Laparoscopic staging and radiofrequency of hepatocellular carcinoma in liver ci rrhosis. A "bridge" treatment to liver transplantation.
OBJECTIVE
Surgical resection and liver transplantation are the only curative treatments for hepatocellular carcinoma, although limited to early stage disease. Our objective was to assess a novel operative combination of laparoscopic ultrasound with laparoscopic radiofrequency ablation of small hepatocellular carcinoma in potential candidates to liver transplantation when radiological evaluation is equivocal. We also evaluated the feasibility and efficacy of laparoscopic radiofrequency ablation.


METHODS
Over a 2-year period, a laparoscopic ultrasound exploration and a laparoscopic radiofrequency ablation was performed in 15 patients (mean age 57+/-5.4 years; male/female 13/2) with hepatocellular carcinoma in liver cirrhosis.


RESULTS
LRFA procedure was completed in all patients and a thermoablation of 36 hepatocellular carcinoma nodules was achieved. Laparoscopic ultrasound identified 12 new malignant lesions (46.1%) undetected by preoperative imaging. Six patients were up-staged as a result of the procedure and 3 were precluded from liver transplantation listing. A complete tumor necrosis was observed in 32 thermoablated nodules (88.8%) via spiral computed tomography 1 month after treatment. Seven patients underwent liver transplantation after a 5.8-month mean interval, and pathological staging of the explants agreed with laparoscopic staging for number/size of hepatocellular carcinoma nodules in all cases. Residual tumor was found in 2/12 (16.6%) thermoablated nodules, in two different liver specimens.


CONCLUSIONS
Laparoscopic ultrasound accurately staged hepatocellular carcinoma in advanced cirrhosis with minimal morbidity and it can be used in potential candidates to liver transplantation. Laparoscopic radiofrequency ablation of hepatocellular carcinoma proved to be a safe and effective technique, representing a valid "bridge" treatment to liver transplantation or an effective palliative option.
Casaccia
Marco
M
Advanced Laparoscopy Unit, General and Transplant Surgery Dept., St. Martino Hospital, University of Genoa, Italy. Marco.Casaccia@unige.it
Andorno
Enzo
E
Nardi
Ilaria
I
Santori
Gregorio
G
Troilo
Bianca
B
Barabino
Gabriele
G
Di Domenico
Stefano
S
Panaro
Fabrizio
F
Valente
Umberto
U
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome