title: Laparoscopic radiofrequency ablation combined with laparoscopic liver resection for more than one HCC on cirrhosis.
abstract: The management of patients affected by more than one hepatocellular carcinoma (HCC) is still controversial but nowadays a multimodal approach to this pathology seems to be the most effective and versatile therapeutic option. When orthotopic liver transplantation is not indicated, survival-time and quality of life improvement is the goal for patients who will have a long metabolic and oncologic disease history. Combined use of minimally invasive nonsurgical treatments [percutaneous ethanol injection, radiofrequency ablation, transcutaneous arterial chemioembolization (TACE)] allows to offer to the patients the advantages of each therapeutic procedure reducing their individual side effects and complications. We consider laparoscopy as a minimally invasive procedure, which can offer the benefits of surgical treatment, by tumor removing, but with an improved postoperative course. If recurrence risk factors are present, the costs/benefits rapport can be decreased by the laparoscopic approach which offers, in addition to a radical resection, a decreased postoperative pain, reduced trauma to the abdominal wall, smaller incisions, reduced peritoneal adhesions and, in selected cases, an earlier beginning of chemiotherapy. We report the case of a patient affected by more than one HCC with a bigger lesion of 50 mm protruding from hepatic segment III, one subcapsular lesion located at segment V, and one deep lesion located at segment VII-VIII. The patient was submitted to a double laparoscopic liver resection in association with laparoscopic radiofrequency ablation. Five months later, the patient presented an early recurrence of malignancy that was treated by TACE. At 8 months from the treatment, the patient presented another multifocal recurrence and was submitted to another TACE. At 2 years from the laparoscopic procedure, the patient is in apparent good conditions with an acceptable quality of life. We think that laparoscopic resection could gain a considerable place in the multimodal treatment of cirrhotic liver with more than one HCC because, by tumor removing, it offers the benefits of surgical treatment with a lower complications rate.
authors: Department of General and Hepato-Pancreato-Biliary Surgery, S.M. Loreto Nuovo Hospital Naples, Italy. chirurgia.loretonuovo@tin.it
authors: Giulio
authors: G
authors: Belli
authors: Alberto
authors: A
authors: D'Agostino
authors: Corrado
authors: C
authors: Fantini
authors: Luigi
authors: L
authors: Cioffi
authors: Andrea
authors: A
authors: Belli
authors: Nadia
authors: N
authors: Russolillo
authors: Serena
authors: S
authors: Langella
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy; D008103:Liver Cirrhosis / Q000150:complications / Q000821:virology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed