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Advantages of Laparoscopic Radiofrequency Ablation Over Percutaneous Radiofrequency Ablation in Hepatocellular Carcinoma

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Abstract

Background

Inoperable hepatocellular carcinoma (HCC) can be treated with laparoscopic radiofrequency ablation (LRFA), which is generally a more accurate and accessible procedure than percutaneous RFA (PRFA). However, few studies have compared survival outcomes between LRFA and PRFA in patients with HCC.

Aims

This study aimed to compare the efficacy of LRFA and PRFA for HCC treatment.

Methods

Patients who underwent PRFA or LRFA as an initial treatment modality between April 2005 and April 2016 were enrolled in this study. The overall and recurrence-free survival rates were examined for each patient. Additionally, propensity score matching was performed for both groups.

Results

The baseline characteristics of patients in the PRFA and LRFA groups showed several minor differences. Multivariate analysis showed that the RFA method was not a critical determinant of recurrence-free or overall survival (p = 0.069 and p = 0.406). Among patients who underwent RFA as the initial treatment modality, there was no significant effect between either RFA procedures on survival. After propensity score matching, univariate analysis showed a significant difference in overall survival between PRFA and LRFA (p = 0.031). Multivariate analysis showed that LRFA is a strong factor that contributed to an improved overall survival in HCC patients (hazard ratio 0.108, p = 0.040). Furthermore, our data showed that LRFA was able to limit multiple intrahepatic recurrences, as well as prevent marginal recurrence.

Conclusions

LRFA appears to be superior to PRFA in terms of survival. LRFA may help reduce mortality in HCC patients.

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References

  1. Thomas MB, Jaffe D, Choti MM, et al. Hepatocellular carcinoma: consensus recommendations of the National Cancer Institute Clinical Trials Planning Meeting. J Clin Oncol. 2010;28:3994–4005.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–1022.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lau WY, Leung TWT, Yu SCH, Ho SKW. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg. 2003;237:171–179.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Tanabe KK, Curley SA, Dodd GD, Siperstein AE, Goldberg SN. Radiofrequency ablation: the experts weigh in. Cancer. 2004;100:641–650.

    Article  PubMed  Google Scholar 

  5. Cha J, Rhim H, Lee JY, et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma: assessment of safety in patients with ascites. Am J Roentgenol. 2009;193:424–429.

    Article  Google Scholar 

  6. Shiina S, Tateishi R, Imamura M, et al. Percutaneous ethanol injection for hepatocellular carcinoma: 20-year outcome and prognostic factors. Liver Int. 2012;32:1434–1442.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Mahnken AH, Bruners P, Gunther RW. Local ablative therapies in HCC: percutaneous ethanol injection and radiofrequency ablation. Dig Dis. 2009;27:148–156.

    Article  PubMed  Google Scholar 

  8. Inokuchi R, Seki T, Ikeda K, et al. Percutaneous microwave coagulation therapy for hepatocellular carcinoma: increased coagulation diameter using a new electrode and microwave generator. Oncol Rep. 2010;24:621–627.

    PubMed  Google Scholar 

  9. Ohmoto K, Mimura N, Iguchi Y, et al. Percutaneous microwave coagulation therapy for superficial hepatocellular carcinoma on the surface of the liver. Hepatogastroenterology. 2003;50:1547–1551.

    PubMed  Google Scholar 

  10. Poulou LS, Botsa E, Thanou I, Ziakas PD, Thanos L. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol. 2015;7:1054–1063.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Thamtorawat S, Hicks RM, Yu J, et al. Preliminary outcome of microwave ablation of hepatocellular carcinoma: breaking the 3-cm barrier? J Vasc Interv Radiol. 2016;27:623–630.

    Article  PubMed  Google Scholar 

  12. Facciorusso A, Di Maso M, Muscatiello N. Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: a systematic review and meta-analysis. Int J Hyperthermia. 2016;32:339–344.

    Article  CAS  PubMed  Google Scholar 

  13. Curley SA, Marra P, Beaty K, et al. Early and late complications after radiofrequency ablation of malignant liver tumors in 608 patients. Ann Surg. 2004;239:450–458.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kong W-T, Zhang W-W, Qiu Y-D, et al. Major complications after radiofrequency ablation for liver tumors: analysis of 255 patients. World J Gastroenterol. 2009;15:2651–2656.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mcwilliams JP, Plotnik AN, Sako EY, et al. Safety of hydroinfusion in percutaneous thermal ablation of hepatic malignancies. J Vasc Interv Radiol. 2014;25:1118–1124.

    Article  PubMed  Google Scholar 

  16. Santambrogio R, Opocher E, Montorsi M. Laparoscopic radiofrequency ablation of hepatocellular carcinoma: a critical review from the surgeon’s perspective. J Ultrasound. 2008;11:1–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Inoue T, Minami Y, Chung H, et al. Radiofrequency ablation for hepatocellular carcinoma: assistant techniques for difficult cases. Oncology. 2010;78:94–101.

    Article  PubMed  Google Scholar 

  18. Thamtorawat S, Limsuwarn P, Tongdee T, Chaiyasoot W, Siriapisith T. Incidence of complication and tumor recurrence after radiofrequency ablation in high-risk location of hepatocellular carcinoma patients. J Med Assoc Thai. 2014;97:95–100.

    PubMed  Google Scholar 

  19. Hirooka M, Kisaka Y, Uehara T, et al. Efficacy of laparoscopic radiofrequency ablation for hepatocellular carcinoma compared to percutaneous radiofrequency ablation with artificial ascites. Dig Endosc. 2009;21:82–86.

