Laparoscopic ultrasound with radiofrequency ablation of hepatic tumors in cirrhotic patients

Document Type : Original Article

Authors

1 Department of Surgery, National Liver Institute, Menouphyia University, Shibin El kom, Egypt

2 Department of Radiology, National Liver Institute, Menouphyia University, Shibin El kom, Egypt

3 Department of Pathology, National Liver Institute, Menouphyia University, Shibin El kom, Egypt

Abstract

Background: The optimal treatment for hepatocellular carcinoma (HCC) is surgical resection. However, only a small percentage of patients are operative candidates due to associated liver cirrhosis. Recent advances in laparoscopic ultrasound and laparoscopy have greatly improved the accuracy in detecting intrahepatic tumors nodules, many of which were missed by preoperative imaging modality.
Objective: Evaluation the safety and efficacy of laparoscopic radiofrequency ablation (RFA) guided with laparoscopic ultrasound in detection and treatment of liver tumors in patients with liver cirrhosis.
Methods: 72 patients with liver tumors (58 HCC, 9 metastatic adencarcinoma, 2 neoendocrine metastasis, 3 other metastasis) were submitted to laparoscopic RFA under laparoscopic ultrasound guidance. 44 patients (61.1%) Child A and 28 patients (38.9%) Child B. Patients with large tumor (>6 cm), portal vein thrombosis, or Child C class were excluded from the study.
Results: Laparoscopic RFA were completed in all patients without any conversion rate. Laparoscopic ultrasound identified 19 new malignant lesions (18.4%) in comparison with the result of preoperative imaging. A total of 103 hepatic focal lesions were treated by RFA (45 patients had one lesion, 23 patient had 2 lesions and 4 patients had 3 lesions). There was no mortality. Morbidity occurred in 4 patients (5.5%) 2 patients had liver abscesses, one patient had pleural effusion and one patient had postoperative bleeding necessitating blood transfusion and surgery. After a mean follow up of 14.3 ± 11.6 months, a complete response with 100% necrosis was achieved in 93 out of 103 lesions(90.3%). 3 lesions (2.9%) showed local recurrences,
5  lesions (4.8%) showed remote recurrences, and 2 lesions (1.9%)  showed both local and remote recurrences.
Conclusion: Laparoscopic RFA guided with laparoscopic ultrasound is an excellent use of existing technology in improvement of safety and efficacy of detection and treatment of intrahepatic tumors in patients with liver cirrhosis

Keywords

Ain Shams Journal of Surgery
Volume 2, Issue 1
January 2009
Pages 35-46

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