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Laparoscopic Ultrasound–Guided versus Percutaneous Radiofrequency Ablation in Treatment of Unresectable HCC
World Journal of Laparoscopic Surgery, September-December 2008;1(3):1-12
Laparoscopic Ultrasound–Guided versus

Percutaneous Radiofrequency Ablation in

Treatment of Unresectable Hepatocellular

Carcinoma

Sherif Z Kotb, Tamer F Yousef, Yaser M Foda
Department of Surgical Oncology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

Abstract Radiofrequency ablation (RFA) has both a curative and
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palliative role in treatment of solid tumours. It is a safe and
Objective: The purpose of this study was to compare laparoscopic
ultrasound–guided radiofrequency ablation (LUSRFA) versus effective treatment modality to achieve tumour destruction in
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percutaneous radiofrequency ablation (PRFA) in treatment of localized patients with unresctable hepatic malignancies. Although
hepatocellular carcinoma (HCC). the RFA can be performed via either laparotomy or percuta-
neously, there is some data focusing on laparoscopic approach. 9
Methods: From January 2005 through April 2008, for 60 consecutive The main aim of thermal tumour ablation therapy is to destroy
patients, who were diagnosed with localized primary liver cancer and

underwent percutaneous RFA (n = 30) or laparoscopic ultrasound the entire tumour by using heat to kill malignant cells without

guided radiofrequency ablation (n = 30) at our institution. RFA was damaging adjacent vital structures, with 0.5-1 cm safety margin

evaluated prospectively intra- and postoperatively (1, 6, 12, 18 and of apparently healthy tissue adjacent to the lesion. 10
24 months after surgery). The aim of the study was to evaluate laparoscopic ultra-
sound guided RFA comparing with percutaneous RFA in
Results: Intra and postoperative complications were significantly lower treatment of localized HCC in patients not candidate for hepatic

in the LUSRFA group than in the PRFA group. The Hospital stay,
intraoperative complications, early and late postoperative resection.

complications were significantly reduced with LUSRFA. However,

there was insignificant decrease in tumour volume in both groups. PATIENTS AND METHODS
Furthermore, Local recurrence and distant metastases in the LUSRFA From January 2005 to April 2008, the medical records of 63

group showed a significant decrease during follow-up periods.
patients with localized HCC requiring RFA at Oncology Center

Conclusion: LUSRFA could be a valuable alternative treatment for Mansoura University (OCMU), in Egypt, were reviewed. All

selected patients withlocalized unresectable hepatic malignancies. patients were self-referred and consisted of PRFA group
Keywords: Radiofrequency; primary liver tumor; local ablation of (n = 30) and LUSRFA group (n = 33). Patient selection for LURIA
liver malignancy; laparoscopic radiofrequency. was made preoperatively on the basis of history, physical, and
radiological diagnostic evidence of localized HCC, three patients
INTRODUCTION were referred to other facilities, as they were not candidate for
RFA as it invade important pedicle as detected by IOUS and
Hepatocellular carcinoma (HCC) is one of the most common thus excluded from the study. Thus, each group was of 30
solid tumours in the world with, at least, one million new cases patients.
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per year. The majority of patients with hepatic cancer have
irresectable disease at the time of presentation. 2 Inclusion Criteria
Locoregional therapy has become the focus of interest in
recent years, hence if the disease is confined completely or All the cases of HCC included in the study were considered
largely to the liver, local tumour ablative therapies can be unresectable due to bilobar location of tumours (n = 2), or
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performed, with good local control of the disease. Local ablative reduced functional hepatic reserve (n = 58), in a site suitable for
therapies include: ethanol injection; acetic acid injection; the laparoscopic approach (n = 33), with patent portal vein, and
cryotherapy ablation; microwave coagulation; laser therapy; away from a large main blood vessel or main biliary duct. With
and radiofrequency thermal ablation. 4,5 no evidence of extrahepatic disease, vascular or biliary invasion,

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