles are discussed in detail. In addition, specific cytokines that can be used as therapeutic targets to reduce immune-related adverse events (irAEs) are introduced. Overall, incomplete LITs in a tumor, combined with specific cytokines, are thought to be effective at improving the therapeutic efficacy and reducing treatment-induced irAEs, and represent a new hope for managing unresectable HCC.

Recent therapeutics in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a malignant tumor of hepatocytes. It is a common malignant tumor of the digestive system that often has initially hidden presentation followed by rapid progression. There are no obvious symptoms in the early stage of HCC. When diagnosed, most patients have locally advanced tumor or distant metastasis; therefore, HCC is difficult to treat and only supportive and symptomatic treatment is adopted. The prognosis is poor and survival time is short. How to effectively treat HCC is important clinically. In recent years, advances in medical technology have resulted in comprehensive treatment methods based on surgery.

Clinical value of prophylactic transcatheter arterial chemoembolization treatment in patients with hepatocellular carcinoma

OBJECTIVE

To investigate the feasibility of surgical resection combined with prophylactic transcatheter arterial chemoembolization (TACE) in reducing the recurrence and improving the survival rate of patients with hepatocellular carcinoma (HCC).

METHODS

In this retrospective study, 76 patients with HCC treated in our hospital from February 2016 to December 2018 were enrolled. Among them, 31 patients who received radical surgery alone were enrolled as the control group, and 45 patients who received prophylactic TACE within 6 months after radical surgery were enrolled as the study group. All cases were followed up for 36 months. The recurrence rate, survival rate, and median survival time of patients at 1, 2, and 3 years after surgery were compared between the two groups. Patients in the study group were divided into subgroup A (interventional therapy within 1 month), subgroup B (interventional therapy within 1-2 months), subgroup C (interventional therapy within 2-3 months), and subgroup D (interventional therapy within 3-6 months). The recurrence rate within 1 year was compared among the four subgroups. Finally, the clinical indicators affecting the recurrence of HCC were analyzed.

RESULTS

The recurrence rate at 1, 2 and 3 years after surgery in the study group was lower than that in the control group (all P<0.05). The survival rate at 1, 2 and 3 years after surgery in the study group was higher than that in the control group (all P<0.05). The median survival time of patients in the study group was slightly higher than that in the control group, with no significant difference (P>0.05). The 1-year recurrence rate of patients in subgroups A and B was significantly lower than that in subgroups C and D (P<0.05). The incomplete envelope, tumor diameter ≥5 cm, and combined cirrhosis were the main causes of recurrence of HCC (P<0.05).

CONCLUSION

Prophylactic TACE significantly reduced the postoperative recurrence rate and improved the survival rate of patients with HCC. The optimal treatment efficacy was associated with interventional therapy within 1-2 months after surgery, while incomplete envelope, tumor diameter ≥5 cm, and combined cirrhosis were the high-risk factors for HCC recurrence.

Hyperthermia ablation combined with transarterial chemoembolization versus monotherapy for hepatocellular carcinoma: A systematic review and meta-analysis

BACKGROUND AND AIMS

The existing evidence has indicated that hyperthermia ablation (HA) and HA combined with transarterial chemoembolization (HATACE) are the optimal alternative to surgical resection for patients with hepatocellular carcinoma (HCC) in the COVID-19 crisis. However, the evidence for decision-making is lacking in terms of comparison between HA and HATACE. Herein, a comprehensive evaluation was performed to compare the efficacy and safety of HATACE with monotherapy.

MATERIALS AND METHODS

Worldwide studies were collected to evaluate the HATACE regimen for HCC due to the practical need for global extrapolation of applicative population. Meta-analyses were performed using the RevMan 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark).

