Surgical Resection vs. Ablative Therapies Through a Laparoscopic Approach for Hepatocellular Carcinoma: a Comparative Study

Roberto Santambrogio, Roberto Santambrogio, Matteo Barabino, Savino Bruno, Nicolò Mariani, Nirvana Maroni, Emanuela Bertolini, Giuseppe Franceschelli, Enrico Opocher

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Abstract

© 2017 The Society for Surgery of the Alimentary Tract Background: When compatible with the liver functional reserve, laparoscopic hepatic resection remains the treatment of choice for hepatocellular carcinoma while laparoscopic ablation therapies appear as a promising less invasive alternative. The aim of the study is to compare two homogeneous groups of patients submitted to either hepatic resection or thermoablation for the treatment of single hepatocellular carcinoma (≤ 3 cm). Methods: We enrolled 264 cirrhotic patients out of 905 cases consecutively evaluated for hepatocellular carcinoma. We performed 59 hepatic resections and 205 thermoablations through a laparoscopic approach, and they were then followed for similar follow-up (41.7 ± 31.5 months for laparoscopic hepatic resection vs. 38.7±32.3 for laparoscopic ablation therapy). Outcomes included short- and long-term morbidities, tumoral recurrence, and overall survival. Results: Short-term morbidity was significantly higher in the resection group (but the two groups had similar rates for severe complications) while, during follow-up, recurrence was more frequent in patients treated with thermoablation, with a clear disadvantage in terms of survival. At multivariate analysis, only the type of surgical treatment was an independent predictor of disease recurrence, while plasmatic alpha-fetoprotein and Hb values, model for end-stage liver disease score, time to recurrence, and the type of surgical treatment were independent predictors of overall survival. Conclusion: Our data ultimately support some therapeutic advantages for hepatic resection in patients with a single nodule and preserved liver function. However, thermoablation is an adequate alternative in patients with nodules that would require complex surgical resections or imply a poor prognosis that might therefore better tolerate a less invasive procedure.
Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalJournal of Gastrointestinal Surgery
DOIs
Publication statusAccepted/In press - Dec 12 2017

Fingerprint

Hepatocellular Carcinoma
Liver
Recurrence
Therapeutics
Survival
Morbidity
End Stage Liver Disease
alpha-Fetoproteins
Multivariate Analysis

Keywords

  • Hepatic surgical resection
  • Hepatocellular carcinoma
  • Liver cirrhosis
  • Radiofrequency ablation

Cite this

Surgical Resection vs. Ablative Therapies Through a Laparoscopic Approach for Hepatocellular Carcinoma: a Comparative Study. / Santambrogio, Roberto; Santambrogio, Roberto; Barabino, Matteo; Bruno, Savino; Mariani, Nicolò; Maroni, Nirvana; Bertolini, Emanuela; Franceschelli, Giuseppe; Opocher, Enrico.

In: Journal of Gastrointestinal Surgery, 12.12.2017, p. 1-11.

Research output: Contribution to journalArticle

Santambrogio, Roberto ; Santambrogio, Roberto ; Barabino, Matteo ; Bruno, Savino ; Mariani, Nicolò ; Maroni, Nirvana ; Bertolini, Emanuela ; Franceschelli, Giuseppe ; Opocher, Enrico. / Surgical Resection vs. Ablative Therapies Through a Laparoscopic Approach for Hepatocellular Carcinoma: a Comparative Study. In: Journal of Gastrointestinal Surgery. 2017 ; pp. 1-11.
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