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Laparoscopic staging and tumor ablation for hepatocellular carcinoma in Child C cirrhotics evaluated for orthotopic liver transplantation

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Abstract

Background: Surgical resection and liver transplantation remain the only treatments that offer cure for hepatoma, but are limited to those with early stage disease. Prelisting radiological staging is not always definitive. In this study, we sought to delineate the role of laparoscopy for clarification of staging in advanced cirrhotic patients when radiological assessment during evaluation for orthotopic liver transplants (OLTx) is equivocal. Methods: Over a 3-year period, 18 patients with advanced liver insufficiency being evaluated for OLTx listing underwent laparoscopic staging when the following criteria were met: (1) lesion(s) with indeterminate size/borders, (2) an indeterminate number of lesions, or (3) lesion(s) and alpha-fero protein (AFP) less than 100 ng/ml. Patients underwent exploratory laparoscopy and laparoscopic ultrasound with biopsy, with or without ablation of lesion(s). Results: Laparoscopic staging was initiated in 18 patients; four of the first six patients were converted to open procedures. Twelve patients were restaged as a result of the procedure: six down-staged and six up-staged. Stage changes were based on laparoscopic visualization of advanced disease in two, ultrasonographic clarification of tumor size/number in seven, and biopsy in three. Twelve of the 14 laparoscopic procedures included laparoscopic radiofrequency ablation while one received ethanol ablation. One patient required 2 units of red blood cells. One patient died on postoperative day 7 because of gastrointestinal bleeding. Four of the six down-staged patients underwent liver transplant, and pathological staging of the explants agreed with laparoscopic staging in all cases. Conclusion: Laparoscopic staging for HCC in advanced cirrhosis can clearly characterize tumor burden when preoperative radiological assessment is equivocal.

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References

  1. PP Anthony KG Ishak NC Nayak HE Poulsen PJ Scheuer LH Sobin (1978) ArticleTitleThe morphology of cirrhosis. Recommendations on definition, nomenclature, and classification by a working group sponsored by the World Health Organization. J Clin Patho . 395–414

    Google Scholar 

  2. RS Chari MP Callery (2001) Colorectal cancer metastatic to the liver: resection and intraarterial chemotherapy. JL Cameron (Eds) Current surgical therapy Mosby St. Louis 375–385

    Google Scholar 

  3. RS Chari H Czerwenka WC Meyers (2001) Diagnostic imaging in the liver. CM Townsend RD Beauchamp BM Evers KL Mattox (Eds) Sabiston textbook of surgery W.B. Saunders Philadelphia 1013–1019

    Google Scholar 

  4. RS Chari DP Foley WC Meyers (2001) Primary hepatic neoplasms. KI Bland JM Daly CP Karakousis (Eds) Surgical oncology: contemporary principles and practice. McGraw-Hill New York 659–671

    Google Scholar 

  5. MP Clarke RA Kane G Steele Jr ES Hamilton TS Ravikumar G Onik ME Clouse (1989) ArticleTitleProspective comparison of preoperative imaging and intraoperative ultrasonography in the detection of liver tumors. Surgery . 849–8557

    Google Scholar 

  6. JM Colombo (1995) ArticleTitleEpidemiology of HCC. Ital J Gastroenterol . 83–87

    Google Scholar 

  7. M Colombo A Sangiovanni (1992) ArticleTitleThe natural history of hepatocellular carcinoma. Ital J Gastroenterol . 95–99

    Google Scholar 

  8. SA Curley F Izzo P Delrio LM Ellis J Granchi P Vallone F Fiore S Pignata B Daniele F Cremona (1999) ArticleTitleRadiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg . 1–8 Occurrence Handle10.1097/00000658-199907000-00001

    Article  Google Scholar 

  9. HB E1 Serag AC Mason (2000) ArticleTitleRisk factors for the rising rates of primary liver cancer in the United States. Arch Intern Med . 3227–3230 Occurrence Handle10.1001/archinte.160.21.3227

    Article  Google Scholar 

  10. SN Goldberg GS Gazelle CC Compton PR Mueller KK Tanabe (2000) ArticleTitleTreatment of intrahepatic malignancy with radiofrequency ablation: radiologic–pathologic correlation. Cancer . 2452–2463 Occurrence Handle10.1002/1097-0142(20000601)88:11<2452::AID-CNCR5>3.3.CO;2-V

    Article  Google Scholar 

  11. N Ince JR Wands (1999) ArticleTitleThe increasing incidence of hepatocellular carcinoma. N Engl J Med . 798–799 Occurrence Handle10.1056/NEJM199903113401009

    Article  Google Scholar 

  12. EC Lai ST Fan CM Lo KM Chu CL Liu J Wong (1995) ArticleTitleHepatic resection for hepatocellular carcinoma. An audit of 343 patients. Ann Surg . 291–298

    Google Scholar 

  13. V Mazzaferro E Regalia R Doci S Andreola A Pulvirenti F Bozzetti F Montalto M Ammatuna A Morabito L Gennani (1996) ArticleTitleLiver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med . 693–699 Occurrence Handle10.1056/NEJM199603143341104

    Article  Google Scholar 

  14. B Ringe R Pichlmayr C Wittekind G Tusch (1991) ArticleTitleSurgical treatment of hepatocellular carcinoma: experience with liver resection and transplantation in 198 patients. World J Surg . 270–285

    Google Scholar 

  15. S Rossi E Buscarini F Garbagnati M Di Stasi P Quaretti M Rago A Zangrandi S Andreola D Silverman L Buscarini (1998) ArticleTitlePercutaneous treatment of small hepatic tumors by an expandable RF needle electrode. Am J Roentgenol . 1015–1022

    Google Scholar 

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

    Google Scholar 

  17. L Solbiati T Ierace SN Goldberg S Sironi T Livraghi R Fiocca G Servadio G Rizzatto PR Mueller A Del Maschio GS Gazelle (1997) ArticleTitlePercutaneous US-guided radio-frequency tissue ablation of liver metastases: treatment and follow-up in 16 patients. Radiology . 194–203

    Google Scholar 

  18. JR Wands HE Blum (1991) ArticleTitlePrimary hepatocellular carcinoma. N Engl J Med . 729–731

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA

    R. D. Kim, P. Nazarey & E. Katz

  2. Departments of Surgery and Cancer Biology, Vanderbilt University, 1312 21st Avenue S., Nashville, TN 37232, USA

    R. S. Chari

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  1. R. D. Kim
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  2. P. Nazarey
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  3. E. Katz
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  4. R. S. Chari
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Correspondence to R. S. Chari.

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Kim, R., Nazarey, P., Katz, E. et al. Laparoscopic staging and tumor ablation for hepatocellular carcinoma in Child C cirrhotics evaluated for orthotopic liver transplantation . Surg Endosc 18, 39–44 (2004). https://doi.org/10.1007/s00464-002-8778-x

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  • DOI: https://doi.org/10.1007/s00464-002-8778-x

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