Radio-Frequency Ablation in Cirrhotic Patients with Hepatocellular Carcinoma

• Published in: The American surgeon Vol. 69; no. 12; pp. 1067 - 1071
• Main Authors: Arch-Ferrer, J.E., Smith, J.K., Bynon, S., Eckhoff, D.E., Sellers, M.T., Bland, K.I., Heslin, M.J.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.12.2003; Southeastern Surgical Congress; SAGE PUBLICATIONS, INC
• Subjects: Adult; Aged; Biological and medical sciences; Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - surgery; Catheter Ablation; Clinical outcomes; Diseases of the digestive system; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver cirrhosis; Liver Cirrhosis - complications; Liver Neoplasms - complications; Liver Neoplasms - mortality; Liver Neoplasms - surgery; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Medical treatment; Middle Aged; Radio frequency; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Surgery; Tumors; Human; Performance evaluation; Statistical analysis; Treatment efficiency; Hepatic disease; Hepatocellular carcinoma; Malignant tumor; Radiofrequency; Cirrhosis; Symptomatology; Concomitant disease; Treatment; Digestive diseases; Adult; Application method; Technique; Survival curve; Comparative study
• DOI: 10.1177/000313480306901209
• ISSN: 0003-1348

Current surgical treatments for hepatocellular carcinoma (HCC) include radio-frequency ablation (RFA), resection, and orthotropic liver transplant (OLT). RFA is particularly attractive in these high-risk patients because surgery is associated with high mortality and there is a relative scarcity of organs available for those in need of transplants. This study was performed to evaluate the management of cirrhotic patients with HCC undergoing RFA at a single Western institution. A retrospective study from March 1999 to June 2002 was performed to evaluate the clinicopathologic and treatment-related variables in cirrhotic patients with HCC. Forty-nine lesions in 26 patients with HCC and cirrhosis underwent RFA. Data was analyzed for safety and overall survival as the main endpoints. The mean age was 60.4 ± 11 years, 19 patients were male, 5 had hepatitis B virus, and 19 had hepatitis C virus. The Child classification was 26 per cent, 39 per cent, and 35 per cent for A, B, and C; the number of lesions was 1 in 62 per cent, 2 in 23 per cent, and more than 2 in 15 per cent. The approach was laparoscopic in 58 per cent, percutaneous in 15 per cent, and open in 27 per cent. There were no mortalities and only 1 complication. Average hospital stay was 2.7 ± 2 days. Subsequent to RFA, 9 patients underwent an OLT within a median of 4.1 months. The median follow-up of the whole group was 13 months and the disease-free survival 9.3 months. Tumor recurrence was identified in 3 previously ablated lesions, nonablated liver in 11, and as pulmonary metastases in 3. Overall survival (P = 0.03) was prolonged for those treated with RFA + OLT over RFA alone. We conclude that RFA is a safe ablative technique in high-risk cirrhotic patients with HCC. This technique may provide a bridge to OLT; however, it remains to be proven whether it prolongs survival in those who do not undergo OLT.