Skip to main content

Advertisement

SpringerLink
Log in

Safety and efficacy of laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis

  • Original article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background: The optimal treatment for hepatocellular carcinoma (HCC) is surgical resection. However, only a small percentage of patients are operative candidates. Percutaneous radiofrequency interstitial thermal ablation (RITA) has been shown to be efficacious in the treatment of unresectable HCC. Recent advances in laparoscopic ultrasound have greatly improved the accuracy in detecting intrahepatic HCC nodules, many of which were missed by computed tomography. Our objective was to introduce a novel operative combination of laparoscopic ultrasound with laparoscopic RITA in the treatment of HCC. Methods: Eighty-eight patients with HCC in liver cirrhosis were submitted to laparoscopic RITA under sonographic guide. Most patients were in Child’s A class of liver function. Patients with large tumors (> 5 cm), portal vein thrombosis, or severe liver disease (Child’s C class) were excluded. Results: The laparoscopic RITA procedure was completed in 86 of 88 patients (98% feasibility rate). Laparoscopy with laparoscopic ultrasound identified 23 new malignant lesions (27%) in comparison with the results of preoperative imaging. A total of 127 lesions were treated by RITA. There was no operative mortality. Sixty-one patients had no complication (71%). After a mean follow-up of 14.3 ± 11.6 months, a complete response with a 100% necrosis was achieved in 70 of 83 patients examined (86%). During follow-up, 9 patients (11%) locally recurred at the RITA site and 38 patients (46%) had new malignant nodules. Conclusions: Laparoscopic RITA of HCC proved to be a safe and effective technique in the short term. This technique may be indicated when the percutaneous approach to the lesion is very difficult or if the patient is too ill to undergo laparotomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. D Azoulay M Johann JS Raccuia D Castaing H Bismuth (1996) ArticleTitle“Protected” double needle biopsy technique for hepatic tumors. J Am Coll Surg 183 160–163 Occurrence Handle1:STN:280:BymA38nlt1Y%3D Occurrence Handle8696549

    CAS  PubMed  Google Scholar 

  2. J Bruix M Sherman JM Llovet M Beaugrand R Lencioni AK Burroughs E Christensen L Pagliaro M Colombo J Rodes (2001) ArticleTitleClinical management of hepatocellular carcinoma. Conclusions of the Barcelona 2000 EASL conference. J Hepatol 35 421–430 Occurrence Handle10.1016/S0168-8278(01)00130-1 Occurrence Handle1:STN:280:DC%2BD3MrksFCmtg%3D%3D Occurrence Handle11592607

    Article  CAS  PubMed  Google Scholar 

  3. L Buscarini E Buscarini (2002) Radiofrequency thermal ablation of hepatocellular carcinoma. N Habib (Eds) Multi-treatment modalities of liver tumours. Kluwer Academic/Plenum New York 119–129

    Google Scholar 

  4. A Castells J Bruix C Bru J Fuster R Vilana M Navasa C Ayuso L Boix J Visa J Rodes (1993) ArticleTitleTreatment of small hepatocellular carcinoma in cirrhotic patients: a cohort study comparing surgical resection and percutaneous ethanol injection. Hepatology 18 1121–1126 Occurrence Handle1:STN:280:ByuD2c7hvFI%3D Occurrence Handle8225217

    CAS  PubMed  Google Scholar 

  5. KK Christians HA Pitt WS Rilling J Franco FA Quiroz MB Adams JR Wallace EJ Quebbeman (2001) ArticleTitleHepatocellular carcinoma: multimodality management. Surgery 130 554–560 Occurrence Handle10.1067/msy.2001.117106 Occurrence Handle1:STN:280:DC%2BD3Mrls1WitQ%3D%3D Occurrence Handle11602884

    Article  CAS  PubMed  Google Scholar 

  6. MH Chung TF Wood GJ Tsioulias DM Rose AJ Bilchik (2001) ArticleTitleLaparoscopic radiofrequency ablation of unresectable hepatic malignancies. A phase 2 trial. Surg Endosc 15 1020–1026 Occurrence Handle1:STN:280:DC%2BD3MrlvVCmsw%3D%3D Occurrence Handle11443478

    CAS  PubMed  Google Scholar 

  7. 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 230 1–8 Occurrence Handle10.1097/00000658-199907000-00001 Occurrence Handle1:STN:280:DyaK1MzisFKitA%3D%3D Occurrence Handle10400029

    Article  CAS  PubMed  Google Scholar 

  8. A Cuschieri J Bracken L Boni (1999) ArticleTitleInitial experience with laparoscopic ultrasound-guided radiofrequency thermal ablation of hepatic tumours. Endoscopy 31 318–321 Occurrence Handle10.1055/s-1999-16 Occurrence Handle1:STN:280:DyaK1Mzgt12msQ%3D%3D Occurrence Handle10376460

