Surgical resection combined with radiofrequency ablation for multifocal hepatocellular carcinomas in patients with cirrhosis / 中国微创外科杂志

ABSTRACT

Objective To investigate the feasibility and efficacy of surgical resection combined with radiofrequency ablation (RFA) for multifocal hepatocellular carcinomas (HCC) in patients with cirrhosis. Methods A total of 18 patients with multifocal HCCs and liver cirrhosis was treated between August 2003 and January 2006. Forty-six hepatic lesions were identified preoperatively by ultrasonography, helical CT, or MRI. Ten patients were found as having 2 lesions, 6 patients having 3 lesions, and 2 patients, 4 lesions. Under general anesthesia, segmental hepatectomy for major lesions (with a 2cm resection margin) and RFA therapy for minor lesions were performed. Results The combination therapy was performed successfully in all the 18 patients. A cholecystectomy was performed simultaneously for gallstones in 2 patients, and a splenectomy with para-esophagogastric devascularization was performed for portal hypertension in 1 patient. The surgical resection time was 37.4?8.8 min, the RFA time per lesion was 25.6 ? 8.9 min, the total RFA time was 39.8 ?14.7 min, the total operative time was 152.4?30.8 min, and the intraoperative blood loss was 465.6 ? 171.0 ml. No severe complications, such as intraabdominal hemorrhage, gastrointestinal tract injury, diaphragmatic injury, and liver function failure, developed after operations. No residual tumor was found on the margin of surgical resection and a complete lesion necrosis was achieved in the RFA regions on contrast-enhanced helical CT scanning 1 month after the procedure. During a follow-up period for 6~31 months (mean, 15.5 months), 5 patients were diagnosed as having new malignant nodules and were given a percutaneous RFA therapy. Out of the 5 patients, one died from tumor recurrence and lung metastases, and two patients died from liver failure at 7 and 16 months after treatment, respectively. Conclusions Surgical resection combined with RFA therapy is a feasible, safe, and effective treatment for proper patients with multifocal HCCs and liver cirrhosis, preserving impaired liver functions to the greatest advantages.