Seeding after radiofrequency ablation of hepatocellular carcinoma in patients with cirrhosis: a prospective study.
BACKGROUND
Neoplastic seeding of hepatocellular carcinoma may arise after radiofrequency ablation.


OBJECTIVE
In order to clarify the real risk of seeding, we observed a prospective cohort of patients undergoing radiofrequency ablation.


METHODS
Ninety-three (22.9%) out of 406 consecutive patients with hepatocellular carcinoma superimposed to cirrhosis diagnosed at our Liver Unit (2000-2005) were selected for radiofrequency ablation according to the Barcelona 2000 EASL guidelines. Seventy-one patients were treated by a percutaneous approach and 22 at laparotomy. After radiofrequency ablation ultrasound scan was repeated every 3 months and spiral-computed tomography every 6 months.


RESULTS
Overall 145 sessions were performed in 93 patients: 113 (77.9%) by a percutaneous approach and 32 (22.1%) at laparotomy. The median follow-up was 23 months (range 1-60). Only 1 of the 71 patients (1.4%; 95% C.I. 0.25-7.56) treated percutaneously and none of the 22 (0%; 95% C.I. 0-14.8) treated at laparotomy showed neoplastic seeding.


CONCLUSIONS
In our experience the risk of seeding of hepatocellular carcinoma after radiofrequency ablation was small (1.1% per patient, 95% C.I. 0.19-5.84; 0.7% per procedure, 95% C.I. 0.12-3.80). A stringent selection of patients for radiofrequency ablation and retraction of the needle with a hot tip may have been instrumental in obtaining this low frequency.
Latteri
F
F
Department of Gastroenterology and Hepatology, University of Palermo, Italy. f.latteri@libero.it
Sandonato
L
L
Di Marco
V
V
Parisi
P
P
Cabibbo
G
G
Lombardo
G
G
Galia
M
M
Midiri
M
M
Latteri
M A
MA
Craxì
A
A
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D011446:Prospective Studies; D016896:Treatment Outcome