title: Percutaneous ablation procedures in cirrhotic patients with hepatocellular carcinoma submitted to liver transplantation: Assessment of efficacy at explant analysis and of safety for tumor recurrence.
abstract: Aims of this retrospective study were to analyze the efficacy and safety of percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) in cirrhotic patients with hepatocellular carcinoma (HCC) submitted to orthotopic liver transplantation (OLT). We studied 40 patients undergoing OLT in whom 46 HCC nodules had been treated with PEI (13 nodules), RFA (30 nodules), or PEI+RFA (3 nodules). Child-Turcotte-Pugh class was A in 18 cases, B in 18, and C in 4. The mean waiting time for OLT was 9.5 months. The effectiveness of ablation techniques was evaluated by histological examination of the explanted livers. Complete necrosis was found in 19 nodules (41.3%), partial or absent necrosis in 27 nodules (58.7%). Among the 30 nodules treated by RFA, 14 were completely necrotic (46.7%) and 16 demonstrated partial necrosis (53.3%). Considering the 13 neoplasms undergoing PEI, 3 nodules showed complete necrosis (23.1%), 6 partial necrosis (46.1%), and 4 absent necrosis (30.8%). The rate of complete necrosis was 53.1% for nodules smaller than 3 cm and 14.3% for larger lesions (P = 0.033) but increased to 61.9% when considering only the lesions smaller than 3 cm treated by RFA. During the follow up, HCC recurred in 3 patients treated by PEI. No cases of HCC recurrence at the abdominal wall level were recorded. Percutaneous ablation procedures are effective treatments in cirrhotic patients with HCC submitted to OLT and are not associated to an increased risk of tumor recurrence. RFA provides complete necrosis in most nodules smaller than 3 cm, and appears to be the best treatment option in these cases.
authors.affiliation: Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy. mpompili@rm.unicatt.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pompili
authors.forename: Vincenzo Giorgio
authors.initials: VG
authors.lastname: Mirante
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Rondinara
authors.forename: Luigi Rainero
authors.initials: LR
authors.lastname: Fassati
authors.forename: Fabio
authors.initials: F
authors.lastname: Piscaglia
authors.forename: Salvatore
authors.initials: S
authors.lastname: Agnes
authors.forename: Marcello
authors.initials: M
authors.lastname: Covino
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Stefano
authors.initials: S
authors.lastname: Fagiuoli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gasbarrini
authors.forename: Gian Ludovico
authors.initials: GL
authors.lastname: Rapaccini
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D015331:Cohort Studies; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D015552:Injections, Intralesional; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000431:Ethanol