Laparoscopic US-Guided Radiofrequency Ablation of Unresectable Hepatocellular Carcinoma in Liver Cirrhosis: Feasibility and Clinical Outcome

Background: Radiofrequency ablation (RFA) is a safe, effective treatment in patients with unresectable primary liver malignancies. The laparoscopic approach to RFA (LRFA) has proved to be superior to the percutaneous approach in lesions that are difficult or impossible to be treated in such a way or in severe liver disease. Recent advances in laparoscopic ultrasound (LUS) have greatly improved the accuracy in detecting intrahepatic hepatocellular carcinoma (HCC) nodules, many of which were missed by computed tomography (CT) or magnetic resonance imaging (MRI). Our aim was to assess the feasibility, clinical outcome, and efficacy of laparoscopic RFA under LUS guidance. Methods: Between February 2006 and May 2007, 24 consecutive patients (male/female, 20/4) with unresectable HCC in liver cirrhosis were treated with LRFA under LUS guidance. Most patients were in Child-Pugh class A (54.1%). Mean age of the patients was 61.79 +/- 7.74 years (range, 45-76; median, 60). Results: LRFA procedure was completed in all patients and a thermoablation of 62 HCC nodules was achieved. LUS identified 13 new malignant lesions (20%) undetected by preoperative imaging. Mean length of surgery was 148 minutes (range, 60-315). Six procedures were associated in 5 patients: adhesiolysis (3), liver resection (1), partial splenectomy (1), and cholecystectomy (1). A pneumothorax needing immediate drainage during the procedure occurred in 1 case. One patient died 4 weeks after surgery because of liver failure. Mean hospital stay was 6.9 days and postoperative morbidity rate was 4 of 24 (16.6%). A complete tumor necrosis was observed in 56 of the 62 thermoablated nodules (90.3%) through spiral CT 1 month after treatment. Conclusions: LRFA is a safe, feasible treatment modality to achieve tumor destruction in selected patients with unresectable HCC that are not treatable with the percutaneous approach. Further, LUS demonstrated great accuracy during the procedure permitting to detect new HCC nodules missed at preoperative imaging.