Laparoscopic Contrast-Enhanced Ultrasonography for Real Time Monitoring of Laparoscopic Radiofrequency Ablation for Hepatocellular Carcinoma: an Observational Pilot Study

Abstract

Background and Aims: Laparoscopic radio-frequency ablation (L-RFA) for hepatocellular carcinoma (HCC) is used for unresectable tumors, with difficult location, unfitted for a percutaneous ablation technique. L-RFA has a high incidence of local recurrence. Even if intraoperative-ultrasound is standardized for staging and RFA probe guidance, the role of laparoscopic contrast-enhanced ultrasound (L-CEUS) for the real time monitoring of L-RFA efficacy has not been previously reported. We evaluated in a pilot observational study the efficacy of L-CEUS to assess the necrotic post-ablative area in difficult to treat HCC.
 Methods: Eight consecutive patients diagnosed with HCC (peripherally located) on liver cirrhosis were referred for L-RFA between May 2016 and December 2018. For L-RFA a SturBurst XL (AngioDinamics®) internally cooled electrode was used, being placed under ultrasound guidance. L-CEUS was used to assess the necrotic post-ablative area. The median follow up period was 18 months.
 Results: L-CEUS real time monitoring of the L-RFA efficacy indicated residual neoplastic tissue in 4 cases (50%). The procedure was repeated by reinserting the needle in the suspected areas indicated by L-CEUS. Complete tumor ablation was achieved in all treated patients. After a median follow-up of 18 months no recurrence of HCC was observed in 7 patients (87.5%).
 Conclusions: L-CEUS was a reliable procedure for the immediate assessment of L-RFA efficacy; half of the ablated HCC nodules required a second ablation session. This approach might decrease the local recurrences, but its role must be further investigated in larger cohorts.

Role of Sonazoid enhanced ultrasound assistant laparoscopic radiofrequency ablation in treating liver malignancy—A single‐center retrospective cohort study

“…Compared to percutaneous and no CEUS groups, we can see longer PFS in the laparoscopic group, intraoperative CEUS group, and laparoscopic CEUS group, especially in the laparoscopic CEUS group, though there is no statistical difference. Bartoș et al demonstrated that local recurrence was lower in the laparoscopic group than in the percutaneous group in the study of ablation of liver metastases, which was consistent with our views 14 . However, RFA is only a part of the comprehensive treatment of CRLM, which is not a local disease but a systemic disease.…”

“…Bartoș et al demonstrated that local recurrence was lower in the laparoscopic group than in the percutaneous group in the study of ablation of liver metastases, which was consistent with our views. 14 However, RFA is only a part of the comprehensive treatment of CRLM, which is not a local disease but a systemic disease. Although almost all the patients with liver metastases get to the status of no evidence of disease (NED) by RFA, local recurrence and 15 Therefore, the efficacy of RFA for laparoscopic HCC may be more meaningful, but it is a pity that there is no further analysis to form the cohort in our study due to the small number of HCC cases the in laparoscopic group.…”

Combined treatments in hepatocellular carcinoma: Time to put them in the guidelines?

“…Another advantage of this maneuver is the reduction of the cooling effect induced by the proximity of tumors to main vascular branches (“heat sink”), the rate of achieving a complete ablation being higher[ 18 ]. Evaluation of the necrotic area and the efficacy of RFA can be performed immediately by contrast-enhanced-IOUS (CE-IOUS), making possible repeated ablation sessions immediately[ 19 ].…”

Nodule-in-nodule Hepatocellular Carcinoma: A Surprise Lesion

“…This technique, already used in open surgery [4], should be considered as complementary to the intraoperative ultrasound: it provides new findings that are based on the pattern of enhancement due to the tumor vascularity. Laparoscopic CEUS is also useful for an immediate evaluation after radiofrequency ablation and permits adjunctive ablations, reducing the risk of local recurrences [5].…”