RESULTS

Thirty-six studies involving a large sample of 5036 patients were included finally. Compared with HA alone, HATACE produced the advantage of 5-year overall survival (OS) rate (OR:1.90; 95%CI:1.46,2.46; p < 0.05) without increasing toxicity (p ≥ 0.05). Compared with TACE alone, HATACE was associated with superior 5-year OS rate (OR:3.54; 95%CI:1.96,6.37; p < 0.05) and significantly reduced the incidences of severe liver damage (OR:0.32; 95%CI:0.11,0.96; p < 0.05) and ascites (OR:0.42; 95%CI:0.20,0.88; p < 0.05). Subgroup analysis results of small (≤3 cm) HCC revealed that there were no significant differences between the HATACE group and HA monotherapy group in regard to the OS rates (p ≥ 0.05).

CONCLUSIONS

Compared with TACE alone, HATACE was more effective and safe for HCC. Compared with HA alone, HATACE was more effective for non-small-sized (>3 cm) HCC with comparable safety. However, the survival benefit of adjuvant TACE in HATACE regimen was not found for the patients with small (≤3 cm) HCC.

Clinical intervention effect of TACE combined with 3DCRT in patients with primary liver cancer

OBJECTIVE

To investigate the clinical intervention effect of transcatheter arterial chemoembolization (TACE) combined with three-dimensional conformal radiotherapy (3DCRT) in patients with primary liver cancer (PLC).

METHODS

A total of 110 PLC patients admitted to our hospital were selected and divided into the study group (SG, n=60, treated with TACE combined with 3DCRT) and the control group (CG, n=50, treated with TACE alone) in accordance with the different clinical intervention measures. The clinical intervention effect and the changes of tumor factors and quality of life scores were compared between the two groups before and after intervention, and the three-year survival and the incidence of adverse reactions were evaluated.

RESULTS

The objective response rate (ORR) and disease control rate (DCR) in the SG (78.33% and 95.00%) were higher than those in the CG (38.00% and 80.00%), whereas the carcinoembryonic antigen (CEA) and alpha fetoprotein (AFP) levels in the SG were lower than those in the CG (P < 0.05). After intervention, the quality of life score in the SG was higher than that in the CG (P < 0.05). The SG was superior to the CG in follow-up survival (P < 0.05).

CONCLUSION

TACE combined with 3DCRT has a high safety and leads to remarkable clinical intervention effects, marked improvement of the serological indices, better quality of life, as well as satisfactory long-term survival.

A systematic review and meta-analysis of radio frequency ablation and routine resection in the treatment of small hepatocellular carcinoma

Background

This study sought to conduct a meta-analysis of the relevant literature on radiofrequency ablation (RFA) and routine resection in the treatment of small hepatocellular carcinoma (SHCC) in recent years, and to examine the clinical efficacy and safety of different schemes.

Methods

PubMed, The Cochrane Library, Embase, CNKI, Chinese biomedical literature, VIP Chinese journal and the Wanfang Database were used to comprehensively search for relevant papers on clinical control studies of RFA and the routine resection SHCC published between January 2008 and December 2019. The clinical efficacy and safety of different schemes in the treatment of SHCC were compared, including the overall survival rate within 1, 3, and 5 years, and the incidence of complications during treatment. A meta-analysis was undertaken using methods provided by the Cochrane Collaboration and RevMan 5.3 software.

Results

A total of 13 publications of studies were retrieved in which 2,384 patients participated. Of these patients, 1,256 (52.68%) were allocated to the RFA group and 1,128 patients (47.32%) to the conventional resection group. The effect size of the 1-year overall survival rate for the two groups was odds ratio (OR): 0.78 [95% confidence interval (CI), 0.43-1.38]; Z test: P=0.32. The effect size of the overall survival rate within 3 years was OR: 0.71 (95% CI, 0.48-1.05); Z test: P=0.07. The difference was not statistically significant. The 5-year overall survival rate of the RFA group and conventional resection group was OR: 0.55 (95% CI, 0.40-0.72). The OR value fell within the CI, excluding 1; Z test: P<0.0001. The difference was statistically significant. The incidence of complications in the RFA group during treatment was lower than that in the conventional resection group (OR: 0.45; 95% CI, 0.32-0.69). The OR value was within the CI, excluding 1; Z test: P=0.0002. The difference was statistically significant.

