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Fully laparoscopic thermo-ablation of liver malignancies with or without liver resection: tumor location is an independent local recurrence risk factor

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Abstract

Background

The aim of this study was to analyze risk factors of local recurrence (LR) after exclusive laparoscopic thermo-ablation (TA) with or without associated liver resection.

Methods

Between 2012 and 2017, among 385 patients who underwent 820 TA in our department, 65 (17%) patients (HCC = 11, LM = 54) had exclusive laparoscopic TA representing 112 lesions (HCC = 17, LM = 95). TA was associated with other procedures in 57% of cases (liver resection 81%). All TA were done without liver clamping. Median tumor size was 1.8 cm [ranges from 0.3 to 4.5], 18% of the lesions were larger than 3 cm in size and 11% close to major liver vessels. Tumors locations were 77.5% in right liver, 36% in S7&S8, and 46% in S7&S8&S4a.

Results

Mortality was nil and morbidity rate 15.4% including Dindo–Clavien > II grade 3%. The median follow-up was 24 months [0.77–75]. Per lesion LR rate after TA was 18% (n = 19 patients) with a mean time of 7.6 months. Among patients with LR, 18 (95%) could have been re-treated successfully (new resection = 11, re-TA = 7). Multivariate analyses revealed that tumor location in S7 alone, S7&S8 and/or S7, S8, or S4a were independent risk factors of LR after TA.

Conclusions

Exclusive laparoscopic TA is a safe and an effective tool to treat liver malignancies with or without liver resection. Other than classical risk factors, tumor location in upper segments of the liver, are independent risk factors for LR.

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Abbreviations

HCC:

Hepatocellular carcinoma

LM:

Liver metastases

TA:

Thermo-ablation

RFA:

Radiofrequency ablation

MWA:

Microwave ablation

LR:

Local recurrence

IOUS:

Intraoperative ultrasonography

DW-MRI:

Diffusion-weighted magnetic resonance imaging

S:

Couinaud’s segment

VS:

Versus

References

  1. Minagawa M, Makuuchi M, Torzilli G, Takayama T, Kawasaki S, Kosuge T, Yamamoto J, Imamura H (2000) Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg 231:487–499

    Article  CAS  Google Scholar 

  2. Kudo M, Izumi N, Kokudo N, Matsui O, Sakamoto M, Nakashima O, Kojiro M, Makuuchi M, HCC Expert Panel of Japan Society of Hepatology (2011) Management of hepatocellular carcinoma in Japan: consensus-based clinical practice guidelines proposed by the Japan Society of Hepatology (JSH) 2010 updated version. Dig Dis Basel Switz 29:339–364. https://doi.org/10.1159/000327577

    Article  Google Scholar 

  3. Meijerink MR, Puijk RS, van Tilborg AAJM, Henningsen KH, Fernandez LG, Neyt M, Heymans J, Frankema JS, de Jong KP, Richel DJ, Prevoo W, Vlayen J (2018) Radiofrequency and microwave ablation compared to systemic chemotherapy and to partial hepatectomy in the treatment of colorectal liver metastases: a systematic review and meta-analysis. Cardiovasc Intervent Radiol 41:1189–1204. https://doi.org/10.1007/s00270-018-1959-3

    Article  PubMed  PubMed Central  Google Scholar 

  4. Santambrogio R, Barabino M, Bruno S, Mariani N, Maroni N, Bertolini E, Franceschelli G, Opocher E (2017) Surgical Resection vs ablative therapies through a laparoscopic approach for hepatocellular carcinoma: a comparative study. J Gastrointest Surg. https://doi.org/10.1007/s11605-017-3648-y

    Article  PubMed  Google Scholar 

  5. Rossi S, Buscarini E, Garbagnati F, Di Stasi M, Quaretti P, Rago M, Zangrandi A, Andreola S, Silverman D, Buscarini L (1998) Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode. AJR Am J Roentgenol 170:1015–1022. https://doi.org/10.2214/ajr.170.4.9530052

    Article  CAS  PubMed  Google Scholar 

  6. Curley SA, Izzo F, Delrio P, Ellis LM, Granchi J, Vallone P, Fiore F, Pignata S, Daniele B, Cremona F (1999) Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg 230:1–8

