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

Abstract

To our knowledge, this is the largest North American series reporting on RFA and resection for HCC from a single institution. Herein, we describe the perioperative and oncologic outcomes to be expected when these modalities are used in a certain treatment algorithm.

Laparoscopic hepatectomy versus radiofrequency ablation for minimally invasive treatment of single, small hepatocellular carcinomas

“…According to the American Association for the Study of Liver Diseases practice guidelines [2], SR is the standard treatment option for patients with HCC; however, the same guidelines suggest that SR is not recommended when the expected operative mortality rate is greater than 3 %, when nonsurgical options such as RFA may be considered as alternative primary treatments [18]. RFA causes large areas of coagulated tumor necrosis, requires few treatment sessions, and achieves high survival rates, and has thus become one of the most common alternatives for treating HCC patients who are not eligible for curative hepatectomy [19].…”

Laparoscopic-Assisted Ablation of Hepatic Tumors: A Review

“…This was in comparison to a 46% recurrence rate in 92 patients undergoing liver resection for HCC (p ¼ 0.167). 9 Similarly, Santambrogio et al published a regional recurrence rate of 30% after laparoscopic RFA for HCC in 102 patients during an unspecified time of follow-up. 6 The effects of laparoscopic thermal ablation on survival have also been described.…”

“…4,5,20 The majority of complications are minor; however, deaths have been reported after both procedures. 4,9 Efficacy Hepatocellular Carcinoma RFA and MWA treatment in HCC are local modalities typically used in patients who are not candidates for surgical resection. Since anatomic resections are not possible, the necessity for complete ablation is vital.…”

“…Incomplete laparoscopic ablation rates from 5.6 to 13% have been published 5,6 ; local recurrence rates range from 2.9 to 22% with a varying range of follow-up. 5,6,9 In addition to local recurrence, intrahepatic recurrence and the development of de novo malignancies poses a significant clinical challenge. In a retrospective review of 92 patients undergoing laparoscopic RFA for HCC, Karabulut et al noted a new liver recurrence in 57% of patients with a median follow-up of 19 months.…”

“…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.…”