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Original Article

Laparoscopic radiofrequency ablation for hepatocellular
Laparoscopic radiofrequency ablation for hepatocellular
carcinoma
carcinoma

Anna Sánchez-López , Anna Pallisera-Lloveras , Ramon Saiz-Mendiguren ,
2
1
1
Manuel Ferrer-Marsal , José Carlos Vicens-Arbona , José Andrés Cifuentes-Ródenas ,
1
1
2
Jose Manuel Ramia 3
1 Department of General Surgery, Hospital Son Llàtzer, 07198 Palma de Mallorca, Spain
2 Department of Radiology, Hospital Son Llàtzer, 07198 Palma de Mallorca, Spain
3 HPB Unit, Department of Surgery, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
ABSTRACT
Aim: The optimal treatment for hepatocellular carcinoma (HCC) is either surgical resection or liver transplantation, but only
one-third of the patients are suitable candidates for surgery. Laparoscopic radiofrequency ablation (RFA) in selected patients
is a safe, feasible technique, which has proved to be superior to the percutaneous approach in patients with severe liver
disease or in lesions in which the percutaneous approach is impossible. The aim of this study is to present our experience
with laparoscopic RFA and demonstrate its safety as an alternative therapeutic procedure in selected patients with HCC.
Methods: This is a retrospective study of patients with HCC who underwent laparoscopic RFA between March 2009
and December 2014. Results: Thirty-two patients with 37 tumors underwent laparoscopic RFA. Median tumor size was
2.24 cm (0.7-4.45 cm). Major complications occurred in 8 patients. Initial complete ablation was achieved in 94.6% (35/37)
lesions and sustained complete ablation rate was 62.85% (22/35). Overall survival rates at 1-, 2-, and 3-year were 89%,
67.5%, and 40%, respectively. Conclusion: Laparoscopic RFA of HCC is safe and the long-term outcomes are similar to
those achieved with liver resection. Further trials combining chemoembolization and RFA are needed to improve long-term
outcomes and to limit local tumor progression.

Key words: Hepatocellular carcinoma; radiofrequency ablation; laparoscopic approach

Address for correspondence:
Dr. José Carlos Vicens-Arbona, Department of General Surgery, Hospital Son Llàtzer, Carretera Manacor Km. 4, 07198 Palma de Mallorca, Spain.
E-mail: jcvicens@hsll.es
Received: 13-02-2015, Accepted: 16-04-2015

INTRODUCTION based on the Barcelona-Clinic Liver Cancer (BCLC) staging
system [1-3] [Figure 1]. Liver transplantation and surgical
Hepatocellular carcinoma (HCC) is the third most common resection are considered the optimal curative strategy, [1-4]
cause of cancer-related deaths and the fifth most common but only one-third of patients with HCC are suitable
form of cancer worldwide. Due to the nature of HCC, candidates for surgery. Radiofrequency ablation (RFA) is
[4]
[1]
tumor stage, liver function, and performance status are considered the most effective local ablative therapy for
the main prognostic variables and treatment allocation is patients who cannot undergo surgery due to the number and
distribution of the nodules and/or the liver impairment, [1,2,5]
and can be performed percutaneously, by laparotomy or by
Access this article online [6,7]
Quick Response Code laparoscopy. Laparoscopic RFA is an interesting alternative
Website: when percutaneous RFA (perRFA) cannot be performed
http://www.hrjournal.net/ due to the tumor location (e.g., in the case of subcapsular
lesions, nodules adjacent to diaphragm without a therapeutic

DOI: window, proximity to adjacent structures, and lesions in deep
10.4103/2394-5079.157692 locations) [7-10] or because of the impossibility of visualizing
the tumor by percutaneous ultrasound. It has been reported
[9]

86 Hepatoma Research | Volume 1 | Issue 2 | July 15, 2015