    Article  CAS  Google Scholar 

  7. Cuschieri A, Bracken J, Boni L (1999) Initial experience with laparoscopic ultrasound-guided radiofrequency thermal ablation of hepatic tumours. Endoscopy 31:318–321. https://doi.org/10.1055/s-1999-16

    Article  CAS  PubMed  Google Scholar 

  8. Eltawil KM, Boame N, Mimeault R, Shabana W, Balaa FK, Jonker DJ, Asmis TR, Martel G (2014) Patterns of recurrence following selective intraoperative radiofrequency ablation as an adjunct to hepatic resection for colorectal liver metastases. J Surg Oncol 110:734–738. https://doi.org/10.1002/jso.23689

    Article  PubMed  Google Scholar 

  9. Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker C-G, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey J-N, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic Surgery (2009) The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg 250:825–830

  10. Hallet J, Sa Cunha A, Cherqui D, Gayet B, Goéré D, Bachellier P, Laurent A, Fuks D, Navarro F, Pessaux P, French Colorectal Liver Metastases Working Group, Association Française de Chirurgie (2017) Laparoscopic compared to open repeat hepatectomy for colorectal liver metastases: a multi-institutional propensity-matched analysis of short- and long-term outcomes. World J Surg 41:3189–3198. https://doi.org/10.1007/s00268-017-4119-z

    Article  Google Scholar 

  11. Tzanis D, Shivathirthan N, Laurent A, Abu Hilal M, Soubrane O, Kazaryan AM, Ettore GM, Van Dam RM, Lainas P, Tranchart H, Edwin B, Belli G, Campos RR, Pearce N, Gayet B, Dagher I (2013) European experience of laparoscopic major hepatectomy. J Hepato-Biliary-Pancreat Sci 20:120–124. https://doi.org/10.1007/s00534-012-0554-2

    Article  Google Scholar 

  12. Cannon RM, Scoggins CR, Callender GG, Quillo A, McMasters KM, Martin RCG (2013) Financial comparison of laparoscopic versus open hepatic resection using deviation-based cost modeling. Ann Surg Oncol 20:2887–2892. https://doi.org/10.1245/s10434-013-2993-7

    Article  PubMed  Google Scholar 

  13. Qiu J, Chen S, Pankaj P, Wu H (2014) Laparoscopic hepatectomy is associated with considerably less morbidity and a long-term survival similar to that of the open procedure in patients with hepatic colorectal metastases. Surg Laparosc Endosc Percutan Tech 24:517–522. https://doi.org/10.1097/SLE.0b013e31829cec2b

    Article  PubMed  Google Scholar 

  14. Lee JJ, Conneely JB, Smoot RL, Gallinger S, Greig PD, Moulton C-A, Wei A, McGilvray I, Cleary SP (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma at a North-American Centre: a 2-to-1 matched pair analysis. HPB 17:304–310. https://doi.org/10.1111/hpb.12342

    Article  PubMed  Google Scholar 

  15. Luo L, Zou H, Yao Y, Huang X (2015) Laparoscopic versus open hepatectomy for hepatocellular carcinoma: short- and long-term outcomes comparison. Int J Clin Exp Med 8:18772–18778

    PubMed  PubMed Central  Google Scholar 

  16. Untereiner X, Cagniet A, Memeo R, Tzedakis S, Piardi T, Severac F, Mutter D, Kianmanesh R, Marescaux J, Sommacale D, Pessaux P (2016) Laparoscopic hepatectomy versus open hepatectomy for colorectal cancer liver metastases: comparative study with propensity score matching. Hepatobiliary Surg Nutr 5:290–299. https://doi.org/10.21037/hbsn.2015.12.06

  17. Ei S, Hibi T, Tanabe M, Itano O, Shinoda M, Kitago M, Abe Y, Yagi H, Okabayashi K, Sugiyama D, Wakabayashi G, Kitagawa Y (2015) Cryoablation provides superior local control of primary hepatocellular carcinomas of %3e2 cm compared with radiofrequency ablation and microwave coagulation therapy: an underestimated tool in the toolbox. Ann Surg Oncol 22:1294–1300. https://doi.org/10.1245/s10434-014-4114-7

