Roberto Santambrogio1, Matteo Barabino2, Savino Bruno3, Mara Costa2, Andrea Pisani Ceretti2, Maria Rachele Angiolini2, Massimo Zuin4, Franca Meloni5, Enrico Opocher2. 1. Chirurgia 2, Epato-bilio-pancreatica e Digestiva, San Paolo Hospital, University of Milan School of Medicine, Via A. di Rudini' 8, 20142, Milan, Italy. rsantambrogio@mclink.it. 2. Chirurgia 2, Epato-bilio-pancreatica e Digestiva, San Paolo Hospital, University of Milan School of Medicine, Via A. di Rudini' 8, 20142, Milan, Italy. 3. Department of Internal Medicine, IRCCS Istituto Clinico Humanitas, Medicine Humanitas University, Rozzano, MI, Italy. 4. Internal Medicine and Hepatology Department, San Paolo Hospital, University of Milan School of Medicine, Milan, Italy. 5. Interventional US Unit, Radiology Department, Valduce Hospital, Como, Italy.
Abstract
BACKGROUND: Radiofrequency ablation (RFA) is widely used as a first-line option in patients with hepatocellular carcinoma (HCC). However, since percutaneous approach of RFA may be, in some cases, unfeasible by the tumor size and its location, laparoscopic ablation therapies (LATs) were used as an alternative. Objective of the present study was to assess the efficacy of laparoscopic ultrasound examination in addition to LATs in the treatment of HCC in patients not eligible for percutaneous RFA or surgical resection. METHODS: Four hundred and twenty-six patients who underwent LATs were analyzed. Laparoscopic approach was offered to patients fulfilling at least one of the following criteria: (a) patients with a single nodule or up to three nodules smaller than 3 cm not suitable for liver transplantation or not eligible for HR because of severe portal hypertension, impaired liver function, or coexistent comorbidities; (b) patients not suitable for percutaneous RFA because of inconvenient tumor location; and (c) short-term recurrence of HCC (<3 months). RESULTS: Technical success was achieved in one session in 396 patients (93 %). One-month mortality and morbidity rates were 0.23 % (1 patient) and 25 % (106 patients), respectively. During a median follow-up of 37.2 months (range 2-193) in the remaining 425 patients, 276 (65 %) developed intra-hepatic recurrence: It appeared as a local tumor progression in 65 cases (15 %). Patients median survival was 39 months (95 % CI 34.8-47.2), while overall survivals at 1, 3, and 5 years were 88, 55, and 34 %, respectively. CONCLUSIONS: In the treatment of HCC, LATs proved to be a safe and effective technique, as they permit to treat with low-morbidity-rate lesions not manageable by percutaneous approach. Moreover, they allow achieving a more accurate staging of the disease in one-fifth of patients, thus better redefining the prognosis of such individuals.
BACKGROUND: Radiofrequency ablation (RFA) is widely used as a first-line option in patients with hepatocellular carcinoma (HCC). However, since percutaneous approach of RFA may be, in some cases, unfeasible by the tumor size and its location, laparoscopic ablation therapies (LATs) were used as an alternative. Objective of the present study was to assess the efficacy of laparoscopic ultrasound examination in addition to LATs in the treatment of HCC in patients not eligible for percutaneous RFA or surgical resection. METHODS: Four hundred and twenty-six patients who underwent LATs were analyzed. Laparoscopic approach was offered to patients fulfilling at least one of the following criteria: (a) patients with a single nodule or up to three nodules smaller than 3 cm not suitable for liver transplantation or not eligible for HR because of severe portal hypertension, impaired liver function, or coexistent comorbidities; (b) patients not suitable for percutaneous RFA because of inconvenient tumor location; and (c) short-term recurrence of HCC (<3 months). RESULTS: Technical success was achieved in one session in 396 patients (93 %). One-month mortality and morbidity rates were 0.23 % (1 patient) and 25 % (106 patients), respectively. During a median follow-up of 37.2 months (range 2-193) in the remaining 425 patients, 276 (65 %) developed intra-hepatic recurrence: It appeared as a local tumor progression in 65 cases (15 %). Patients median survival was 39 months (95 % CI 34.8-47.2), while overall survivals at 1, 3, and 5 years were 88, 55, and 34 %, respectively. CONCLUSIONS: In the treatment of HCC, LATs proved to be a safe and effective technique, as they permit to treat with low-morbidity-rate lesions not manageable by percutaneous approach. Moreover, they allow achieving a more accurate staging of the disease in one-fifth of patients, thus better redefining the prognosis of such individuals.
Authors: Shi-Lai Li; Ming Su; Tao Peng; Kai-Yin Xiao; Li-Ming Shang; Bang-Hao Xu; Zhi-Xiong Su; Xin-Ping Ye; Ning Peng; Quan-Lin Qin; De-Feng Chen; Jie Chen; Le-Qun Li Journal: Asian Pac J Cancer Prev Date: 2013
Authors: Iswanto Sucandy; Susannah Cheek; Benjamin J Golas; Allan Tsung; David A Geller; James W Marsh Journal: HPB (Oxford) Date: 2016-07-09 Impact factor: 3.647
Authors: Neal Bhutiani; Prejesh Philips; Charles R Scoggins; Kelly M McMasters; Melissa H Potts; Robert C G Martin Journal: HPB (Oxford) Date: 2016-05-01 Impact factor: 3.647