Assessment of systemic inflammatory response (SIR) in patients undergoing radiofrequency ablation or partial liver resection for liver tumors

Abstract 

Introduction

Local therapies for liver tumors are considered to be safe. However, cryoablation (CA) has been associated with an exaggerated systemic inflammatory response (SIR). Aim of this study was to assess the degree of SIR after radiofrequency ablation (RFA) in comparison with major (MR) or minor (mR) liver resection.

Material and methods

Thirty-nine patients were treated with RFA (n=11), MR (n=10) or mR (n=18). SIR parameters [white blood count (WBC) and C-reactive protein (CRP)], proinflammatory mediators [IL-6, TNF-α and sPLA2], liver damage parameters [AST/ALT] and platelet counts were determined at different time points. The volume of ablated liver was calculated on the first CT after RFA in order to correlate ablated liver volume with liver enzyme release and SIR. All data are expressed as median values with quartiles [25%, 75%].

Results

RFA induced a moderate SIR, as demonstrated by a significant elevation of CRP (77mg/L vs 3mg/L), IL-6 (96pg/ml vs 4pg/ml) and sPLA2 (41ng/ml vs 7ng/ml, p<0.05).

Peak point values of SIR (WBC and CRP at 24 vs 48h and 48 vs 72h) and proinflammatory response parameters (24 vs 48h) occurred earlier after RFA than after mR or MR. Time-to-time comparison revealed even increased levels of CRP (77mg/L [59, 160]) 24h after RFA when compared to patients undergoing major or minor resection (50mg/L [28, 66] and 59mg/L [24, 91], respectively) and increased levels of IL-6 (67pg/ml [42, 131]) 4h after RFA when compared to patients undergoing minor resection (29pg/ml [20, 55]). Postoperative levels of AST and LDH correlated significantly with the ablated liver volume 1h after RFA (RC=0.860 and RC=0.868, respectively, p<0.05).

Conclusion

RFA induced a moderate SIR of the same magnitude as in patients undergoing partial liver resection. None of the patients showed signs of an exaggerated SIR, as has been reported after cryoablation.

Keywords: Colorectal cancer, Liver, Radiofrequency ablation, RFA, Cancer, Surgery, Liver resection