title: Laparoscopic ablation of hepatocellular carcinoma in cirrhotic patients unsuitable for liver resection or percutaneous treatment: a cohort study.
abstract: The aim of this study was to demonstrate the safety and efficacy of laparoscopic ablation for cirrhotic HCC patients. Between January 2004 and December 2009, laparoscopic ablation was applied prospectively in 169 consecutive HCC patients (median age 62 years, 43% hepatitis C positive) considered ineligible for liver resection and/or percutaneous ablation. There was clinically relevant portal hypertension in 72% of cases. A significant proportion of subjects (50%) had multinodular tumors or nodules larger than 25 mm. The main ablation techniques used were radiofrequency in 103 patients (61%), microwave ablation in 8 (5%), and ethanol injection in 58 (34%). The primary endpoint was 3-year survival. There was no perioperative mortality. The overall morbidity rate was 25%. The median postoperative hospital stay was 3 days (range 1-19 days). Patients survived a median 33 months with a 3-year survival rate of 47%. Cox's multivariate analysis identified patient age, presence of diabetes, albumin ≤37 g/l, and alpha-fetoprotein >400 µg/l as significant preoperative predictors of survival, while the chance to undergo liver transplantation and postoperative ascites were the only independent postoperative predictor of survival. Laparoscopic ablation is a safe and effective therapeutic option for selected HCC patients ineligible for liver resection and/or percutaneous ablation.
authors: Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda Ospedaliera Universitaria di Padova, Padua, Italy.
authors: Umberto
authors: U
authors: Cillo
authors: Alessandro
authors: A
authors: Vitale
authors: Davide
authors: D
authors: Dupuis
authors: Stefano
authors: S
authors: Corso
authors: Daniele
authors: D
authors: Neri
authors: Francesco
authors: F
authors: D'Amico
authors: Enrico
authors: E
authors: Gringeri
authors: Fabio
authors: F
authors: Farinati
authors: Valter
authors: V
authors: Vincenzi
authors: Giacomo
authors: G
authors: Zanus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D015331:Cohort Studies; D000431:Ethanol / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008099:Liver / Q000473:pathology / Q000601:surgery; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008872:Microwaves; D008875:Middle Aged; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins; D000431:Ethanol