    Article  PubMed  Google Scholar 

  18. Gagner M, Rogula T, Selzer D (2004) Laparoscopic liver resection: benefits and controversies. Surg Clin North Am 84:451–462. https://doi.org/10.1016/j.suc.2003.11.002

    Article  PubMed  Google Scholar 

  19. Dindo D, Clavien P-A (2008) What is a surgical complication? World J Surg 32:939–941. https://doi.org/10.1007/s00268-008-9584-y

    Article  PubMed  Google Scholar 

  20. Elias D, Sideris L, Pocard M, de Baere T, Dromain C, Lassau N, Lasser P (2005) Incidence of unsuspected and treatable metastatic disease associated with operable colorectal liver metastases discovered only at laparotomy (and not treated when performing percutaneous radiofrequency ablation). Ann Surg Oncol 12:298–302. https://doi.org/10.1245/ASO.2005.03.020

    Article  CAS  PubMed  Google Scholar 

  21. Berber E, Siperstein A (2008) Local recurrence after laparoscopic radiofrequency ablation of liver tumors: an analysis of 1032 tumors. Ann Surg Oncol 15:2757–2764. https://doi.org/10.1245/s10434-008-0043-7

    Article  PubMed  Google Scholar 

  22. Takahashi H, Akyuz M, Aksoy E, Karabulut K, Berber E (2017) Local recurrence after laparoscopic radiofrequency ablation of malignant liver tumors: Results of a contemporary series. J Surg Oncol 115:830–834. https://doi.org/10.1002/jso.24599

    Article  PubMed  Google Scholar 

  23. Nordlinger B, Sorbye H, Glimelius B, Poston GJ, Schlag PM, Rougier P, Bechstein WO, Primrose JN, Walpole ET, Finch-Jones M, Jaeck D, Mirza D, Parks RW, Mauer M, Tanis E, Van Cutsem E, Scheithauer W, Gruenberger T, EORTC Gastro-Intestinal Tract Cancer Group, Cancer Research UK, Arbeitsgruppe Lebermetastasen und–tumoren in der Chirurgischen Arbeitsgemeinschaft Onkologie (ALM-CAO), Australasian Gastro-Intestinal Trials Group (AGITG), Fédération Francophone de Cancérologie Digestive (FFCD) (2013) Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial. Lancet Oncol 14:1208–1215. https://doi.org/10.1016/S1470-2045(13)70447-9

    Article  CAS  Google Scholar 

  24. Leung U, Kuk D, D’Angelica MI, Kingham TP, Allen PJ, DeMatteo RP, Jarnagin WR, Fong Y (2015) Long-term outcomes following microwave ablation for liver malignancies. Br J Surg 102:85–91. https://doi.org/10.1002/bjs.9649

    Article  CAS  PubMed  Google Scholar 

  25. Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L (2005) Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 242:158–171

    Article  Google Scholar 

  26. Siperstein A, Garland A, Engle K, Rogers S, Berber E, Foroutani A, String A, Ryan T, Ituarte P (2000) Local recurrence after laparoscopic radiofrequency thermal ablation of hepatic tumors. Ann Surg Oncol 7:106–113

    Article  CAS  Google Scholar 

  27. North DA, Groeschl RT, Sindram D, Martinie JB, Iannitti DA, Bloomston M, Schmidt C, Rilling WS, Gamblin TC, Martin RCG (2014) Microwave ablation for hepatic malignancies: a call for standard reporting and outcomes. Am J Surg 208:284–294. https://doi.org/10.1016/j.amjsurg.2014.02.002

    Article  PubMed  Google Scholar 

  28. Pearson AS, Izzo F, Fleming RY, Ellis LM, Delrio P, Roh MS, Granchi J, Curley SA (1999) Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies. Am J Surg 178:592–599

    Article  CAS  Google Scholar 

  29. Gravante G, Overton J, Sorge R, Bhardwaj N, Metcalfe MS, Lloyd DM, Dennison AR (2011) Radiofrequency ablation versus resection for liver tumours: an evidence-based approach to retrospective comparative studies. J Gastrointest Surg Off J Soc Surg Aliment Tract 15:378–387. https://doi.org/10.1007/s11605-010-1377-6

