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Successful treatment of hepatocellular carcinoma by laparoscopic radiofrequency ablation in a patient with hemophilia A

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Abstract

Percutaneous radiofrequency ablation (RFA) is a good indication for hepatocellular carcinoma (HCC) in cases involving ≦ 3 tumors of ≦ 30 mm in size, many hepatologists are hesitant to perform the procedure for patients with hemorrhagic disorders. We herein report the successful treatment of HCC by laparoscopic RFA in a patient with hemophilia A. A 48-year-old man with moderate form of hemophilia A had a single HCC at segment 8. To perform laparoscopic RFA safely, recombinant factor VIII (rFVIII) was administered to maintain factor VIII activity (FVIII:C) > 80% on the operation day and > 40% for 6 days after the operation in accordance with the guidelines. A total of 23,000 units of rFVIII was used. Laparoscopic RFA was completed with an operation time of 105 min and < 10 mL of blood loss. As a result, blood transfusion was not required. At 2 years after the initial treatment, HCC recurred at segment 7. Under rFVIII supplementation, we performed a second laparoscopic RFA without any events. Although partial hepatectomy is the main procedure used to treat HCC in patients with hemophilia, we could reduce in total use of rFVIII, blood and operation time by laparoscopic RFA compared with those in partial hepatectomy.

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References

  1. Darby SC, Ewart DW, Giangrande PLF, et al. Mortality from liver cancer and liver disease in haemophilic men and boys in UK given blood products contaminated with hepatitis C. Lancet. 1997;350:1425–31.

    Article  CAS  Google Scholar 

  2. Xu Q, Kobayashi S, Ye X, et al. Comparison of hepatic resection and radiofrequency ablation for small hepatocellular carcinoma: a meta-analysis of 16,103 patients. Sci Rep. 2014;4:1–9.

    Article  CAS  Google Scholar 

  3. Meijer K, Haagsma EB. HCV-related liver cancer in people with haemophilia. Haemophilia. 2012;18:17–24.

    Article  CAS  Google Scholar 

  4. Morimoto N, Isoda N, Takaoka Y, et al. Short-term results of laparoscopic radiofrequency ablation using a multipolar system for localized hepatocellular carcinoma. Liver Cancer. 2017;6:137–45.

    Article  Google Scholar 

  5. Takaoka Y, Morimoto N, Miura K, et al. A successful treatment for hepatocellular carcinoma with Osler–Rendu–Weber disease using radiofrequency ablation under laparoscopy. Clin J Gastroenterol. 2018;11:501–6.

    Article  Google Scholar 

  6. Yanabu N, Mori K, Wada Y, et al. Hepatic resection in a patient with hemophilia A—a protocol for supplementation of factor VIII concentrate. Jpn J Gastroenterol Surg. 1993;26:2832–5.

    Article  Google Scholar 

  7. Dzik WH, Laposata M, Hertl M, Sandberg WS, Chatterji M, Misdraji J. Case 38-2008: a 58-year-old man with hemophilia, hepatocellular carcinoma, and intractable bleeding. N Engl J Med. 2008;359:2587–97.

    Article  CAS  Google Scholar 

  8. Morimoto N, Isoda N, Watanabe S, et al. Evaluation of bleeding from needle tract in laparoscopic bipolar radiofrequency ablation. Kanzo. 2015;56:306–8.

    Article  Google Scholar 

  9. Minami Y, Hayaishi S, Kudo M. Radiofrequency ablation for hepatic malignancies: is needle tract cauterization necessary for preventing iatrogenic bleeding? Dig Dis. 2013;31:480–4.

    Article  Google Scholar 

  10. Takamatsu J, Kamiya T, Saito H. Successful resection of hepatocellular carcinoma found in a patient with anti-HCV antibody positive hemophilia A. Japanese Journal of Transfusion Medicine. 1992;38:548–53.

