Radiofrequency interstitial thermal ablation of hepatocellular carcinoma in liver cirrhosis - Role of the laparoscopic approach

Background: The laparoscopic approach to radiofrequency interstitial therma l ablation (RITA) of hepatocellular carcinoma (HCC) with intraoperative ult rasound guidance has been proposed with the aim of obtaining additional inf ormation for a better neoplastic staging and a complete and effective treat ment of the liver lesions in patients with a difficult percutaneous approac h. Methods: In this pilot study, 29 patients with HCC in Liver cirrhosis were submitted to laparoscopic RITA under sonographic guide. Most of these patie nts 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) w ere excluded from the study. Results: The laparoscopic RITA procedure was completed in 27 of 29 patients (93% feasibility rate). The laparoscopic ultrasound examination identified new malignant liver nodules in five patients (18.5%). A total of 44 lesion s were treated. The mean operative time was 75.8 +/- 20.5 min (range, 45-12 0 min), and the mean RITA time was 18 +/- 10 min (range, 10-56 min). There was no operative mortality, and postoperative morbidity was low (four cases ) without any mortality. A complete tumor necrosis was observed in 90% of t he patients via spiral computed tomography (CT) 1 month after treatment. Conclusions: Laparoscopic RITA of hepatocellular carcinoma proved to be a s afe and effective technique, at least in the short term. Its role in the tr eatment of HCC needs to be defined in larger series.