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Treatment mortality and morbidity One case developed a new lesion detected 4 months
We found the difference in overall survival in the two post-procedure at the follow-up triphasic CT study
different treatment groups regarding child type as shown managed by a second session.
in Table 2.
Cholecystitis developed in 1 patient with a segment 5
Group A: Resection nodule adjacent to the gall bladder wall. Bile duct injury
There was no operative mortality (within 30 days of developed in another patient 1 month post-procedure.
surgery) after resection; mean hospital stay was 6 days.
One- and two-year survivals were 85% (17) and 70% (14) DISCUSSION
respectively.
HCC accounts for more than 90% of primary liver cancer,
Post-resection complications varied greatly. Wound the third most common cause of cancer-related death.
infection (seroma) occured in 4 patients and were It is the fifth most prevalent cancer in men and the
[5,6]
managed conser vatively via repeated dressing and seventh in women. The prognosis for untreated HCC
antibiotic administration according to the culture is generally poor. Curative treatment consists of surgical
obtained from the wound. Incisional hernia occured in resection, RFA, and liver transplantation. [7]
2 patients. Hernioplasty was performed in one of them
while the other one refused. Chest complications were Management of cirrhotic HCC involves several
[8]
the most common complications, big incision and severe specialties. To correctly select candidates for resection, it
pain limits respiration, leading to retained secretions is essential to consider not only the tumor characteristics,
and chest infections. Chest complications occured but also the accurate estimate of liver function with the
in 8 patients. Ascitis occured in 3 patients and were aid of imaging. The risk of incorrect staging of associated
managed medically. One patient developed recurrence cirrhosis may result in post-operative liver failure,
after 18 months (this patient was managed by RFA but followed by chronic decompensated cirrhosis. [9]
was excluded from our results, as RFA was done after
finishing the study). The high mortality and morbidity associated with chronic
liver disease limits liver resection in cirrhotic patients.
[10]
Group B: Percutaneous radiofrequency ablation Liver transplantation is the choice of treatment, with the
There was no in-hospital mortality after RFA; the mean best results in terms of long-term survival, but this option
hospital stay ranged from 4 h to 24 h with a mean of is feasible in a small number of patients because of the
[11]
7 h. One- and two-year survival was respectively, 80% shortage of donors. However, current progresses in
(16) and 65% (13). liver resection techniques and in post-operative follow-
up have improved the resection results in terms of
Pain after procedures was present in all patients (mild operative risk and long-term survival. [9,12]
to moderate pain presented in 16 patients which was
managed using analgesia. Severe pain presented in 4 Indications for resection depend on the size, number and
patients and was managed using sedation). Pain lasted location of lesions as well as the estimation of remnant
for 24-72 h in most patients. Delayed pain occurred in liver volume (RLV). The best candidates are patients with
2 patients lasting for 1 week. This was attributed to the a single peripheral lesion, which permits the preservation
proximity of the ablated lesions to the diaphragm. Pain of more than 50% of RLV. [13]
occurred either isolated or as a part of the post-ablation
syndrome that occurred in 12 patients with flu-like Tumor location is an essential assessment parameter.
manifestations including low-grade fever, pain, malaise, With regard to peripheral lesions, no matter how bulky
myalgia, nausea, and vomiting. the mass is, resection may be performed with a curative
intent and anatomically, without compromising a large
Table 2: Overall survival by patient and child type in the parenchymal volume. In contrast, a small central lesion
[14]
two different treatment groups
1 year (%) 2 years (%) (< 3 cm) may require the sacrifice of a significantly great
Total patients parenchymal volume, with risk of post-operative liver
HR (n = 20) 17 (85) 14 (70) failure, so RFA is preferable if possible. [15]
RFA (n = 20) 16 (80) 13 (65)
Child A
HR (n = 17) 15 (75) 13 (65) Surgical resection of HCC remains the gold standard.
RFA (n = 12) 10 (50) 9 (45)
Child B Unfortunately, its usefulness has been limited by
HR (n = 3) 2 (10) 1 (0.5)
RFA (n = 8) 6 (30) 4 (20) many factors, including tumor multiplicity and poor
RFA: radiofrequency ablation; HR: hepatic resection hepatic reserve to tolerate surgery. Other techniques

Hepatoma Research | Volume 2 | April 1, 2016 95