    Google Scholar 

  11. Shen SC, Harada A, Kurokawa T, et al. Partial hepatectomy for hepatocellular carcinoma in a patient with hemophilia: a case report. Hepatogastroenterology. 1994;41:283–6.

    CAS  Google Scholar 

  12. Kawashima K, Ishiyama S, Narushima Y, et al. A case of hepatocellular carcinoma in a patient with hemophilia A associated with human immunodeficiency virus infection. J Jpn Surg Assoc. 2005;64:421–5.

    Article  Google Scholar 

  13. Narushima Y, Ishiyama S, Kawashima K, et al. Operated hepatocellular carcinoma in two HIV- and HCV-positive hemophilic patients. J Hepatobiliary Pancreat Surg. 2004;11:207–10.

    Article  Google Scholar 

  14. Koga C, Shirabe K, Nagaie T. Partial hepatectomy in a patient with hemophilia a under supplementation of factor VIII concentrate: a case report. J Jpn College Surg. 2008;33:648–52.

    Article  Google Scholar 

  15. Jones AE, Roy A, Armstrong T, et al. Successful liver surgery in a haemophilia patient with high titre factor VIII inhibitor. Haemophilia. 2009;15:1332–3.

    Article  CAS  Google Scholar 

  16. Uchino K, Tateishi R, Nakagawa H, et al. Uninodular combined hepatocellular and cholangiocarcinoma with multiple non-neoplastic hypervascular lesions appearing in the liver of a patient with HIV and HCV coinfection. J Clin Virol. 2013;57:173–7.

    Article  Google Scholar 

  17. Inokawa Y, Sugimoto H, Kanda M, et al. Hepatectomy for hepatocellular carcinoma in patients with hemophilia. J Hepatobiliary Pancreat Sci. 2014;21:824–8.

    Article  Google Scholar 

  18. Kobayashi K, Kokudo T, Yamaguchi T, et al. Hepatectomy in patients with inherited blood coagulation disorders can be safely performed with adequate coagulation factor replacement. Haemophilia. 2019;25:463–7.

    Article  CAS  Google Scholar 

  19. Tan HY, Gong JF, Yu F, et al. Long-term efficacy of laparoscopic radiofrequency ablation in early hepatocellular carcinoma: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A. 2019;29:770–9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shomotsuke, Tochigi, 329-0498, Japan

    Kouichi Miura, Hiroshi Maeda & Naoto Sato

  2. Department of Biochemistry, Jichi Medical University, Shimotsuke, Tochigi, Japan

    Tsukasa Ohmori

Authors
  1. Rie Goka
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  2. Naoki Morimoto
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  3. Kouichi Miura
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  4. Shunji Watanabe
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  5. Yoshinari Takaoka
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  6. Hiroaki Nomoto
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  7. Mamiko Tsukui
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  8. Takeshi Fujieda
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  9. Hiroshi Maeda
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  10. Naoto Sato
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  11. Tsukasa Ohmori
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  12. Norio Isoda
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  13. Hironori Yamamoto
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Corresponding author

Correspondence to Kouichi Miura.

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Conflict of interest

Tsukasa Ohmori received research supports from Mitsubishi-Tanabe and lecture fees from Novonordisk pharma. Both fees are outside of the study. Other authors (Rie Goka, Naoki Morimoto, Kouichi Miura, Shunji Watanabe, Yoshinari Takaoka, Hiroaki Nomoto, Mamiko Tsukui, Takeshi Fujieda, Hiroshi Maeda, Naoto Sato, Norio Isoda, Hironori Yamamoto) have no conflict of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from the patient for being included in the study.

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Goka, R., Morimoto, N., Miura, K. et al. Successful treatment of hepatocellular carcinoma by laparoscopic radiofrequency ablation in a patient with hemophilia A. Clin J Gastroenterol 13, 907–913 (2020). https://doi.org/10.1007/s12328-020-01133-4

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  • DOI: https://doi.org/10.1007/s12328-020-01133-4

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