    Article  CAS  PubMed  Google Scholar 

  9. DE Dupuy SN Goldberg (200l) ArticleTitleImage-guided radiofrequency tumor ablation: challenges and opportunities—part II. J Vasc Interv Radiol 12 1135–1148

    Google Scholar 

  10. J Figueras E Jaurrieta C Valls E Ramos T Serrano A Rafecas J Fabregat J Torras (2000) ArticleTitleResection or transplantation for hepatocellular carcinoma in cirrhotic patients: outcomes based on indicated treatment strategy. J Am Coll Surg 190 566–573 Occurrence Handle10.1016/S1072-7515(00)00251-9

    Article  Google Scholar 

  11. A Foroutani AM Garland E Berber A String K Engle TL Ryan JM Pearl AE Siperstein (2000) ArticleTitleLaparoscopic ultrasound vs triphasic computed tomography for detecting liver tumors. Arch Surg 135 933–938 Occurrence Handle10.1001/archsurg.135.8.933 Occurrence Handle1:STN:280:DC%2BD3cvhs12rsA%3D%3D Occurrence Handle10922255

    Article  CAS  PubMed  Google Scholar 

  12. SN Goldberg JB Kruskal BS Oliver ME Clouse GS Gazelle (2000) ArticleTitlePercutaneous tumor ablation: increased coagulation by combining radio-frequency ablation and ethanol instillation in a rat breast tumor model. Radiology 217 827–831 Occurrence Handle1:STN:280:DC%2BD3M%2FotVOmtg%3D%3D Occurrence Handle11110950

    CAS  PubMed  Google Scholar 

  13. SN Goldberg L Solbiati PF Hahn E Cosman JE Conrad R Fogle GS Gazelle (1998) ArticleTitleLarge-volume tissue ablation with radiofrequency by using a clustered, internally cooled electrode technique: laboratory and clinical experience in liver metastases. Radiology 209 371–379 Occurrence Handle1:STN:280:DyaK1M%2FisVKqsQ%3D%3D Occurrence Handle9807561

    CAS  PubMed  Google Scholar 

  14. O Goletti R Lencioni N Armillotta A Puglisi PV Lippolis L Lorenzetti D Cioni B Musco C Bartolozzi E Cavina (2000) ArticleTitleLaparoscopic radiofrequency thermal ablation of hepatocarcinoma: preliminary experience. Surg Laparosc Endosc Percutan Tech 10 284–290 Occurrence Handle10.1097/00019509-200010000-00005 Occurrence Handle1:STN:280:DC%2BD3M7gtFGhsA%3D%3D Occurrence Handle11083210

    Article  CAS  PubMed  Google Scholar 

  15. DA Iannitti DE Dupuy (2001) Laparoscopic ablation of liver tumors. FL Greene BT Heniford (Eds) Minimally invasive cancer management. Springer-Verlag New York 183–199

    Google Scholar 

  16. K Ido N Isoda C Kawamoto M Hozumu T Suzuki N Nagamine Y Nakazawa K Ono N Hirota H Hyodoh K Kimura (1997) ArticleTitleLaparoscopic microwave coagulation therapy for solitary hepatocellular carcinoma performed under laparoscopic ultrasonography. Gastrointest Endosc 45 415–420 Occurrence Handle1:STN:280:ByiA3cfhtVQ%3D Occurrence Handle9165326

    CAS  PubMed  Google Scholar 

  17. M Ikeda S Okada H Ueno T Okusaka H Kuriyama (2001) ArticleTitleRadiofrequency ablation and percutaneous ethanol injection in patients with small hepatocellular carcinoma: a comparative study. Jpn J Clin Oncol 31 322–326 Occurrence Handle10.1093/jjco/hye063 Occurrence Handle1:STN:280:DC%2BD3MvnsFWgsA%3D%3D Occurrence Handle11518745

    Article  CAS  PubMed  Google Scholar 

  18. T Ishikawa T Kohno T Shibayama Y Fukushima S Obi T Teratani S Shiina Y Shiratori M Omata (2001) ArticleTitleThoracoscopic thermal ablation therapy for hepatocellular carcinoma located beneath the diaphragm. Endoscopy 33 697–702 Occurrence Handle10.1055/s-2001-16216 Occurrence Handle1:STN:280:DC%2BD3MvktlCgsA%3D%3D Occurrence Handle11490387

    Article  CAS  PubMed  Google Scholar 

  19. J Jakimowicz G Stultines F Smulders (1998) ArticleTitleLaparoscopic insufflation in the abdomen reduces portal venous flow. Surg Endosc 12 129–132 Occurrence Handle10.1007/s004649900612 Occurrence Handle1:STN:280:DyaK1c7ktVemsQ%3D%3D Occurrence Handle9479726

