Laparoscopic radiofrequency ablation for hepatocellular carcinoma

Abstract

Aim: The optimal treatment for hepatocellular carcinoma (HCC) is either surgical resection or liver transplantation, but only one-third of the patients are suitable candidates for surgery. Laparoscopic radiofrequency ablation (RFA) in selected patients is a safe, feasible technique, which has proved to be superior to the percutaneous approach in patients with severe liver disease or in lesions in which the percutaneous approach is impossible. The aim of this study is to present our experience with laparoscopic RFA and demonstrate its safety as an alternative therapeutic procedure in selected patients with HCC.

Methods: This is a retrospective study of patients with HCC who underwent laparoscopic RFA between March 2009 and December 2014.

Results: Thirty-two patients with 37 tumors underwent laparoscopic RFA. Median tumor size was 2.24 cm (0.7-4.45 cm). Major complications occurred in 8 patients. Initial complete ablation was achieved in 94.6% (35/37) lesions and sustained complete ablation rate was 62.85% (22/35). Overall survival rates at 1-, 2-, and 3-year were 89%, 67.5%, and 40%, respectively.

Conclusion: Laparoscopic RFA of HCC is safe and the long-term outcomes are similar to those achieved with liver resection. Further trials combining chemoembolization and RFA are needed to improve long-term outcomes and to limit local tumor progression.

Keywords

Hepatocellular carcinoma / radiofrequency ablation / laparoscopic approach

References

[1] Raza A.Hepatocellular carcinoma review: current treatment and evidence-based medicine..World J Gastroenterol2014;20:4115-27 PMCID:PMC3989948

[2] Bruix J.Management of hepatocellular carcinoma: an update..Hepatology2011;53:1020-2 PMCID:PMC3084991

[3] European Association for the Study of the Liver; European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma..J Hepatol2012;56:908-43

[4] Casaccia M,Nardi I,Barabino G,Valente U.Laparoscopic US-guided radiofrequency ablation of unresectable hepatocellular carcinoma in liver cirrhosis: feasibility and clinical outcome..J Laparoendosc Adv Surg Tech A2008;18:797-801

[5] Tateishi R,Teratani T,Sato S,Fujishima T,Kawabe T.Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases..Cancer2005;103:1201-9

[6] Topal B,Aerts R,Thijs M.Morbidity and mortality of laparoscopic vs. open radiofrequency ablation for hepatic malignancies..Eur J Surg Oncol2007;33:603-7

[7] Siperstein A,Engle K,Berber E,Foroutani A.Laparoscopic radiofrequency ablation of primary and metastatic liver tumors. Technical considerations..Surg Endosc2000;14:400-5

[8] Herbold T,Bangard C,Drebber U.The laparoscopic approach for radiofrequency ablation of hepatocellular carcinoma-indication, technique and results..Langenbecks Arch Surg2013;398:47-53

[9] de la Serna S,Sánchez-Cabús S,Ferrer J,Fondevila C,Fuster J.Results of laparoscopic radiofrequency ablation for HCC. Could the location of the tumour influence a complete response to treatment? A single European centre experience..HPB (Oxford)2015;17:387-93 PMCID:PMC4402048

[10] Lee SD,Cho JY,Hwang DW,Yoon CJ,Kim JH.Safety and efficacy of laparoscopic radiofrequency ablation for hepatic malignancies..J Korean Surg Soc2012;83:36-42 PMCID:PMC3392314

[11] Santambrogio R,Zuin M,Bruno S,Costa M.Safety and efficacy of laparoscopic radiofrequency ablation of hepatocellular carcinoma in patients with liver cirrhosis..Surg Endosc2003;17:1826-32

[12] Dindo D,Clavien PA.Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of survey..Ann Surg2004;240:205-13 PMCID:PMC1360123

[13] Tiong LU,Maddern GJ.Bimodal electric tissue ablation (BETA) compared with the Cool-Tip RFA system..ANZ J Surg2012;82:269-74

[14] Boas FE,Louie JD,Hwang GL,Hovsepian DM,Sze DY.Optimal imaging surveillance schedules after liver-directed therapy for hepatocellular carcinoma..J Vasc Interv Radiol2015;26:69-73

[15] Cillo U,Dupuis D,Neri D,Gringeri E,Vincenzi V.Laparoscopic ablation of hepatocellular carcinoma in cirrhotic patients unsuitable for liver resection or percutaneous treatment: a cohort study..PLoS One2013;8:e57249 PMCID:PMC3578795

[16] Jung MK,Kim TS,Cho CM,Kweon YO,Choi YH.Laparoscopic and percutaneous ultrasound guided radiofrequency ablation for hepatocellular carcinoma: a preliminary study..Taehan Kan Hakhoe Chi2002;8:209-17

[17] Zhou YM,Zhao YF,Li B.Meta-analysis of laparoscopic versus open resection for hepatocellular carcinoma..Dig Dis Sci2011;56:1937-43

[18] Jakimowicz J,Smulders F.Laparoscopic insufflation of the abdomen reduces portal venous flow..Surg Endosc1998;12:129-32

[19] Chinnaratha MA,Pateria P,MacQuillan G,Pathi R,Wigg AJ.High local recurrence of early-stage hepatocellular carcinoma after percutaneous thermal ablation in routine clinical practice..Eur J Gastroenterol Hepatol2015;27:349-54

[20] Santambrogio R,Costa M,Montorsi M.Survival and intra-hepatic recurrences after laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis..J Surg Oncol2005;89:218-25

[21] Livraghi T,Meloni MF.The risk of tumor seeding after percutaneous ablation for hepatocellular carcinoma..Br J Surg2005;92:856-8