Laparoscopic US-guided radiofrequency ablation of unresectable hepatocellular carcinoma in liver cirrhosis: Feasibility and clinical outcome

Marco Casaccia, Enzo Andorno, Ilaria Nardi, Bianca Troilo, Gabriele Barabino, Gregorio Santori, Umberto Valente

Research output: Contribution to journalArticle

Abstract

Background: Radiofrequency ablation (RFA) is a safe, effective treatment in patients with unresectable primary liver malignancies. The laparoscopic approach to RFA (LRFA) has proved to be superior to the percutaneous approach in lesions that are difficult or impossible to be treated in such a way or in severe liver disease. Recent advances in laparoscopic ultrasound (LUS) have greatly improved the accuracy in detecting intrahepatic hepatocellular carcinoma (HCC) nodules, many of which were missed by computed tomography (CT) or magnetic resonance imaging (MRI). Our aim was to assess the feasibility, clinical outcome, and efficacy of laparoscopic RFA under LUS guidance. Methods: Between February 2006 and May 2007, 24 consecutive patients (male/female, 20/4) with unresectable HCC in liver cirrhosis were treated with LRFA under LUS guidance. Most patients were in Child-Pugh class A (54.1%). Mean age of the patients was 61.79 ± 7.74 years (range, 45-76; median, 60). Results: LRFA procedure was completed in all patients and a thermoablation of 62 HCC nodules was achieved. LUS identified 13 new malignant lesions (20%) undetected by preoperative imaging. Mean length of surgery was 148 minutes (range, 60-315). Six procedures were associated in 5 patients: adhesiolysis (3), liver resection (1), partial splenectomy (1), and cholecystectomy (1). A pneumothorax needing immediate drainage during the procedure occurred in 1 case. One patient died 4 weeks after surgery because of liver failure. Mean hospital stay was 6.9 days and postoperative morbidity rate was 4 of 24 (16.6%). A complete tumor necrosis was observed in 56 of the 62 thermoablated nodules (90.3%) through spiral CT 1 month after treatment. Conclusions: LRFA is a safe, feasible treatment modality to achieve tumor destruction in selected patients with unresectable HCC that are not treatable with the percutaneous approach. Further, LUS demonstrated great accuracy during the procedure permitting to detect new HCC nodules missed at preoperative imaging.

Original languageEnglish
Pages (from-to)797-801
Number of pages5
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume18
Issue number6
DOIs
Publication statusPublished - Dec 1 2008

Fingerprint

Liver Cirrhosis
Hepatocellular Carcinoma
Neoplasms
Spiral Computed Tomography
Liver
Liver Failure
Cholecystectomy
Pneumothorax
Splenectomy
Liver Diseases
Drainage
Length of Stay
Necrosis
Therapeutics
Tomography
Magnetic Resonance Imaging
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic US-guided radiofrequency ablation of unresectable hepatocellular carcinoma in liver cirrhosis : Feasibility and clinical outcome. / Casaccia, Marco; Andorno, Enzo; Nardi, Ilaria; Troilo, Bianca; Barabino, Gabriele; Santori, Gregorio; Valente, Umberto.

In: Journal of Laparoendoscopic and Advanced Surgical Techniques, Vol. 18, No. 6, 01.12.2008, p. 797-801.

Research output: Contribution to journalArticle

Casaccia, Marco ; Andorno, Enzo ; Nardi, Ilaria ; Troilo, Bianca ; Barabino, Gabriele ; Santori, Gregorio ; Valente, Umberto. / Laparoscopic US-guided radiofrequency ablation of unresectable hepatocellular carcinoma in liver cirrhosis : Feasibility and clinical outcome. In: Journal of Laparoendoscopic and Advanced Surgical Techniques. 2008 ; Vol. 18, No. 6. pp. 797-801.
@article{17d65bfc6d3e4455b76aa19cf69a45e4,
title = "Laparoscopic US-guided radiofrequency ablation of unresectable hepatocellular carcinoma in liver cirrhosis: Feasibility and clinical outcome",
abstract = "Background: Radiofrequency ablation (RFA) is a safe, effective treatment in patients with unresectable primary liver malignancies. The laparoscopic approach to RFA (LRFA) has proved to be superior to the percutaneous approach in lesions that are difficult or impossible to be treated in such a way or in severe liver disease. Recent advances in laparoscopic ultrasound (LUS) have greatly improved the accuracy in detecting intrahepatic hepatocellular carcinoma (HCC) nodules, many of which were missed by computed tomography (CT) or magnetic resonance imaging (MRI). Our aim was to assess the feasibility, clinical outcome, and efficacy of laparoscopic RFA under LUS guidance. Methods: Between February 2006 and May 2007, 24 consecutive patients (male/female, 20/4) with unresectable HCC in liver cirrhosis were treated with LRFA under LUS guidance. Most patients were in Child-Pugh class A (54.1{\%}). Mean age of the patients was 61.79 ± 7.74 years (range, 45-76; median, 60). Results: LRFA procedure was completed in all patients and a thermoablation of 62 HCC nodules was achieved. LUS identified 13 new malignant lesions (20{\%}) undetected by preoperative imaging. Mean length of surgery was 148 minutes (range, 60-315). Six procedures were associated in 5 patients: adhesiolysis (3), liver resection (1), partial splenectomy (1), and cholecystectomy (1). A pneumothorax needing immediate drainage during the procedure occurred in 1 case. One patient died 4 weeks after surgery because of liver failure. Mean hospital stay was 6.9 days and postoperative morbidity rate was 4 of 24 (16.6{\%}). A complete tumor necrosis was observed in 56 of the 62 thermoablated nodules (90.3{\%}) through spiral CT 1 month after treatment. Conclusions: LRFA is a safe, feasible treatment modality to achieve tumor destruction in selected patients with unresectable HCC that are not treatable with the percutaneous approach. Further, LUS demonstrated great accuracy during the procedure permitting to detect new HCC nodules missed at preoperative imaging.",
author = "Marco Casaccia and Enzo Andorno and Ilaria Nardi and Bianca Troilo and Gabriele Barabino and Gregorio Santori and Umberto Valente",
year = "2008",
month = "12",
day = "1",
doi = "10.1089/lap.2008.0039",
language = "English",
volume = "18",
pages = "797--801",
journal = "Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A",
issn = "1092-6429",
publisher = "Mary Ann Liebert Inc.",
number = "6",