    Article  CAS  PubMed  Google Scholar 

  20. T Kumada S Nakano I Takeda K Sugiyama T Osada S Kiriyama Y Sone H Toyoda S Shimada M Takahashi T Sassa (1997) ArticleTitlePatterns of recurrence after initial treatment in patients with small hepatocellular carcinoma. Hepatology 25 87–92 Occurrence Handle1:STN:280:ByiC3sfisVA%3D Occurrence Handle8985270

    CAS  PubMed  Google Scholar 

  21. R Lencioni D Cioni C Bartolozzi (2001) ArticleTitlePercutaneous radiofrequency thermal ablation of liver malignancies: techniques, indications, imaging findings, and clinical results. Abdom Imaging 26 345–360 Occurrence Handle10.1007/s002610000194 Occurrence Handle1:STN:280:DC%2BD38%2FhvVShsQ%3D%3D Occurrence Handle11441546

    Article  CAS  PubMed  Google Scholar 

  22. E Lezoche AM Paganini F Feliciotti M Guerrieri F Lugnani A Tamburini (1998) ArticleTitleUltrasound-guided laparoscopic cryoablation of hepatic tumors: preliminary report. World J Surg 22 829–836 Occurrence Handle10.1007/s002689900478 Occurrence Handle1:STN:280:DyaK1czjvVensQ%3D%3D Occurrence Handle9673555

    Article  CAS  PubMed  Google Scholar 

  23. HK Lim D Choi WJ Lee SH Kim SJ Lee HJ Jang JH Lee JH Lim IW Choo (2001) ArticleTitleHepatocellular carcinoma treated with percutaneous radio-frequency ablation: evaluation with follow-up multiphase helical CT. Radiology 221 447–454 Occurrence Handle11687689

    PubMed  Google Scholar 

  24. T Livraghi L Bolondi L Buscarini M Cottone A Mazziotti A Morabito G Torzilli (1995) ArticleTitleNo treatment, resection, and ethanol injection in hepatocellular carcinoma: a retrospective analysis of survival in 391 patients with cirrhosis. J Hepatol 22 522–526 Occurrence Handle10.1016/0168-8278(95)80445-5 Occurrence Handle1:STN:280:ByqA2sfmtFA%3D Occurrence Handle7650331

    Article  CAS  PubMed  Google Scholar 

  25. T Livraghi A Giorgio G Marin A Salmi I De Sio L Bolondi M Pompili F Brunello S Lazzaroni G Torzilli A Zucchi (1995) ArticleTitleHepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology 197 101–108 Occurrence Handle1:STN:280:BymD38zhtlU%3D Occurrence Handle7568806

    CAS  PubMed  Google Scholar 

  26. T Livraghi SN Goldberg S Lazzaroni F Meloni T Ierace L Solbiati GS Gazelle (2000) ArticleTitleHepatocellular carcinoma: radiofrequency ablation of medium and large lesions. Radiology 214 761–768 Occurrence Handle10715043

    PubMed  Google Scholar 

  27. JM Llovet J Fuster J Bruix (1999) ArticleTitleIntention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 30 1433–1440

    Google Scholar 

  28. CM Lo ECS Lai CL Liu ST Fan J Wong (1998) ArticleTitleLaparoscopy and laparoscopic ultrasonography avoid exploratory laparotomy in patients with hepatocellular carcinoma. Ann Surg 227 527–532 Occurrence Handle10.1097/00000658-199804000-00013 Occurrence Handle1:STN:280:DyaK1c3itlSjtw%3D%3D Occurrence Handle9563541

    Article  CAS  PubMed  Google Scholar 

  29. J Machi (1999) ArticleTitleIntraoperative and laparoscopic ultrasound. Surg Oncol Clin North Am 8 205–226 Occurrence Handle1:STN:280:DyaK1M%2Fkt1WntQ%3D%3D

    CAS  Google Scholar 

  30. M Makuuchi K Takayasu N Moriyama (1987) Diagnostic significance of intraoperative ultrasonography. M Makuuchi (Eds) Abdominal intraoperative ultrasonography. Igaku-Shoin Tokyo 54–88

    Google Scholar 

  31. M Montorsi R Santambrogio (2002) Laparoscopic radiofrequency thermal ablation of hepatocellular carcinoma in patients with liver cirrhosis. N Habib (Eds) Multi-treatment modalities of liver tumours. Kluwer Academic/Plenum New York 131–146

    Google Scholar 

  32. M Montorsi R Santambrogio P Bianchi G Dapri A Spinelli M Podda (2002) ArticleTitlePerspectives and drawbacks of minimally invasive surgery for hepatocellular carcinoma. Hepato-Gastroenterology 49 56–61 Occurrence Handle11941985