    Article  Google Scholar 

  30. Correa-Gallego C, Fong Y, Gonen M, D’Angelica MI, Allen PJ, DeMatteo RP, Jarnagin WR, Kingham TP (2014) A retrospective comparison of microwave ablation vs. radiofrequency ablation for colorectal cancer hepatic metastases. Ann Surg Oncol 21:4278–4283. https://doi.org/10.1245/s10434-014-3817-0

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ringe KI, Lutat C, Rieder C, Schenk A, Wacker F, Raatschen H-J (2015) Experimental evaluation of the heat sink effect in hepatic microwave ablation. PLoS ONE 10:e0134301. https://doi.org/10.1371/journal.pone.0134301

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Deshazer G, Merck D, Hagmann M, Dupuy DE, Prakash P (2016) Physical modeling of microwave ablation zone clinical margin variance. Med Phys 43:1764. https://doi.org/10.1118/1.4942980

    Article  PubMed  Google Scholar 

  33. Varadarajulu S, Jhala NC, Drelichman ER (2009) EUS-guided radiofrequency ablation with a prototype electrode array system in an animal model (with video). Gastrointest Endosc 70:372–376. https://doi.org/10.1016/j.gie.2009.03.008

    Article  PubMed  Google Scholar 

  34. Groeschl RT, Wong RK, Quebbeman EJ, Tsai S, Turaga KK, Pappas SG, Christians KK, Hohenwalter EJ, Tutton SM, Rilling WS, Gamblin TC (2013) Recurrence after microwave ablation of liver malignancies: a single institution experience. HPB 15:365–371. https://doi.org/10.1111/j.1477-2574.2012.00585.x

    Article  PubMed  Google Scholar 

  35. Mann CD, Metcalfe MS, Lloyd DM, Maddern GJ, Dennison AR (2010) The safety and efficacy of ablative techniques adjacent to the hepatic vasculature and biliary system. ANZ J Surg 80:41–49. https://doi.org/10.1111/j.1445-2197.2009.05174.x

    Article  PubMed  Google Scholar 

  36. Reed DN, Vitale GC, Wrightson WR, Edwards M, McMasters K (2003) Decreasing mortality of bile leaks after elective hepatic surgery. Am J Surg 185:316–318

    Article  Google Scholar 

  37. de Jong EA, Moelker A, Leertouwer T, Spronk S, Van Dijk M, van Eijck CHJ (2013) Percutaneous transhepatic biliary drainage in patients with postsurgical bile leakage and nondilated intrahepatic bile ducts. Dig Surg 30:444–450. https://doi.org/10.1159/000356711

    Article  PubMed  Google Scholar 

  38. Lahat E, Eshkenazy R, Zendel A, Zakai BB, Maor M, Dreznik Y, Ariche A (2014) Complications after percutaneous ablation of liver tumors: a systematic review. Hepatobiliary Surg Nutr 3:317–323. https://doi.org/10.3978/j.issn.2304-3881.2014.09.07

    Article  PubMed  PubMed Central  Google Scholar 

  39. Kosari K, Gomes M, Hunter D, Hess DJ, Greeno E, Sielaff TD (2002) Local, intrahepatic, and systemic recurrence patterns after radiofrequency ablation of hepatic malignancies. J Gastrointest Surg 6:255–263

    Article  Google Scholar 

  40. Shady W, Petre EN, Gonen M, Erinjeri JP, Brown KT, Covey AM, Alago W, Durack JC, Maybody M, Brody LA, Siegelbaum RH, D’Angelica MI, Jarnagin WR, Solomon SB, Kemeny NE, Sofocleous CT (2016) Percutaneous radiofrequency ablation of colorectal cancer liver metastases: factors affecting outcomes: a 10-year experience at a single center. Radiology 278:601–611. https://doi.org/10.1148/radiol.2015142489

    Article  PubMed  Google Scholar 

  41. Berber E, Pelley R, Siperstein AE (2005) Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: a prospective study. J Clin Oncol 23:1358–1364. https://doi.org/10.1200/JCO.2005.12.039

