title: Laparoscopic approach for down-staging in hepatocellular carcinoma patients who are candidates for liver transplantation.
abstract: BACKGROUND
  The aim of this study was to assess the impact of laparoscopic thermoablation (LTA) and laparoscopic resection (LR) as neoadjuvant therapy before orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC).
  
  
  METHODS
  From June 2005 to November 2010, 50 consecutive patients affected by HCC with liver cirrhosis were treated with LTA under ultrasound guidance or LR. Of them, 10 patients (mean age, 58.3 ± 5.59 years; male:female, 8:2) underwent OLT. They were mostly Child-Pugh class A (80%).
  
  
  RESULTS
  A LTA of 12 nodules was achieved in 7 patients and an LR of 3 HCC nodules in the other 3 subjects. The mean length of surgery was 163 minutes (range; 60-370). The mean hospital stay was 6.1 days. Transient mild postoperative liver failure was reported in 1 case. Complete tumor necrosis was observed in 10 thermoablated nodules (83.3%) via spiral computerized tomographic scan at 1 month after treatment; the resected patients showed absence of recurrence. All patients underwent OLT after a mean interval of 7 months. The histology of the native liver showed complete necrosis in 9/12 thermoablated nodules (75%); a recurrence at surgical site occurred in 1 patient in the resection group.
  
  
  CONCLUSIONS
  Laparoscopic ultrasound can be used in potential OLTs candidates to accurately stage HCC in advanced cirrhosis with minimal morbidity. LTA and LR proved to be safe and effective techniques for HCC patients, representing a valid "bridge" to OLT.
authors.affiliation: Department of Surgical Sciences and Integrated Diagnostics (DISC), Organ Transplantation Section, University of Genoa, Italy. Electronic address: marco.casaccia@unige.it.
authors.forename: M
authors.initials: M
authors.lastname: Casaccia
authors.forename: E
authors.initials: E
authors.lastname: Andorno
authors.forename: G
authors.initials: G
authors.lastname: Santori
authors.forename: I
authors.initials: I
authors.lastname: Fontana
authors.forename: G
authors.initials: G
authors.lastname: Varotti
authors.forename: C
authors.initials: C
authors.lastname: Ferrari
authors.forename: M
authors.initials: M
authors.lastname: Ertreo
authors.forename: U
authors.initials: U
authors.lastname: Valente
mesh_terms: D001706:Biopsy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging