Laparoscopic radiofrequency ablation of unresectable hepatocellular carcinoma: long-term follow-up

Abstract

Background. Hepatocellular carcinoma (HCC) has seen a dramatic rise in the USA over the last 30 years. Unresectable disease is present in 80Á90% of patients, for which radiofrequency ablation (RFA) is an option. The aim of this study is to report the long-term survival after laparoscopic RFA. Methods. This is a prospective analysis of 104 patients who underwent 122 ablations for unresectable HCC from April 1997 to December 2006 at a tertiary care center. Overall survival (OS) and disease-free survival (DFS) were calculated using KaplanÁMeier curves, excluding 11 patients who subsequently underwent liver transplantation. Patients were analyzed using Child-Pugh classification, Barcelona Clinic Liver Cancer (BCLC) staging and various clinical parameters. Results. Median (range) data: age 63 years (41Á81), lesion size 3.5 cm (1Á10), number of lesions 1 (1Á5), AFP 26.5 ng/ml (3.7Á43588.5) and time from diagnosis to RFA 2 months (mos) (1Á42). The median KaplanÁMeier survival for all patients was 26 mos (OS) while DFS was 14 mos. Univariate analysis demonstrated improved OS for the absence vs. presence of ascites (31 vs. 15 mos, p00.003), Bilirubin B2 mg/dl vs. ]2 mg/dl (27 vs. 19 mos, p 00.01), AFP B400 vs. ]400 (29 vs. 13 mos, p B0.0001) and Child-Pugh Grade (A028, B015, C05 mos, p0 0.01). Significant factors for improved DFS: absence vs. presence of ascites (16 vs. 5 mos, p00.02), Bilirubin B2 vs. ]2 (14 vs. 5 mos, p00.0278), AFP B400 vs. ]400 (15 vs. 4 mos, p00.0025), Child-Pugh Grade (A016, B 010, C03 mos, p 00.03). Patient age, largest tumor size, number of lesions, INR and albumin did not reach clinical significance. Three and five-year actual survival rates are 21 and 8.3%, respectively. Conclusions. Our study suggests that RFA may have a positive impact on survival for unresectable HCC. It also determines which patients fare best after RFA, by determining predictive factors that improve their survival.

Resection and radiofrequency ablation in the treatment of hepatocellular carcinoma: a single-center experience

“…The parameters reported to affect survival in the literature include tumor size, number of tumors, tumor differantiation, microvascular invasion, Child class, AFP level, treatment modality, and ethnicity [3,10,[13][14][15][16][17]. In our study, while AFP was the independent predictor of disease- free survival, underlying liver function and number of tumors independently predicted overall survival.…”

“…We have previously reported effective local tumor control with low morbidity using laparoscopic RFA for HCC [3,10]. In this work we expand our previously published series by adding the patients who have been treated with liver resection and describe our algorithm.…”

“…We have been approaching HCC in a multidisciplinary fashion and triaging patients to resection or RFA based on certain criteria. We have previously reported on laparoscopic RFA for unresectable HCC [3,10]. In this work we expand our previously published series by adding the patients who had been treated with liver resection.…”

“…Although liver transplantation and surgical resection remain the gold standard, only a small percentage of patients are good candidates for these modalities [3][4][5]. Recently there has been a paradigm shift in the treatment algorithm of patients with HCC, with radiofrequency ablation (RFA) being considered an alternative to resection for small HCC [3,[6][7][8][9]. We have acquired experience with both modalities over the last 14 years.…”

Laparoscopic-Assisted Ablation of Hepatic Tumors: A Review

“…The most common applications are in patients with hepatocellular carcinoma (HCC), and in those with hepatic metastases from colorectal carcinoma (colorectal cancer liver metastases [CRLM]). [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] The indications for laparoscopic RFA or MWA can be divided into patient-specific and tumor-specific categories. In discussing indications for laparoscopic thermal ablation, it should be noted that surgical resection with tumor-free margins remains the accepted gold standard of therapy for both HCC and CRLM.…”