Department of General, Visceral and Cancer Surgery, University of Cologne, Center of Integrated Oncology (CIO), Joseph-Stelzmann-Straße 9, 50931 Cologne, Germany.
Langenbecks Arch Surg. 2013 Jan;398(1):47-53. doi: 10.1007/s00423-012-1018-5. Epub 2012 Oct 24.
The therapeutic regimen for patients suffering of HCC in liver cirrhosis must pay attention to the underlying liver disease. Surgical resection is often limited by liver function and transplantation, as an optimal therapy for many early diagnosed HCC, by the availability of organs. Due to three prospective, randomized trials radiofrequency ablation (RFA) is the standard method of local ablation. RFA compared with resection for HCC in liver cirrhosis yields similar results concerning overall survival but a lower rate of complications. The laparoscopic approach may be advantageous concerning the major drawback of RFA which is still the rate of local failure as shown by a meta-analysis of local recurrences.
Indication for RFA was HCC in liver cirrhosis either as a definite therapy or as a bridging procedure for transplantation if the expected waiting time exceeded 6 months. Laparoscopic ultrasound, standardized algorithm of laparoscopic RFA procedure, track ablation and a Trucut biopsy were performed. The postoperative follow-up was done according to institutional standards. Patient data and parameters of laparoscopic RFA were prospectively documented, analyzed and compared with the results of previously published series found in a Medline search.
34 patients were treated by laparoscopic RFA. The average time of follow-up was 36.9 ± 28.3 months. There was no procedure-related mortality or surgical complications. An upstaging of the tumor stage by laparoscopic ultrasound was achieved in 32 % of the patients. The overall survival of these patients was 44.7 ± 6.9 months. The intrahepatic recurrence rate was 61.8 % based on the number of patients treated. The results have been analyzed and compared with six independent papers identified in a Medline search that report on the treatment of patients with HCC in a liver cirrhosis by laparoscopic RFA with a mean follow-up of 12 or more months.
Laparoscopic RFA is a feasible and reliable therapy for unresectable HCCs in patients with cirrhosis. The laparoscopic RFA combines the advantage of a minimally invasive procedure concerning liver dysfunction with the ability of an accurate intraoperative staging by laparoscopic ultrasound.
患有肝硬化肝癌的患者的治疗方案必须注意潜在的肝脏疾病。手术切除通常受到肝功能和可供移植器官的限制。由于三项前瞻性随机试验，射频消融（RFA）是局部消融的标准方法。RFA 与肝硬化肝癌的切除术相比，在总生存率方面具有相似的结果，但并发症发生率较低。腹腔镜方法在 RFA 的主要缺点方面可能具有优势，即局部复发的荟萃分析显示的局部失败率仍然较高。
RFA 的适应证为肝硬化肝癌，无论是作为明确的治疗方法还是作为移植的桥接治疗方法，如果预期等待时间超过 6 个月。进行腹腔镜超声检查、标准化的腹腔镜 RFA 程序算法、轨迹消融和 Trucut 活检。根据机构标准进行术后随访。前瞻性记录患者数据和腹腔镜 RFA 参数，并与在 Medline 搜索中找到的以前发表的系列结果进行分析和比较。
34 例患者接受了腹腔镜 RFA 治疗。平均随访时间为 36.9±28.3 个月。无手术相关死亡或手术并发症。腹腔镜超声检查使肿瘤分期提高了 32%。这些患者的总生存率为 44.7±6.9 个月。根据治疗的患者数量，肝内复发率为 61.8%。结果已进行分析，并与在 Medline 搜索中找到的六篇独立论文进行了比较，这些论文报告了通过腹腔镜 RFA 治疗肝硬化肝癌患者的结果，平均随访时间超过 12 个月。
腹腔镜 RFA 是一种可行且可靠的治疗方法，适用于肝硬化无法切除的 HCC 患者。腹腔镜 RFA 结合了微创程序的优势，可通过腹腔镜超声实现准确的术中分期。
