Mid- to Long-term Outcome of Laparoscopic Ultrasound-guided Radiofrequency Ablation for Malignant Hepatic Tumors

Purpose: To evaluate the mid- to long-term efficacy of laparoscopic ultrasound-guided radiofrequency ablation(LURFA) in malignant hepatic tumors that are difficult or impossible to be curatively treated with the percutaneous approach or laparoscopic liver resection (LLR).

Materials and Methods: From 2011 to 2020, 62 patients with liver tumors (37 hepatocellular carcinomas and 25 metastatic colorectal cancers), who were not feasible to be curatively treated by percutaneous radiofrequency ablation or LLR, were enrolled and completely ablated  only by LURFA . Patients who underwent concurrent surgical resection were excluded. Image modalities for the follow-up were CT or MRI. The cumulative incidence of local recurrence and survival  were analyzed.

Results: All ninety-three tumors with a mean diameter of 22 mm (8-50 mm) and mean number of 1.5 (1-7 tumors) in 62 patients were successfully treated. According to Morioka Consensus for LLR, 51.6% of patients (32/62) had tumors in difficult locations(segment I,VII, VIII, and Iva ). Over a median follow-up period of 62.5 months (range, 37 to 98months), the 1-year, 2-year, 3-year 5-year and 8-year cumulative incidence of local recurrence were 8.1%, 11.3%, 12.9%, 12.9% and 14.5%. In patients with hepatocellular carcinoma,  1-year, 3- year,5- year and 8-year survival rates were 98.4%, 60.3% and 49.3%, 25.1% respectively. In patients with metastatic colorectal cancers , 1-year, 3-year,5-year and 8-year survival rates were 100%, 76.0%, 40.0%, 32.0% and 14.6% respectively. The mean hospital stay was 4 days (range 4–11 days). Adverse events of grade 3 occurred in 4.8% (3/62) of the patients only.

Conclusion: Laparoscopic ultrasound-guided radiofrequency ablation is a safe and effective treatment for malignant hepatic tumors, especially in difficult percutaneous ablation or LLR areas. LURFA combines the advantage (assessing  difficult segments of liver, protecting surrounding viscera and aggressive ablation) of a minimally invasive procedure and has a low local recurrence rate.