title: Laparoscopic RFA with splenectomy for hepatocellular carcinoma.
abstract: BACKGROUND
  The treatment of hepatocellular carcinoma (HCC) is complicated and challenging because of the frequent presence of cirrhosis. Therefore, we propose a novel surgical approach to minimize the invasiveness and risk in patients with HCC, hypersplenism, and esophagogastric varices.
  
  
  METHODS
  This was a retrospective study carried out in 25 patients with HCC and hypersplenism and who underwent simultaneous laparoscopic-guided radio-frequency ablation and laparoscopic splenectomy with endoscopic variceal ligation. Tumor size was restricted to a single nodule of <3 cm. Characteristics of the patients (cirrhosis etiology, liver function, tumor size, spleen size), surgery (complications, blood loss, time of stay), and follow-up (recurrence and survival) were examined.
  
  
  RESULTS
  Mean operative time was 128 ± 18 min. Mean blood loss was 206 ± 57 mL. Length of stay was 7.0 ± 1.5 days. Mean total costs were 8064 USD. Cytopenia and thrombocytopenia recovered quickly after surgery. No procedure was converted to open surgery. Two patients showed worsening liver function after surgery, three patients showed worsening of ascites, and five patients suffered from portal vein thrombosis. The 1-year tumor-free survival was 78.8 %, and the 21-month tumor-free survival was 61.4 %. According to a literature review, these outcomes were comparable to those of simultaneous open hepatic resection and splenectomy.
  
  
  CONCLUSIONS
  Laparoscopic-guided radio-frequency ablation with laparoscopic splenectomy and endoscopic variceal ligation could be an available technique for patients with HCC <3 cm, hypersplenism, and esophagogastric varices. This approach may help to minimize the surgical risks and results in a fast increase in platelet counts with an acceptable rate of complications.
authors.affiliation: Department of General Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
authors.forename: Kunpeng
authors.initials: K
authors.lastname: Hu
authors.affiliation: Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
authors.forename: Purun
authors.initials: P
authors.lastname: Lei
authors.affiliation: Department of General Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
authors.forename: Zhicheng
authors.initials: Z
authors.lastname: Yao
authors.affiliation: Department of General Surgery, Affiliated Hospital of Jiangnan University, Wuxi, 214000, China.
authors.forename: Chenhu
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of General Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
authors.forename: Qingliang
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of General Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
authors.forename: Shilei
authors.initials: S
authors.lastname: Xu
authors.affiliation: Department of Hepatobiliary Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Xiong
authors.affiliation: Department of General Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
authors.forename: He
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Hepatobiliary Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
authors.forename: Ruiyun
authors.initials: R
authors.lastname: Xu
authors.affiliation: Department of Hepatobiliary Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
authors.forename: Meihai
authors.initials: M
authors.lastname: Deng
authors.affiliation: Department of General Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China. liubojake@126.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006971:Hypersplenism / Q000601:surgery; D010535:Laparoscopy; D007902:Length of Stay; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000517:prevention & control; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D061646:Operative Time; D010976:Platelet Count; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Ablation; Endoscopic variceal ligation; Hepatocellular carcinoma; Hypersplenism; Laparoscopy; Splenectomy