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All patient and tumor characteristics of the laparoscopic Table 1: Patient and tumor characteristics
RFA procedures are shown in Table 1. The main reasons for Variable Result
preferring laparoscopy to the percutaneous approach were: Patient characteristics (n = 32)
subcapsular location in 26 cases, intrahepatic location in eight Age 63.56 (38-83) years
cases which were difficult to define by perRFA, and location Gender (male/female) 21/11
very close to adjacent viscera in three cases. Etiology
HCV 23
Non-HCV 9
Although according to BCLC guidelines patients with Child
liver function Child C are not initially candidates for Child A 23
RFA, one patient with Child C finally underwent RFA as Child B 8
palliative treatment after discussion with the Hepatobiliary Child C 1
Committee. Cirrhosis 25
Non-cirrhosis 7
Two patients had a simultaneous surgical procedure Previous treatment
associated with the laparoscopic RFA. One of them had a TACE 2
perRFA 1
cholecystectomy due to the proximity of one of the tumors Tumor characteristics (n = 37)
to the gallbladder, which was performed prior to the RFA. The Uninodular 27 (84%)
specimen was removed by using an endobag and no tumoral Size 2.24 (0.7-4.5) cm
seeding was reported. The other simultaneous procedure was ≤ 2 cm 19
a hysteroscopy for a uterine biopsy. 2.1-3 cm 14
> 3 cm 4
Radiofrequency ablation results Location
An initial complete ablation was achieved in 35 of the 37 Subcapsular 26
lesions that underwent laparoscopic RFA (94.6%). In one Intrahepatic 8
3
Adjacent to viscera
patient without initial complete ablation the lesion was perRFA: percutaneous radiofrequency ablation; TACE: transarterial
subsequently treated by laparoscopic alcoholization and chemoembolization; HCV: hepatitis C virus
in the other transarterial chemoembolization (TACE) was
performed. Table 2: Post-operative complications
Variable Result
Morbidity Clavien I 3
Clavien II 3
No complications were reported during any of the
laparoscopic RFA procedures nor in relation to other Clavien IIIa 0
Clavien IIIb 1
simultaneous techniques. Conversion to open surgery Clavien IVa 0
was not needed in any patient. The mean post-operative Clavien IVb 0
hospital stay was 4.9 days (1-30). All complications are Clavien V 1
detailed in Table 2 following the modified Clavien-Dindo
Classification System. Eight patients presented some local recurrence rate was observed in cirrhotic patients,
[12]
kind of complication: only one of them required emergency HCV , with subcapsular tumors, although the differences
+
reintervention, following a hemoperitoneum (Clavien IIIb). were not statistically significant. Twenty-two lesions of
One patient presented liver decompensation with mild ascites the 35, which achieved initial complete response did not
and was successfully treated with diuretics (Clavien I). present local recurrence at the end of the follow-up period,
representing a rate of sustained complete ablation of 62.85%.
Recurrence Mean follow-up was 18.72 months (range 3-44). Distant
The median follow-up period was 28.3 ± 2.3 months. After recurrence was observed in 15 patients after a mean delay
achieving initial complete ablation (35 procedures), local of 16.66 months of follow-up (range 4-39).
recurrence was seen in 13 cases, after a median delay of
8.38 months (range 3-30). Six recurrent lesions were treated Mortality and survival
by TACE, 5 by new laparoscopic RFA, 1 by perRFA, 1 by One patient was lost to follow-up and 16 had died by the
sorafenib, and 1 underwent symptomatic treatment only. end of the follow-up period. No mortality related to the main
procedure was reported. One death was reported 30 days
Cumulative recurrence rates at 6, 12, and 36 months after the surgical procedure in a patient with Child-Pugh C
were 22.85%, 34.28%, and 37.18%, respectively. A higher cirrhosis who, after RFA, also had complications related to

Hepatoma Research | Volume 1 | Issue 2 | July 15, 2015 89