Conclusions

The short-term effect of RFA in the treatment of SHCC is basically the same as that of routine resection; however, the long-term effect is significantly lower than that of routine resection. RFA has a lower incidence of complications during treatment, and thus better clinical safety.

The blood cells in NSCLC and the changes after RFA

Lung cancer has attracted a lot of attention because of its high morbidity and mortality. The emergence of RFA provides a new treatment for unresectable NSCLC patients. In addition to killing in situ lung tumors, RFA also provides new immuno-activated antigens, for the treatment of lung cancer. It changes the tumor microenvironment and activates the entire immune system of patients. The peripheral blood cell count is easy to achieve and the blood cells are important in tumor immunity, which changes after RFA. On the one hand, the changes in blood cells identify the immune changes of NSCLC; on the other hand, it provides support and suspicion for the treatment of RFA.

Recent Advances: The Imbalance of Immune Cells and Cytokines in the Pathogenesis of Hepatocellular Carcinoma

Recent advancement in the immunological understanding of genesis of hepatocellular carcinoma (HCC) has implicated a decline in anti-tumour immunity on the background of chronic inflammatory state of liver parenchyma. The development of HCC involves a network of immunological activity in the tumour microenvironment involving continuous interaction between tumour and stromal cells. The reduction in anti-tumour immunity is secondary to changes in various immune cells and cytokines, and the tumour microenvironment plays a critical role in modulating the process of liver fibrosis, hepatocarcinogenesis, epithelial-mesenchymal transition (EMT), tumor invasion and metastasis. Thus, it is considered as one of primary factor behind the despicable tumour behavior and observed poor survival; along with increased risk of recurrence following treatment in HCC. The primary intent of the present review is to facilitate the understanding of the complex network of immunological interactions of various immune cells, cytokines and tumour cells associated with the development and progression of HCC.

Immunological Basis of Genesis of Hepatocellular Carcinoma: Unique Challenges and Potential Opportunities through Immunomodulation

A majority of hepatocellular carcinoma (HCC) develops in the setting of persistent chronic inflammation as immunological mechanisms have been shown to play a vital role in the initiation, growth and progression of tumours. The index review has been intended to highlight ongoing immunological changes in the hepatic parenchyma responsible for the genesis and progression of HCC. The in-situ vaccine effect of radiofrequency (RF) is through generation tumour-associated antigens (TAAs), following necrosis and apoptosis of tumour cells, which not only re-activates the antitumour immune response but can also act in synergism with checkpoint inhibitors to generate a superlative effect with intent to treat primary cancer and distant metastasis. An improved understanding of oncogenic responses of immune cells and their integration into signaling pathways of the tumour microenvironment will help in modulating the antitumour immune response. Finally, we analyzed contemporary literature and summarised the recent advances made in the field of targeted immunotherapy involving checkpoint inhibitors along with RF application with the intent to reinstate antitumour immunity and outline future directives in very early and early stages of HCC.

Personal RF-EMF exposure from mobile phone base stations during temporary events

BACKGROUND

In recent years, radiofrequency electromagnetic fields (RF-EMF) exposure has increased owing to new communication technologies. Simultaneously, increased exposure to RF-EMF has led to society's growing concern about the possible effects they may have on human health. Many studies have described personal RF-EMF exposure by using personal exposimeters to know a population's daily exposure to mobile phone base stations and to other sources whose installations tend to be permanent. Nonetheless during special events like concerts or fairs, where many people gather, permanent installations might not suffice to cover demand. So telephone companies install temporary stations for these events, and modify the exposure pattern of these areas or populations.

OBJECTIVE

To study if installing temporary antennae for large events, and high concentrations of mobile phones, modify the exposure pattern compared to usual situations.

