title: Intraoperative ablation for small HCC not amenable for percutaneous radiofrequency ablation in Child A cirrhotic patients.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) was initially started by radiologists as a percutaneous treatment, but surgeons started to use RFA by surgical approach for patients with tumors at locations difficult for the percutaneous procedure. The aim was to evaluate the results of intraoperative RFA for small hepatocellular carcinomas (HCCs) (<3 cm) in locations difficult for a percutaneous approach.
  
  
  METHODS
  Two hundred forty-seven patients with small solitary HCC (<3 cm) were treated; 196 via percutaneous RFA while 51 patients presented at sites not amenable for percutaneous route. Twenty-seven out of 51 patients underwent surgical resection, while 24/51 patients underwent intraoperative RFA.
  
  
  RESULTS
  The location and depth of the tumor from the liver capsule was the only significant factors in the choice of the surgeon between resection and RFA. RFA was successful in all tumors (complete ablation rate of 100 %). In the surgery group, all patients achieved R0 resection. Complication rate was comparable (p = 1.0). After a median follow-up of 37 months (range, 10-45 months), no tumors showed neither local progression nor local recurrence and no significant difference was observed between two groups as regards early recurrence and number of de novo lesions (p = 0.49). One-year and 3-year survival rates were 93 % and 81 %, respectively, in the resection group comparable to the corresponding rates of 92 % and 74 % in the RFA group (p = 0.9).
  
  
  CONCLUSIONS
  For small HCC in locations difficult for a percutaneous approach, intraoperative RFA can be an alternative option for deep-seated tumors necessitating more than one segmentectomy achieving similar tumor control, and overall and disease-free survival.
authors.affiliation: Department of Surgery, Faculty of Medicine, Alexandria University, El Sultan Hussein Street, El-Azarita, Khartom Square, Alexandria, 21131, Egypt. draelgendi@gmail.com
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Gendi
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Shafei
authors.forename: Fatma
authors.initials: F
authors.lastname: Abdel-Aziz
authors.forename: Essam
authors.initials: E
authors.lastname: Bedewy
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007432:Intraoperative Period; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies