Laparoscopic Ultrasound with Radiofrequency Ablation of Hepatic Tumors in Cirrhotic Patients

National Liver Institute, Monouphyia University, Shibin El kom, Egypt.

Abstract

Background: The optimal treatment for hepatocellular carcinoma (HCC) is surgical resection. However, only a small percentage of patients are operative candidates due to associated liver cirrhosis. Recent advances in laparoscopic ultrasound and Laparoscopy have greatly improved the accuracy in detecting intrahepatic tumors nodules, many of which were missed by preoperative imaging modality.
Objective: our objective is to evaluate the safety and efficacy of laparoscopic Radiofrequency Ablation (RFA) guided with laparoscopic ultrasound in detecting and treatment of liver tumors in patient with liver cirrhosis.
Methods: 72 patients with liver tumors (58 HCC, 9 metastatic Aden carcinoma, 2 neoendocrine metastasis, 3 other metastasis) were submitted to laparoscopic RFA under laparoscopic ultrasound guidance. Child A class of liver functions in 44 patients (61.1%) and 28 patients Child B (38.9%). Patients with large tumor (>8 cm), portal vein thrombosis, or Child C Class were excluded from the study.
Results: Laparoscopic Radiofrequency ablation procedures were completed in all patients without any conversion rate. Laparoscopic ultrasound identified 19 new malignant lesions (18.4%) in comparison with the result of preoperative imaging. A total of 103 Lesions were treated by RFA (45 patients had one lesion, 23 patient had 2 lesions and 4 patients had 3 lesions) There was no mortality. Morbidity occurred in 4 patients (5.5%) 2 patients had liver abscesses, one patient had pleural effusion and one patient had postoperative bleeding necessitate blood transfusion and surgery. After a mean follow up of 14.3+/- 11.6 months, a complete response with 100% necrosis was archived in 69 of 72 patients examined (95.8%). 3 patients (4.1%) locally recurred at the RFA side and 7patients (9.7%) had of new malignant nodules.
Conclusion: laparoscopic RFA guided with laparoscopic ultrasound is an excellent use of existing technology in improvement of safety and efficacy of detection and treatment of intrahepatic tumors in patients with liver cirrhosis.
Key Word: Laparoscopy- Radiofrequency Ablation (RFA) – Liver tumors.

Session: Poster of Distinction

Program Number: P008