METHODS

Personal RF-EMF exposure from mobile phones (uplink) and mobile phone base stations (downlink) installed at the 2017 Albacete Fair (Spain) was recorded. Between 7 and 17 September, more than 2,500,000 people visited this Fair. Measurements were taken by two Satimo EME SPY 140 personal exposimeters, placed one each side of a research team member's waist. These exposimeters were programmed to take measurements every 4 s at different time of day; morning, afternoon and night; and in several places, around the Fair Enclosure (zones Ejidos and Paseo) and inside the enclosure (Interior). These measurements were repeated on a weekday, at the weekend and the day after the Fair ended after temporary base stations had been removed. They were also taken for 1 h in all three zones, for each time of day; that is, 9 h were recorded for each study day.

RESULTS

The mean RF-EMF recorded exposure from base stations (downlink-DL) on the days the Fair opened (morning, afternoon and night) for the three studied zones was 791.8 μW/m², while the exposure produced by mobile phones (uplink-UL) was 59.0 μW/m². These values were 391.2 μW/m² (DL) and 10.3 μW/m² (UL) a few days after the event ended. In study zones Ejidos and Paseo, both outside, the highest mean exposure was recorded at the weekend as 1494.1 and 848.1 μW/m² respectively. For the Interior zone, the mean value recorded during the Fair was 354.8 μW/m². These values contrast with those recorded in the three zones after the event ended: 556.37 (Ejidos), 144.1 (Paseo); 473.21 μW/m² (Interior). The fact that the mean exposure recorded at Interior was slightly higher after the Fair could be due to signal shielding by so many people. The reduction in exposure in Paseo after the Fair was outstanding, probably due to the antennae being placed on low towers. Major differences were also found in the RF-EMF exposure from UL. In this case, the weekend values taken during the Fair were between 28.2 μW/m² at Interior (weekday) and 98.1 μW/m² at Ejidos (weekend), which dropped to 5.5 at Paseo after the Fair, to 11.7 μW/m² at Interior and to 13.6 μW/m² at Ejidos.

CONCLUSIONS

Installing mobile phone base stations, and a dense public using mobile phones, imply a significant increase in personal RF-EMF exposure compared to that recorded during normal periods in the same area. However, the recorded measurements were below legally established limits.

Immunomodulatory Changes Following Isolated RF Ablation in Colorectal Liver Metastases: A Case Report

Background: Colorectal cancer (CRC) is the third most common cancer worldwide and the second leading cause of cancer-related deaths in developed countries. The liver is the most prevalent site of metastasis from CRC. Currently, the gold-standard treatment for colorectal liver metastases (CLMs) is surgical resection. However, depending on the pattern of the disease, a significant number of patients may require different approaches alone or in combination with surgery, including thermal ablation (radiofrequency (RFA) or microwave (MWA) ablation) or transarterial liver-directed therapies, although the latter is not yet part of the standard treatment for CRC liver metastases. Methods and Results: We present the case of a 63-yearold man with bilobar CLM who was treated with transarterial embolization (TAE) and RFA followed by chemotherapy. A post-RFA study of immune parameters revealed the downregulation of CD39 expression in the circulating CD4⁺ T cell population and a reduction of the serum levels of cytokines IL-10, TGF-β, IFN-gamma and IL-17, which positively correlated with the diminished serum level of gamma-glutamyl transferase (GGT) and the subdued inflammatory markers: the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR). Later, the patient underwent chemotherapy. Liver failure developed within two years and nine months following tumour ablation, leading to the death of the patient. Conclusions: However, the denial of adjuvant chemotherapy by the patient gave us the opportunity to assess the immunomodulatory changes following RFA in the absence of any other therapeutic modalities.

Immunomodulatory Effect after Irreversible Electroporation in Patients with Locally Advanced Pancreatic Cancer

Purpose

Irreversible electroporation (IRE) has been demonstrated to be a safe and effective method for locally advanced pancreatic cancer (LAPC). The aim of this study was to evaluate the immunomodulatory effect after IRE and to evaluate the prognostic value of variations of the immune parameters in LAPC patients after IRE.

Methods

Peripheral blood samples of 34 patients were obtained preoperatively and on the third day (D3) and seventh day (D7) after IRE, respectively. The phenotypes of lymphocytes were analyzed by flow cytometry, and dynamic changes of serum levels of cytokines, complement, and immunoglobulin were assayed by enzyme-linked immunosorbent assay. Receiver operating characteristic (ROC) curve and concordance index (C-index) were used to compare the survival predictive ability.

