Long-term outcome of laparoscopic ablation therapies for unresectable hepatocellular carcinoma: a single European center experience of 426 patients.
BACKGROUND
Radiofrequency ablation (RFA) is widely used as a first-line option in patients with hepatocellular carcinoma (HCC). However, since percutaneous approach of RFA may be, in some cases, unfeasible by the tumor size and its location, laparoscopic ablation therapies (LATs) were used as an alternative. Objective of the present study was to assess the efficacy of laparoscopic ultrasound examination in addition to LATs in the treatment of HCC in patients not eligible for percutaneous RFA or surgical resection.


METHODS
Four hundred and twenty-six patients who underwent LATs were analyzed. Laparoscopic approach was offered to patients fulfilling at least one of the following criteria: (a) patients with a single nodule or up to three nodules smaller than 3 cm not suitable for liver transplantation or not eligible for HR because of severe portal hypertension, impaired liver function, or coexistent comorbidities; (b) patients not suitable for percutaneous RFA because of inconvenient tumor location; and (c) short-term recurrence of HCC (<3 months).


RESULTS
Technical success was achieved in one session in 396 patients (93 %). One-month mortality and morbidity rates were 0.23 % (1 patient) and 25 % (106 patients), respectively. During a median follow-up of 37.2 months (range 2-193) in the remaining 425 patients, 276 (65 %) developed intra-hepatic recurrence: It appeared as a local tumor progression in 65 cases (15 %). Patients median survival was 39 months (95 % CI 34.8-47.2), while overall survivals at 1, 3, and 5 years were 88, 55, and 34 %, respectively.


CONCLUSIONS
In the treatment of HCC, LATs proved to be a safe and effective technique, as they permit to treat with low-morbidity-rate lesions not manageable by percutaneous approach. Moreover, they allow achieving a more accurate staging of the disease in one-fifth of patients, thus better redefining the prognosis of such individuals.
Chirurgia 2, Epato-bilio-pancreatica e Digestiva, San Paolo Hospital, University of Milan School of Medicine, Via A. di Rudini' 8, 20142, Milan, Italy. rsantambrogio@mclink.it.
Roberto
R
Santambrogio
Chirurgia 2, Epato-bilio-pancreatica e Digestiva, San Paolo Hospital, University of Milan School of Medicine, Via A. di Rudini' 8, 20142, Milan, Italy.
Matteo
M
Barabino
Department of Internal Medicine, IRCCS Istituto Clinico Humanitas, Medicine Humanitas University, Rozzano, MI, Italy.
Savino
S
Bruno
Chirurgia 2, Epato-bilio-pancreatica e Digestiva, San Paolo Hospital, University of Milan School of Medicine, Via A. di Rudini' 8, 20142, Milan, Italy.
Mara
M
Costa
Chirurgia 2, Epato-bilio-pancreatica e Digestiva, San Paolo Hospital, University of Milan School of Medicine, Via A. di Rudini' 8, 20142, Milan, Italy.
Andrea Pisani
AP
Ceretti
Chirurgia 2, Epato-bilio-pancreatica e Digestiva, San Paolo Hospital, University of Milan School of Medicine, Via A. di Rudini' 8, 20142, Milan, Italy.
Maria Rachele
MR
Angiolini
Internal Medicine and Hepatology Department, San Paolo Hospital, University of Milan School of Medicine, Milan, Italy.
Massimo
M
Zuin
Interventional US Unit, Radiology Department, Valduce Hospital, Como, Italy.
Franca
F
Meloni
Chirurgia 2, Epato-bilio-pancreatica e Digestiva, San Paolo Hospital, University of Milan School of Medicine, Via A. di Rudini' 8, 20142, Milan, Italy.
Enrico
E
Opocher
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome
Hepatocellular carcinoma; Laparoscopic ultrasound; Liver cirrhosis; Radiofrequency interstitial thermal ablation