Laparoscopic approach for down-staging in hepatocellular carcinoma patients who are candidates for liver transplantation

M. Casaccia, E. Andorno, G. Santori, I. Fontana, G. Varotti, C. Ferrari, M. Ertreo, U. Valente

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Abstract

Introduction The aim of this study was to assess the impact of laparoscopic thermoablation (LTA) and laparoscopic resection (LR) as neoadjuvant therapy before orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). Methods From June 2005 to November 2010, 50 consecutive patients affected by HCC with liver cirrhosis were treated with LTA under ultrasound guidance or LR. Of them, 10 patients (mean age, 58.3 ± 5.59 years; male:female, 8:2) underwent OLT. They were mostly Child-Pugh class A (80%). Results A LTA of 12 nodules was achieved in 7 patients and an LR of 3 HCC nodules in the other 3 subjects. The mean length of surgery was 163 minutes (range; 60-370). The mean hospital stay was 6.1 days. Transient mild postoperative liver failure was reported in 1 case. Complete tumor necrosis was observed in 10 thermoablated nodules (83.3%) via spiral computerized tomographic scan at 1 month after treatment; the resected patients showed absence of recurrence. All patients underwent OLT after a mean interval of 7 months. The histology of the native liver showed complete necrosis in 9/12 thermoablated nodules (75%); a recurrence at surgical site occurred in 1 patient in the resection group. Conclusions Laparoscopic ultrasound can be used in potential OLTs candidates to accurately stage HCC in advanced cirrhosis with minimal morbidity. LTA and LR proved to be safe and effective techniques for HCC patients, representing a valid "bridge" to OLT.

Original languageEnglish
Pages (from-to)2669-2671
Number of pages3
JournalTransplantation Proceedings
Volume45
Issue number7
DOIs
Publication statusPublished - Sep 2013

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Liver Transplantation
Hepatocellular Carcinoma
Necrosis
Recurrence
Neoadjuvant Therapy
Liver Failure
Liver Cirrhosis
Length of Stay
Histology
Fibrosis
Morbidity
Liver
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Transplantation

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Laparoscopic approach for down-staging in hepatocellular carcinoma patients who are candidates for liver transplantation. / Casaccia, M.; Andorno, E.; Santori, G.; Fontana, I.; Varotti, G.; Ferrari, C.; Ertreo, M.; Valente, U.

In: Transplantation Proceedings, Vol. 45, No. 7, 09.2013, p. 2669-2671.

Research output: Contribution to journalArticle

Casaccia, M, Andorno, E, Santori, G, Fontana, I, Varotti, G, Ferrari, C, Ertreo, M & Valente, U 2013, 'Laparoscopic approach for down-staging in hepatocellular carcinoma patients who are candidates for liver transplantation', Transplantation Proceedings, vol. 45, no. 7, pp. 2669-2671. https://doi.org/10.1016/j.transproceed.2013.07.014
Casaccia, M. ; Andorno, E. ; Santori, G. ; Fontana, I. ; Varotti, G. ; Ferrari, C. ; Ertreo, M. ; Valente, U. / Laparoscopic approach for down-staging in hepatocellular carcinoma patients who are candidates for liver transplantation. In: Transplantation Proceedings. 2013 ; Vol. 45, No. 7. pp. 2669-2671.
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