Background:
The optimal treatment for hepatocellular carcinoma (hcc) is surgical resection. however, only a small percentage of patients are operative candidates. percutaneous radiofrequency interstitial thermal ablation proved to be effective, too. our objective was to assess a novel operative combination of laparoscopic ultrasound (lus) with laparoscopic radiofrequency (lrf) in the treatment of hcc not amenable to liver resection.
Methods:
One hundred and four patients with hcc in liver cirrhosis were submitted to laparoscopic lrf. a lrf was indicated in patients not amenable to liver resection that had at least one of the following criteria: (a) severe impairment of the coagulation tests; (b) large tumors (but <5 cm) or multiple lesions requiring repeated punctures; (c) superficial lesions adjacent to visceral structures; (d) deep-sited lesions with a very difficult or impossible percutaneous approach; (e) short-term recurrence of hcc following percutaneous loco-regional therapies.
Results:
The lrf procedure was completed in 102 out of 104 patients (98% feasibility rate). lus identified 26 new malignant lesions (25%) undetected by pre-operative imaging. there was no operative mortality. seventy-six patients had no complication (73%). at 1-month computed tomography (ct) evaluation, a complete response with a 100% necrosis was achieved in 88 out of 101 patients (87%). during the follow-up (mean follow-up: 22.5 +/- 15.9 months), 55 patients (54%) developed new malignant nodules (42% of these recurrences were localized in the same segment of the hcc treated).
Conclusions:
Lrf of hcc proved to be a safe and effective technique at least in the short and mid-term: in fact it permits to treat lesions not treatable with the per cutaneous approach, to detect 25% of new hcc nodules and it has a low morbidity rate.