Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
Department of Radiology, University of Minnesota, Minneapolis, Minnesota.
J Surg Oncol. 2020 Jun;121(8):1218-1224. doi: 10.1002/jso.25924. Epub 2020 Apr 8.
Thermal ablation can be used as a bridge to transplant or with curative intent for hepatocellular carcinoma (HCC). We report our experience with laparoscopic ablation of HCC in patients deemed inaccessible by the percutaneous approach.
We performed a retrospective review of surgical ablations from 2009 to 2017. Patient demographics, disease and treatment characteristics, and outcomes were abstracted from the medical record. Kaplan-Meier modeling was performed for survival and recurrence.
Thirty-three patients were included with a median age of 62 (interquartile range [IQR], 57-67). Most patients were male (76%) and Caucasian (70%). Ninety-seven percent had underlying cirrhosis. Median model for end stage liver disease-sodium was 9.5 (IQR, 8-12). The median maximal diameter of ablated lesions was 2.6 cm (IQR, 1.8-3.0). Thirty-nine lesions were ablated; 97% were completed laparoscopically. The median maximal diameter of the ablation zone was 4.8 cm (IQR, 3.8-5.7) with a median difference of ablation zone to the tumor of 2.0 cm (IQR, 1.5-2.75). Twelve patients received additional treatment. Median disease-free survival was 66.7 months and median follow-up 42.9 months. Disease recurrence occurred in 13 patients (39%)-systemic recurrence in 6%, intrahepatic recurrence in 27% and local recurrence in 6%.
Laparoscopic thermal ablation of HCC is safe and provides good oncologic outcomes for otherwise inaccessible tumors.
热消融可作为移植的桥梁或用于具有治愈意图的肝细胞癌（HCC）。我们报告了对经皮方法无法到达的 HCC 患者进行腹腔镜消融的经验。
我们对 2009 年至 2017 年的手术消融进行了回顾性分析。从病历中提取患者人口统计学、疾病和治疗特征以及结果。进行 Kaplan-Meier 建模以进行生存和复发分析。
共纳入 33 例患者，中位年龄为 62 岁（四分位距 [IQR]，57-67）。大多数患者为男性（76%）和白种人（70%）。97%的患者存在基础肝硬化。中位终末期肝病模型钠（model for end stage liver disease-sodium）为 9.5（IQR，8-12）。消融病灶的最大直径中位数为 2.6cm（IQR，1.8-3.0）。共消融 39 个病灶，97%的病灶经腹腔镜完成。消融区域的最大直径中位数为 4.8cm（IQR，3.8-5.7），消融区域与肿瘤之间的中位数差异为 2.0cm（IQR，1.5-2.75）。12 例患者接受了额外的治疗。无病生存期的中位数为 66.7 个月，中位随访时间为 42.9 个月。13 例患者（39%）发生疾病复发-系统性复发占 6%，肝内复发占 27%，局部复发占 6%。
腹腔镜热消融 HCC 是安全的，可为无法经皮到达的肿瘤提供良好的肿瘤学结果。