Results

There was a transitory decrease followed by a steady increase for CD4⁺ T cell, CD8⁺ T cell, NK cell, IL-2, C3, C4, and IgG while a reverse trend was detected for Treg cell, IL-6, and IL10 after IRE. The alteration of CD8⁺ T cell between D3 and D7 was identified as a prognostic factor for both overall survival (OS) and progression-free survival (PFS). The values of ROC curve (AUC) and C-indexes of the alteration of CD8⁺ T cell for OS and PFS were 0.816 and 0.773 and 0.816 and 0.639, respectively, which were larger than those of other immune or inflammation-based indexes.

Conclusions

This study presented the first evidence of IRE-based immunomodulatory in patients with LAPC. The alteration of CD8⁺ T cell between D3 and D7 showed relatively good performance and could be used as an effective tool for prognostic evaluation for LAPC patients after IRE.

Positive Immuno-Modulation Following Radiofrequency Assisted Liver Resection in Hepatocellular Carcinoma

INTRODUCTION

Hepatocellular carcinoma (HCC) often develops on a background of chronic inflammation and a complex immunosuppressive network with increased regulatory T cells, impaired CD8⁺ T cells and the secretion of immunosuppressive cytokines. Previous clinical studies have reported a superior disease-free survival (DFS) following a radiofrequency-based ablation or resection in HCC tumours compared to conventional liver resection techniques. The aim of this study was to investigate whether there is any correlation with the use of a radiofrequency-assisted liver resection and clinical outcome.

MATERIAL AND METHODS

Patients' peripheral blood was collected prior and 7 days following surgery from patients undergoing a liver resection for HCC. There were 5 liver resections performed using CUSA and 6 liver resections with the RF-based device, HabibTM 4X. The primary endpoint of the study was to assess the immunological parameters of circulating immune cell populations as well as serum cytokines. The Student's t-test, chi-square or Fisher's Exact test were applied for statistical comparisons, as appropriate.

RESULTS

Patients undergoing an RF-assisted liver resection with HabibTM 4X had a significant decrease in the inhibitory Treg cells (p = 0.002) and a significant increase in CD8⁺ T lymphocytes (p = 0.050) and CD4⁺CD45RO⁺/CD4⁺ memory T cells (p = 0.002) compared to those patients undergoing a liver resection with CUSA. It was also noted that the RF-assisted liver resection group had a significant decrease in circulating TGF-ß (p = 0.000), IL10 (p = 0.000) and a significant increase in IFN-gamma (p = 0. 027) and IL-17 compared to the CUSA group.

CONCLUSION

A liver resection with RF-based device HabibTM 4X was associated with positive immunomodulatory changes in circulating immune cells and circulating cytokines which could explain the significant improvement in DFS.

A Systematic Review and Meta-Analysis Comparing Liver Resection with the Rf-Based Device Habib™-4X with the Clamp-Crush Technique

Liver cancer is the sixth most common cancer and third most common cause of cancer-related mortality. Presently, indications for liver resections for liver cancers are widening, but the response is varied owing to the multitude of factors including excess intraoperative bleeding, increased blood transfusion requirement, post-hepatectomy liver failure and morbidity. The advent of the radiofrequency energy-based bipolar device Habib™-4X has made bloodless hepatic resection possible. The radiofrequency-generated coagulative necrosis on normal liver parenchyma provides a firm underpinning for the bloodless liver resection. This meta-analysis was undertaken to analyse the available data on the clinical effectiveness or outcomes of liver resection with Habib™-4X in comparison to the clamp-crush technique. The RF-assisted device Habib™-4X is considered a safe and feasible modality for liver resection compared to the clamp-crush technique owing to the multitude of benefits and mounting clinical evidence supporting its role as a superior liver resection device. The most intriguing advantage of the RF-device is its ability to induce systemic and local immunomodulatory changes that further expand the boundaries of survival outcomes following liver resection.