Risk of intra-abdominal seeding after laparoscopic-assisted thermal ablation of exophytic hepatocellular carcinoma tumors

• Published in: Surgical endoscopy Vol. 36; no. 10; pp. 7569 - 7576
• Main Authors: Garbarine, Ian C., Gerber, David A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2022; Springer Nature B.V
• Subjects: Abdomen; Abdominal Cavity - pathology; Abdominal Surgery; Ablation; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Catheter Ablation - adverse effects; Cohort Studies; Gastroenterology; Gynecology; Hepatology; Humans; Laparoscopy; Laparoscopy - adverse effects; Liver cancer; Liver Neoplasms - pathology; Medicine; Medicine & Public Health; Proctology; Surgery; Treatment Outcome; Tumors; Intra-abdominal seeding; Hepatocellular carcinoma; Exophytic; Laparoscopic-assisted; Ablation; Dissemination
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-022-09192-z

Background Laparoscopic-assisted thermal ablation has been used successfully to treat early hepatocellular carcinoma (HCC) tumors, defined as < 3 cm in diameter. This approach allows for ablation of tumors located in areas of the liver that are otherwise inaccessible for a percutaneous approach. Thermal ablation of exophytic tumors remains controversial due to a reported increased risk of tumor seeding of the abdominal cavity and incomplete ablation. Methods This cohort study consisted of 663 HCC tumors treated with thermal ablation at a single, quaternary academic medical center between 2/2001 and 1/2021. Post treatment, patients were followed at a defined interval schedule beginning at one month post treatment, then every 3 months for 2 years, every 6 months in year 3, followed by yearly studies. Patients’ medical records were reviewed for three years post ablation for evidence of complete ablation and intra-abdominal dissemination of disease. Results 326 patient records met the inclusion criteria. Comparing the exophytic and non-exophytic groups, there were statistically significant differences in etiology of liver disease ( p  = 0.048) and TNM stage ( p  = 0.03), as well as a higher rate of incomplete ablation in the non-exophytic group (10.2% vs 3.3%; p  = 0.045). Otherwise, there were no statistically significant differences in baseline characteristics, tumor characteristics, or use of thermal ablation technology. Rates of intra-abdominal dissemination of HCC were low in both groups: 1.1% ( n  = 1) in the exophytic group and 1.7% ( n  = 4) in the non-exophytic group. There was no significant difference in intra-abdominal dissemination of HCC between the groups ( p  > 0.99, RR = 0.66; 95% CI 0.07–5.79). Additionally, no differences were seen in dissemination between microwave ablation and radiofrequency ablation ( p  > 0.99). Conclusion This study demonstrates that laparoscopic-assisted thermal ablation of small, exophytic tumors is safe and does not increase the risk for disseminated intra-abdominal HCC disease.