    PubMed  Google Scholar 

  33. M Montorsi R Santambrogio P Bianchi E Opocher B Tagliaferri M Zuin E Bertolini M Podda (2001) ArticleTitleRadiofrequency interstitial thermal ablation (RITA) of hepatocellular carcinoma (HCC) in liver cirrhosis: role of the laparoscopic approach. Surg Endosc 15 141–145 Occurrence Handle10.1007/s004640000242 Occurrence Handle1:STN:280:DC%2BD3Mvit1GhtA%3D%3D Occurrence Handle11285956

    Article  CAS  PubMed  Google Scholar 

  34. YD Podnos G Henry JA Ortiz P Ji J Cooke S Cao DK Imagawa (2001) ArticleTitleLaparoscopic ultrasound with radiofrequency ablation in cirrhotic patients with hepatocellular carcinoma: technique and technical considerations. Am Surg 67 1181–1184 Occurrence Handle1:STN:280:DC%2BD38%2FktlentA%3D%3D Occurrence Handle11768826

    CAS  PubMed  Google Scholar 

  35. R Santambrogio P Bianchi E Opocher A Mantovani L Schubert F Ghelma M Panzera M Verga GP Spina (1996) ArticleTitleIntraoperative ultrasonography (IOUS) during laparoscopic cholecystectomy. Surg Endosc 10 622–627 Occurrence Handle10.1007/s004649900114 Occurrence Handle1:STN:280:BymB2s%2Fit1Y%3D Occurrence Handle8662399

    Article  CAS  PubMed  Google Scholar 

  36. R Santambrogio P Bianchi A Pasta A Palmisano M Montorsi (2002) ArticleTitleUltrasound-guided interventional procedures for the liver during laparoscopy. Technical considerations. Surg Endosc 16 349–354 Occurrence Handle10.1007/s004640090082 Occurrence Handle1:STN:280:DC%2BD383jtVajug%3D%3D

    Article  CAS  Google Scholar 

  37. S Seki H Sakaguchi H Kadoya H Morikawa D Habu S Nishiguchi S Shiomi T Kitada T Kuroki (2000) ArticleTitleLaparoscopic microwave coagulation therapy for hepatocellular carcinoma. Endoscopy 32 591–597 Occurrence Handle10.1055/s-2000-9014 Occurrence Handle1:STN:280:DC%2BD3M%2Fot1antQ%3D%3D Occurrence Handle10935786

    Article  CAS  PubMed  Google Scholar 

  38. A Siperstein A Garland K Engle S Rogers E Berber A String A Foroutani T Ryan (2000) ArticleTitleLaparoscopic radiofrequency ablation of primary and metastatic liver tumors. Technical considerations. Surg Endosc 14 400–405

    Google Scholar 

  39. VR Tandan M Asch M Margolis A Page S Gallinger (1997) ArticleTitleLaparoscopic vs open intraoperative ultrasound examination of the liver: a controlled study. J Gastrointest Surg 1 146–151 Occurrence Handle10.1016/S1091-255X(97)80102-3 Occurrence Handle9834341

    Article  PubMed  Google Scholar 

  40. T Yamasaki F Kurokawa H Shirahashi N Kusano K Hironaka K Okita (2001) ArticleTitlePercutaneous radiofrequency ablation therapy with combined angiography and computed tomography assistance for patients with hepatocellular carcinoma. Cancer 91 1342–1348 Occurrence Handle10.1002/1097-0142(20010401)91:7<1342::AID-CNCR1137>3.0.CO;2-0 Occurrence Handle1:STN:280:DC%2BD3M3js1ygtw%3D%3D Occurrence Handle11283935

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was partially supported by a grant from Unità di Ricerca FIRC “Prevenzione, diagnosi e terapia del carcinoma epatico.”

Author information

Authors and Affiliations

  1. Unità di Chirurgia Epato-biliare, Dipartimento di Medicina e Chirurgia San Paolo, Università degli Studi di Milano, Via A. di Rudinì 8, Italy

    R. Santambrogio, M. Costa & M. Montorsi

  2. Cattedra di Medicina Interna, Dipartimento di Medicina e Chirurgia San Paolo, Università degli Studi di Milano, Via A. di Rudinì 8, Italy

    M. Podda, M. Zuin, E. Bertolini & S. Bruno

  3. Unità of Radiologia Diagnostica Interventistica, Dipartimento di Medicina e Chirurgia San Paolo, Università degli Studi di Milano, Via A. di Rudinì 8, Italy

    G. P. Cornalba

Authors
  1. R. Santambrogio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Podda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Zuin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Bertolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Bruno
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. P. Cornalba
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. Montorsi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Santambrogio.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Santambrogio, R., Podda, M., Zuin, M. et al. Safety and efficacy of laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis . Surg Endosc 17, 1826–1832 (2003). https://doi.org/10.1007/s00464-002-8960-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-002-8960-1

Keywords

Search

Navigation