    Article  PubMed  Google Scholar 

  42. Kobayashi S, Fukui K, Takeda Y, Nakahira S, Tsujie M, Shimizu J, Miyamoto A, Eguchi H, Nagano H, Doki Y, Mori M (2018) Short-term outcomes of open liver resection and laparoscopic liver resection: Secondary analysis of data from a multicenter prospective study (CSGO-HBP-004). Ann Gastroenterol Surg 2:87–94. https://doi.org/10.1002/ags3.12046

    Article  PubMed  Google Scholar 

  43. Okuda Y, Honda G, Kurata M, Kobayashi S, Sakamoto K, Takahashi K (2015) A safe and valid procedure for pure laparoscopic partial hepatectomy of the most posterosuperior area: the top of segment 7. J Am Coll Surg 220:e17–21. https://doi.org/10.1016/j.jamcollsurg.2014.11.021

    Article  PubMed  Google Scholar 

  44. Ogiso S, Conrad C, Araki K, Nomi T, Anil Z, Gayet B (2015) Laparoscopic transabdominal with transdiaphragmatic access improves resection of difficult posterosuperior liver lesions. Ann Surg 262:358–365. https://doi.org/10.1097/SLA.0000000000001015

    Article  PubMed  Google Scholar 

  45. Tanaka K, Kojima T, Hiraguchi E, Hashida H, Noji T, Hirano S (2016) Laparoscopy-guided transthoracic transdiaphragmatic radiofrequency ablation for hepatic tumors located beneath the diaphragm. J Laparoendosc Adv Surg Tech A 26:180–184. https://doi.org/10.1089/lap.2015.0380

    Article  PubMed  Google Scholar 

  46. Yu NC, Raman SS, Kim YJ, Lassman C, Chang X, Lu DSK (2008) Microwave liver ablation: influence of hepatic vein size on heat-sink effect in a porcine model. J Vasc Interv Radiol JVIR 19:1087–1092. https://doi.org/10.1016/j.jvir.2008.03.023

    Article  PubMed  Google Scholar 

  47. D’Hondt M, Lucidi V, Vermeiren K, Van Den Bossche B, Donckier V, Sergeant G (2017) The interval approach: an adaptation of the liver-first approach to treat synchronous liver metastases from rectal cancer. World J Surg Oncol 15:54. https://doi.org/10.1186/s12957-017-1123-6

    Article  PubMed  PubMed Central  Google Scholar 

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Author notes

  1. Geoffrey Ledoux and Koceila Amroun have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France

    Geoffrey Ledoux, Rami Rhaiem, Audrey Cagniet, Arman Aghaei, Daniele Sommacale, Tullio Piardi & Reza Kianmanesh

  2. Reims Medical Faculty, Reims, France

    Geoffrey Ledoux, Rami Rhaiem, Audrey Cagniet, Arman Aghaei, Olivier Bouche, Christine Hoeffel, Daniele Sommacale, Tullio Piardi & Reza Kianmanesh

  3. University of Reims Champagne Ardenne, Reims, France

    Geoffrey Ledoux, Koceila Amroun, Rami Rhaiem, Audrey Cagniet, Arman Aghaei, Olivier Bouche, Christine Hoeffel, Daniele Sommacale, Tullio Piardi & Reza Kianmanesh

  4. Department of Surgery, Jean Godinot Cancer Institute, Reims, France

    Koceila Amroun

  5. Deprtement of Oncology, Robert Debré University- Hospital, Reims, France

    Olivier Bouche

  6. Departement of Radiology, Robert Debré University- Hospital, Reims, France

    Christine Hoeffel

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Dr Ledoux, Amroun, Rhaiem, Cagniet, Aghaei, Bouché, Hoeffel, Sommacale, Piardi, and Kianmanesh have no conflicts of interest or financial ties to disclose.

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Ledoux, G., Amroun, K., Rhaiem, R. et al. Fully laparoscopic thermo-ablation of liver malignancies with or without liver resection: tumor location is an independent local recurrence risk factor. Surg Endosc 35, 845–853 (2021). https://doi.org/10.1007/s00464-020-07456-0

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