Results of laparoscopic radiofrequency ablation for HCC. Could the location of the tumour influence a complete response to treatment? A single European centre experience
Results of laparoscopic radiofrequency ablation for HCC. Could the location of the tumour influence a complete response to treatment? A single European centre experience
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DOI：
10.1111/hpb.12379
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发表时间：
2015-05-01
期刊：
影响因子：
2.9
通讯作者：
Garcia-Valdecasas, Juan-Carlos
中科院分区：
文献类型：
--
作者：
de la Serna, Sofia;Vilana, Ramon;Garcia-Valdecasas, Juan-Carlos
简介对于特定患者，射频消融 (RFA) 是一种行之有效的肝细胞癌 (HCC) 治疗方法。然而，包膜下或靠近邻近内脏的病变妨碍了经皮入路。在这种情况下，腹腔镜 RFA (LRFA) 是一种潜在的替代方案。本研究的目的是分析 HCC 患者 LRFA 的安全性和可行性。 患者和方法 对 2000 年 12 月至 2013 年 3 月在单一机构接受 LRFA 的符合严格纳入标准的 HCC 患者进行回顾性研究。 结果 41 名患者接受了 51 个结节的 42 个 LRFA。结节的中位尺寸为 2.5（范围 1.2-4.7）cm。 31 个肿瘤位于被膜下，17 个位于胆囊附近。 17名患者出现主要并发症。初始完全缓解 (ICR) 率为 94%，且位于胆囊附近的肿瘤中较低。随访期结束时，持续完全缓解 (SCR) 率为 70%，胆囊邻近肿瘤的持续完全缓解 (SCR) 率较低，而包膜下肿瘤的持续完全缓解 (SCR) 率较高。 1年、3年和5年总生存率分别为92.6%、64.5%和43%。结论肝细胞癌LRFA安全、可行，在选定的患者中取得了良好的效果。 LRFA 应成为治疗包膜下病变的一线技术，因为它可以最大限度地降低肿瘤种植的风险并改善 ICR。靠近胆囊会干扰治疗效果（ICR 发生率较低，SCR 发生率较低）。
IntroductionIn selected patients, radiofrequency ablation (RFA) is a well-established treatment for hepatocellular carcinoma (HCC). However, subcapsular or lesions close to adjacent viscera preclude a percutaneous approach. In this setting laparoscopic-RFA (LRFA) is a potential alternative. The aim of this study was to analyse the safety and feasibility of LRFA in patients with HCC.Patients and MethodsRetrospective study of patients with HCC meeting strict inclusion criteria who underwent LRFA at a single Institution from December 2000 to March 2013.ResultsForty-one patients underwent 42 LRFA of 51 nodules. The median size of the nodule was 2.5 (range 1.2-4.7) cm. Thirty-one tumours were subcapsular and 17 located near the gallbladder. Major complications occurred in 17 patients. The initial complete response (ICR) rate was 94% and was lower among tumours located adjacent to the gallbladder. At the end of the follow-up period, the sustained complete response (SCR) rate was 70% and was lower in tumours adjacent to the gallbladder while increased for subcapsular tumours. The 1-, 3- and 5-year overall survival rate was 92.6%, 64.5% and 43%, respectively.ConclusionLRFA of HCC is safe, feasible and achieves excellent results in selected patients. LRFA should be the first-line technique for subcapsular lesions as it minimizes the risk of tumoural seeding and improves ICR. Proximity to gallbladder interferes in treatment efficacy (lower rate of ICR and lower rate of SCR).