CT-guided versus laparoscopic radiofrequency ablation in recurrent small hepatocellular carcinoma against the diaphragmatic dome

Huaiyin Ding,Qin Zheng,Chuandong Zhu,Mu Su,Lixue Wang,Yuan Wan

doi:10.1038/srep44583

Huaiyin Ding, Qin Zheng + Show 4 more

Open Access

https://doi.org/10.1038/srep44583

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Journal: Scientific Reports	Publication Date: Mar 14, 2017
Citations: 18	License type: open-access

Affiliation: Southeast University

Abstract

Computed tomography-guided radiofrequency ablation (CT-RFA) and laparoscopic RFA (L-RFA) have been used to treat intrahepatic recurrent small hepatocellular carcinoma (HCC) against the diaphragmatic dome. However, the therapeutic safety, efficacy, and hospital fee have never been compared between the two techniques due to scarcity of cases. In this retrospective study, 116 patients were divided into two groups with a total of 151 local recurrent HCC lesions abutting the diaphragm. We compared overall survival (OS), local tumor progression (LTP), postoperative complications, and hospital stay and fee between the two groups. Our findings revealed no significant differences in 5-year OS (36.7% vs. 44.6%, p = 0.4289) or 5-year LTP (73.3% vs. 67.9%, p = 0.8897) between CT-RFA and L-RFA. The overall hospital stay (2.8 days vs. 4.1 days, p < 0.0001) and cost (¥ 19217.6 vs. ¥ 25553.6, p < 0.0001) were significantly lower in the CT-RFA in comparison to that of L-RFA. In addition, we elaborated on the choice of percutaneous puncture paths depending on the locations of the HCC nodules and 11-year experience with CT-RFA. In conclusion, CT-RFA is a relatively easy and economic technique for recurrent small HCC abutting the diaphragm, and both CT-RFA and L-RFA are effective techniques.

Highlights

Convenient, less expensive, and minimally invasive; it may encounter shortcomings, such as partial visibility of the tumor, a poor electrode path, and a high risk of collateral thermal damage to the diaphragm[19]
A comparison of recurrent Hepatocellular carcinoma (HCC) against the diaphragmatic dome revealed no significant differences between the computed tomography (CT)-radiofrequency ablation (RFA) and L-RFA groups
This study aimed to provide information that would contribute to the creation of evidence-based guidelines for the referral of patients with non-resectable recurrent HCC in the subphrenic area

Summary

Introduction

Convenient, less expensive, and minimally invasive; it may encounter shortcomings, such as partial visibility of the tumor, a poor electrode path, and a high risk of collateral thermal damage to the diaphragm[19]. L-RFA carries the risk of major comorbidities due to general anesthesia, bowel injury, and hepatic decompensation in patients with cirrhosis[21]. These two approaches show differentiated therapeutic efficacy and safety in HCC. The therapeutic safety and efficacy of image-guided RFA and L-RFA for recurrent small HCC located under the diaphragm have not been compared. We compared postoperative major and minor complications, overall hospital cost, five-year overall survival rate (OS), and rate of five-year local tumor progression (LTP) between CT-RFA and L-RFA for HCC located under the diaphragm within a single institution. CT-RFA is an easy, effective and economic approach for recurrent small HCC abutting the diaphragm

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