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Langenbeck's Archives of Surgery

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01-01-2013 | Original Article

The laparoscopic approach for radiofrequency ablation of hepatocellular carcinoma—indication, technique and results

Authors: Till Herbold, Roger Wahba, Christopher Bangard, Münevver Demir, Uta Drebber, Dirk L. Stippel

Published in: Langenbeck's Archives of Surgery | Issue 1/2013

Abstract

Background

The therapeutic regimen for patients suffering of HCC in liver cirrhosis must pay attention to the underlying liver disease. Surgical resection is often limited by liver function and transplantation, as an optimal therapy for many early diagnosed HCC, by the availability of organs. Due to three prospective, randomized trials radiofrequency ablation (RFA) is the standard method of local ablation. RFA compared with resection for HCC in liver cirrhosis yields similar results concerning overall survival but a lower rate of complications. The laparoscopic approach may be advantageous concerning the major drawback of RFA which is still the rate of local failure as shown by a meta-analysis of local recurrences.

Method

Indication for RFA was HCC in liver cirrhosis either as a definite therapy or as a bridging procedure for transplantation if the expected waiting time exceeded 6 months. Laparoscopic ultrasound, standardized algorithm of laparoscopic RFA procedure, track ablation and a Trucut biopsy were performed. The postoperative follow-up was done according to institutional standards. Patient data and parameters of laparoscopic RFA were prospectively documented, analyzed and compared with the results of previously published series found in a Medline search.

Results

34 patients were treated by laparoscopic RFA. The average time of follow-up was 36.9 ± 28.3 months. There was no procedure-related mortality or surgical complications. An upstaging of the tumor stage by laparoscopic ultrasound was achieved in 32 % of the patients. The overall survival of these patients was 44.7 ± 6.9 months. The intrahepatic recurrence rate was 61.8 % based on the number of patients treated. The results have been analyzed and compared with six independent papers identified in a Medline search that report on the treatment of patients with HCC in a liver cirrhosis by laparoscopic RFA with a mean follow-up of 12 or more months.

Conclusions

Laparoscopic RFA is a feasible and reliable therapy for unresectable HCCs in patients with cirrhosis. The laparoscopic RFA combines the advantage of a minimally invasive procedure concerning liver dysfunction with the ability of an accurate intraoperative staging by laparoscopic ultrasound.

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Title: The laparoscopic approach for radiofrequency ablation of hepatocellular carcinoma—indication, technique and results
Authors: Till Herbold
Roger Wahba
Christopher Bangard
Münevver Demir
Uta Drebber
Dirk L. Stippel
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 1/2013
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-012-1018-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The laparoscopic approach for radiofrequency ablation of hepatocellular carcinoma—indication, technique and results

Abstract

Background

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusions

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