    Article  PubMed  Google Scholar 

  20. Wong J, Lee KF, Yu SCH, et al. Percutaneous radiofrequency ablation versus surgical radiofrequency ablation for malignant liver tumours: the long term results. HPB. 15:595–601.

  21. Jakimowicz J, Stultiens G, Smulders F. Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc. 1998;12:129–132.

    Article  CAS  PubMed  Google Scholar 

  22. Herbold T, Wahba R, Bangard C, et al. The laparoscopic approach for radiofrequency ablation of hepatocellular carcinoma-indication, technique and results. Langenbecks Arch Surg. 2013;398:47–53.

    Article  PubMed  Google Scholar 

  23. Okabayashi T, Kobayashi M, Akimori T, et al. Usefulness of laparoscopic radiofrequency ablation of hepatocellular carcinoma. Surg Technol Int. 2005;14:177–181.

    PubMed  Google Scholar 

  24. Santambrogio R, Podda M, Zuin M, et al. Safety and efficacy of laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis. Surg Endosc. 2003;17:1826–1832.

    Article  CAS  PubMed  Google Scholar 

  25. Ito T, Tanaka S, Iwai S, et al. Outcomes of laparoscopic hepatic resection versus percutaneous radiofrequency ablation for hepatocellular carcinoma located at the liver surface: a case–control study with propensity score matching. Hepatol Res. 2016;46:565–574.

    Article  PubMed  Google Scholar 

  26. Nishigaki Y, Hayashi H, Tomita E, et al. Usefulness of contrast-enhanced ultrasonography using Sonazoid for the assessment of therapeutic response to percutaneous radiofrequency ablation for hepatocellular carcinoma. Hepatol Res. 2015;45:432–440.

    Article  PubMed  Google Scholar 

  27. Lee SD, Han H-S, Cho JY, et al. Safety and efficacy of laparoscopic radiofrequency ablation for hepatic malignancies. J Korean Surg Soc. 2012;83:36–42.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Smith MK, Mutter D, Forbes LE, Mulier S, Marescaux J. The physiologic effect of the pneumoperitoneum on radiofrequency ablation. Surg Endosc. 2004;18:35–38.

    Article  CAS  PubMed  Google Scholar 

  29. Arimura E, Kotoh K, Nakamuta M, et al. Local recurrence is an important prognostic factor of hepatocellular carcinoma. World J Gastroenterol. 2005;11:5601–5606.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Mulier S, Ni Y, Jamart J, et al. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg. 2005;242:158–171.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Tateishi R, Shiina S, Teratani T, et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma. Cancer. 2005;103:1201–1209.

    Article  PubMed  Google Scholar 

  32. Curley SA, Izzo F, Ellis LM, Nicolas Vauthey J, Vallone P. Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis. Ann Surg. 2000;232:381–391.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Takahashi S, Kudo M, Chung H, et al. Initial treatment response is essential to improve survival in patients with hepatocellular carcinoma who underwent curative radiofrequency ablation therapy. Oncology. 2007;72:98–103.

    Article  PubMed  Google Scholar 

  34. Hori T, Nagata K, Hasuike S, et al. Risk factors for the local recurrence of hepatocellular carcinoma after a single session of percutaneous radiofrequency ablation. J Gastroenterol. 2003;38:977–981.

    Article  PubMed  Google Scholar 

  35. Abdelaziz A, Elbaz T, Shousha HI, et al. Efficacy and survival analysis of percutaneous radiofrequency versus microwave ablation for hepatocellular carcinoma: an Egyptian multidisciplinary clinic experience. Surg Endosc. 2014;28:3429–3434.

    Article  PubMed  Google Scholar 

  36. Doi K, Beppu T, Ishiko T, et al. Endoscopic radiofrequency ablation in elderly patients with hepatocellular carcinoma. Anticancer Res. 2015;35:3033–3040.

    PubMed  Google Scholar 

  37. Sakaguchi H, Seki S, Tsuji K, et al. Endoscopic thermal ablation therapies for hepatocellular carcinoma: a multi-center study. Hepatol Res. 2009;39:47–52.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was approved by the Institutional Review Board of Chungnam National University Hospital (IRB Number: 2016-06-009).

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Authors and Affiliations

  1. Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea

    Hyuk Soo Eun, Byung Seok Lee, Gee Young Yun, Eaum Seok Lee, Jong Seok Joo, Jae Kyu Sung, Hee Seok Moon, Sun Hyung Kang, Ju Seok Kim, Hae Jin Shin, Tae Kyun Kim & Seok Hyun Kim

  2. Clinical Trials Center, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea

    In Sun Kwon

  3. Department of Surgery, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 35015, Republic of Korea

    Kwangsik Chun

  4. Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea

    Hyuk Soo Eun, Byung Seok Lee, In Sun Kwon, Gee Young Yun, Eaum Seok Lee, Jong Seok Joo, Jae Kyu Sung, Hee Seok Moon, Sun Hyung Kang, Ju Seok Kim, Hae Jin Shin, Tae Kyun Kim & Seok Hyun Kim

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  1. Hyuk Soo Eun
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Correspondence to Hyuk Soo Eun, Kwangsik Chun or Seok Hyun Kim.

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The authors declare that they have no conflict of interest.

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For this type of retrospective study, formal consent is not required.

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Informed consent was obtained from all individual participants included in this study.

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Eun, H.S., Lee, B.S., Kwon, I.S. et al. Advantages of Laparoscopic Radiofrequency Ablation Over Percutaneous Radiofrequency Ablation in Hepatocellular Carcinoma. Dig Dis Sci 62, 2586–2600 (2017). https://doi.org/10.1007/s10620-017-4688-6

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  • DOI: https://doi.org/10.1007/s10620-017-4688-6

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