Journal of Gastrointestinal Surgery

, Volume 22, Issue 4, pp 650–660 | Cite as

Surgical Resection vs. Ablative Therapies Through a Laparoscopic Approach for Hepatocellular Carcinoma: a Comparative Study

  • Roberto Santambrogio
  • Matteo Barabino
  • Savino Bruno
  • Nicolò Mariani
  • Nirvana Maroni
  • Emanuela Bertolini
  • Giuseppe Franceschelli
  • Enrico Opocher
Original Article
  • 146 Downloads

Abstract

Background

When compatible with the liver functional reserve, laparoscopic hepatic resection remains the treatment of choice for hepatocellular carcinoma while laparoscopic ablation therapies appear as a promising less invasive alternative. The aim of the study is to compare two homogeneous groups of patients submitted to either hepatic resection or thermoablation for the treatment of single hepatocellular carcinoma (≤ 3 cm).

Methods

We enrolled 264 cirrhotic patients out of 905 cases consecutively evaluated for hepatocellular carcinoma. We performed 59 hepatic resections and 205 thermoablations through a laparoscopic approach, and they were then followed for similar follow-up (41.7 ± 31.5 months for laparoscopic hepatic resection vs. 38.7±32.3 for laparoscopic ablation therapy). Outcomes included short- and long-term morbidities, tumoral recurrence, and overall survival.

Results

Short-term morbidity was significantly higher in the resection group (but the two groups had similar rates for severe complications) while, during follow-up, recurrence was more frequent in patients treated with thermoablation, with a clear disadvantage in terms of survival. At multivariate analysis, only the type of surgical treatment was an independent predictor of disease recurrence, while plasmatic alpha-fetoprotein and Hb values, model for end-stage liver disease score, time to recurrence, and the type of surgical treatment were independent predictors of overall survival.

Conclusion

Our data ultimately support some therapeutic advantages for hepatic resection in patients with a single nodule and preserved liver function. However, thermoablation is an adequate alternative in patients with nodules that would require complex surgical resections or imply a poor prognosis that might therefore better tolerate a less invasive procedure.

Keywords

Hepatocellular carcinoma Hepatic surgical resection Radiofrequency ablation Liver cirrhosis 

Abbreviations

HCC

Hepatocellular carcinoma

LHR

Laparoscopic hepatic resection

LAT

Laparoscopic ablation therapy

HR

Hepatic resection

RFA

Radiofrequency ablation

MWA

Microwave ablation

BCLC

Barcelona Clinic Liver Cancer

Pts

Patients

LPT

Laparotomic

AFP

Alpha-fetoprotein

CT

Computed tomography

MRI

Magnetic resonance imaging

LUS

Laparoscopic ultrasound

IR

Interquartile range

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Roberto Santambrogio
    • 1
    • 2
  • Matteo Barabino
    • 1
  • Savino Bruno
    • 3
  • Nicolò Mariani
    • 1
  • Nirvana Maroni
    • 1
  • Emanuela Bertolini
    • 4
  • Giuseppe Franceschelli
    • 5
  • Enrico Opocher
    • 1
  1. 1.UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, ASST Santi Paolo e CarloUniversità di MilanoMilanItaly
  2. 2.ASST Santi Paolo e CarloMilanItaly
  3. 3.Humanitas University Medicine and Humanitas Research HospitalMilanItaly
  4. 4.UOC di Medicina VI, ASST Santi Paolo e CarloUniversità di MilanoMilanItaly
  5. 5.UOC di Radiologia Diagnostica ed Interventistica, ASST Santi Paolo e CarloUniversità di MilanoMilanItaly

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