Radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis: a critical appraisal of the laparoscopic approach

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 in the treatment of unresectable HCC. Recent advances in laparoscopic ultrasound have improved the accuracy in detecting small intrahepatic HCC nodules missed by preoperative imaging techniques. Our objective was to evaluate a novel operative combination of laparoscopic ultrasound with laparoscopic radiofrequency (LRF) in the treatment of HCC not amenable to liver resection. The aim of our review was to evaluate the advantages and limits of the laparoscopic approach according the criteria of the evidence-based medicine. Conclusions: LRF of HCC proved to be a safe and effective technique at least in the short and mid-term. This technique may be indicated in selected cases when the percutaneous approach to the lesion is very difficult or contraindicated.