}

TY - JOUR

T1 - Laparoscopic US-guided radiofrequency ablation of unresectable hepatocellular carcinoma in liver cirrhosis

T2 - Feasibility and clinical outcome

AU - Casaccia, Marco

AU - Andorno, Enzo

AU - Nardi, Ilaria

AU - Troilo, Bianca

AU - Barabino, Gabriele

AU - Santori, Gregorio

AU - Valente, Umberto

PY - 2008/12/1

Y1 - 2008/12/1

N2 - Background: Radiofrequency ablation (RFA) is a safe, effective treatment in patients with unresectable primary liver malignancies. The laparoscopic approach to RFA (LRFA) has proved to be superior to the percutaneous approach in lesions that are difficult or impossible to be treated in such a way or in severe liver disease. Recent advances in laparoscopic ultrasound (LUS) have greatly improved the accuracy in detecting intrahepatic hepatocellular carcinoma (HCC) nodules, many of which were missed by computed tomography (CT) or magnetic resonance imaging (MRI). Our aim was to assess the feasibility, clinical outcome, and efficacy of laparoscopic RFA under LUS guidance. Methods: Between February 2006 and May 2007, 24 consecutive patients (male/female, 20/4) with unresectable HCC in liver cirrhosis were treated with LRFA under LUS guidance. Most patients were in Child-Pugh class A (54.1%). Mean age of the patients was 61.79 ± 7.74 years (range, 45-76; median, 60). Results: LRFA procedure was completed in all patients and a thermoablation of 62 HCC nodules was achieved. LUS identified 13 new malignant lesions (20%) undetected by preoperative imaging. Mean length of surgery was 148 minutes (range, 60-315). Six procedures were associated in 5 patients: adhesiolysis (3), liver resection (1), partial splenectomy (1), and cholecystectomy (1). A pneumothorax needing immediate drainage during the procedure occurred in 1 case. One patient died 4 weeks after surgery because of liver failure. Mean hospital stay was 6.9 days and postoperative morbidity rate was 4 of 24 (16.6%). A complete tumor necrosis was observed in 56 of the 62 thermoablated nodules (90.3%) through spiral CT 1 month after treatment. Conclusions: LRFA is a safe, feasible treatment modality to achieve tumor destruction in selected patients with unresectable HCC that are not treatable with the percutaneous approach. Further, LUS demonstrated great accuracy during the procedure permitting to detect new HCC nodules missed at preoperative imaging.

AB - Background: Radiofrequency ablation (RFA) is a safe, effective treatment in patients with unresectable primary liver malignancies. The laparoscopic approach to RFA (LRFA) has proved to be superior to the percutaneous approach in lesions that are difficult or impossible to be treated in such a way or in severe liver disease. Recent advances in laparoscopic ultrasound (LUS) have greatly improved the accuracy in detecting intrahepatic hepatocellular carcinoma (HCC) nodules, many of which were missed by computed tomography (CT) or magnetic resonance imaging (MRI). Our aim was to assess the feasibility, clinical outcome, and efficacy of laparoscopic RFA under LUS guidance. Methods: Between February 2006 and May 2007, 24 consecutive patients (male/female, 20/4) with unresectable HCC in liver cirrhosis were treated with LRFA under LUS guidance. Most patients were in Child-Pugh class A (54.1%). Mean age of the patients was 61.79 ± 7.74 years (range, 45-76; median, 60). Results: LRFA procedure was completed in all patients and a thermoablation of 62 HCC nodules was achieved. LUS identified 13 new malignant lesions (20%) undetected by preoperative imaging. Mean length of surgery was 148 minutes (range, 60-315). Six procedures were associated in 5 patients: adhesiolysis (3), liver resection (1), partial splenectomy (1), and cholecystectomy (1). A pneumothorax needing immediate drainage during the procedure occurred in 1 case. One patient died 4 weeks after surgery because of liver failure. Mean hospital stay was 6.9 days and postoperative morbidity rate was 4 of 24 (16.6%). A complete tumor necrosis was observed in 56 of the 62 thermoablated nodules (90.3%) through spiral CT 1 month after treatment. Conclusions: LRFA is a safe, feasible treatment modality to achieve tumor destruction in selected patients with unresectable HCC that are not treatable with the percutaneous approach. Further, LUS demonstrated great accuracy during the procedure permitting to detect new HCC nodules missed at preoperative imaging.

UR - http://www.scopus.com/inward/record.url?scp=58149117765&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=58149117765&partnerID=8YFLogxK

U2 - 10.1089/lap.2008.0039

DO - 10.1089/lap.2008.0039

M3 - Article

C2 - 18922065

AN - SCOPUS:58149117765

VL - 18

SP - 797

EP - 801

JO - Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A

JF - Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A

SN - 1092-6429

IS - 6

ER -