Comprehensive laparoscopic management for metastatic hepatoma / 中华普通外科杂志

ABSTRACT

Objective To study the efficacy of laparoscopic hepatectomy combined with Iodine-125 and radiofrequency ablation(RFA)in the treatment of metastatic hepatic carcinoma.Methods There were 124 patients diagnosed as hepatic metastasis detected by CT or MR scan, and were divided into two treatment groups. Group A(combined group of 41 cases)with laparoscopic excision,RFA and iodine-125 treatment and group B(control group of 83 cases)with transhepatic artery chemoembolization(TACE)and systematic chemotherapy.Results Nine new hepatic metastatic foci were found by laparoscopic ulstrasound during the operation in group A,and in this group,18 hepatic metastatic lesions located on the surface in 13 patients were removed,then RAF applied to the hepatic metastases,and iodine-125 planted in place,altogether 59 foci near to the porta hepatis or large vessels were treated by laparoscopic RFA and iodine-125 implantation.All patients were followed-up from 26 to 45 months(average 35.4 months).The total relief rate was 90.2% and 30.1 % in group A and B respectively(x~2=39.68,P＜0.05＝.The median survival time was 19 and 11 months in group A and B respectively(t=-9.74,P＜0.05＝.The survival rate at 1-,2-and 3-years was 80.5%,48.8%,24.4% and 54.2%,28.9%,9.6% in group A and B respectively (x~2=8.11,4.73,4.81,P＜0.05＝.Conclusions Laparoscopic excision,Iodine-125 implantation and radiofrequency ablation in the treatment of metastatic liver carcinoma is safe、effective,and this approach prolongs the patient's survival time.