Laparoscopic radiofrequency ablation versus percutaneous radiofrequency ablation for subphrenic hepatocellular carcinoma

다국어 초록 (Multilingual Abstract)

Purpose: Radiofrequency ablation is a curative treatment option for very early-stage or earlystage hepatocellular carcinoma (HCC). However, percutaneous radiofrequency ablation (PRFA) for subphrenic tumors is technically challenging. Laparoscopic radiofrequency ablation (LRFA) has been used to overcome this disadvantage. This study compared the treatment outcomes between LRFA and PRFA for subphrenic HCC.Methods: This retrospective study screened patients who underwent PRFA or LRFA for subphrenic HCC between 2013 and 2018. Therapeutic outcomes, including local tumor progression (LTP), intrahepatic distant recurrence (IDR), extrahepatic metastasis (EM), disease-free survival (DFS), and overall survival (OS), were compared between the two groups.Results: Thirty patients in the PRFA group and 23 patients in the LRFA group were included. LTP was observed in six patients in the PRFA group (20%), but in no patients in the LRFA group. The cumulative LTP rates at 1, 3, and 5 years were 3.7%, 23.4%, and 23.4%, respectively, in the PRFA group and 0.0% in the LRFA group (P=0.015). The IDR, EM, and DFS rates were not significantly different between the two groups (P=0.304, P=0.175, and P=0.075, respectively). The OS rates at 1, 3, and 5 years were 96.6%, 85.7%, and 71.6%, respectively, in the PRFA group and 100%, 95.7%, and 95.7%, respectively, in the LRFA group (P=0.049).Conclusion: LRFA demonstrated better therapeutic outcomes than did PRFA for subphrenic tumors in terms of LTP and OS. Therefore, LRFA can be considered as the first-line treatment option for subphrenic HCC.

참고문헌 (Reference)

1 Lee MW, "Updated 10-year outcomes of percutaneous radiofrequency ablation as firstline therapy for single hepatocellular carcinoma < 3 cm : emphasis on association of local tumor progression and overall survival" 30 : 2391-2400, 2020

2 Santambrogio R, "Safety and efficacy of laparoscopic radiofrequency ablation of hepatocellular carcinoma in patients with liver cirrhosis" 17 : 1826-1832, 2003

3 de la Serna S, "Results of laparoscopic radiofrequency ablation for HCC. Could the location of the tumour influence a complete response to treatment? A single European centre experience" 17 : 387-393, 2015

4 Filippousis P, "Radiofrequency ablation of subcapsular hepatocellular carcinoma : single center experience" 77 : 299-304, 2011

5 Kim YJ, "Radiofrequency ablation of hepatocellular carcinoma : can subcapsular tumors be safely ablated?" 190 : 1029-1034, 2008

6 Poon RT, "Radiofrequency ablation for subcapsular hepatocellular carcinoma" 11 : 281-289, 2004

7 Rhim H, "Radiofrequency ablation for hepatocellular carcinoma abutting the diaphragm : the value of artificial ascites" 34 : 371-380, 2009

8 Lee MW, "Planning US for percutaneous radiofrequency ablation of small hepatocellular carcinomas(1-3 cm) : value of fusion imaging with conventional US and CT/MR images" 24 : 958-965, 2013

9 Rhim H, "Percutaneous radiofrequency ablation with artificial ascites for hepatocellular carcinoma in the hepatic dome : initial experience" 190 : 91-98, 2008

10 강태욱 ; 임현철 ; 김은영 ; 이원재 ; 임효근 ; 김영선 ; 최동일, "Percutaneous Radiofrequency Ablation for the Hepatocellular Carcinoma Abutting the Diaphragm: Assessment of Safety and Therapeutic Efficacy" 대한영상의학회 10 (10): 34-42, 2009

11 Kang TW, "Longterm therapeutic outcomes of radiofrequency ablation for subcapsular versus nonsubcapsular hepatocellular carcinoma : a propensity score matched study" 280 : 300-312, 2016

12 Ko SE, "Laparoscopic radiofrequency ablation of subcapsular hepatocellular carcinomas : risk factors related to a technical failure" 36 : 504-514, 2022

13 Jakimowicz J, "Laparoscopic insufflation of the abdomen reduces portal venous flow" 12 : 129-132, 1998

14 Santambrogio R, "Laparoscopic ablation therapies for hepatocellular carcinoma : could specific indications for the laparoscopic approach influence the effectiveness?" 72 : 435-443, 2020

15 Cillo U, "Laparoscopic ablation of hepatocellular carcinoma in cirrhotic patients unsuitable for liver resection or percutaneous treatment : a cohort study" 8 : e57249-, 2013

16 Ahmed M, "Image-guided tumor ablation : standardization of terminology and reporting criteria : a 10-year update" 273 : 241-260, 2014

17 Song KD, "Hepatic resection vs percutaneous radiofrequency ablation of hepatocellular carcinoma abutting right diaphragm" 11 : 227-237, 2019

18 Odeberg S, "Haemodynamic effects of pneumoperitoneum and the influence of posture during anaesthesia for laparoscopic surgery" 38 : 276-283, 1994

19 Ishikawa T, "Effect of treatment support on preventing local recurrence of hepatocellular carcinoma directly adjacent to the diaphragm" 7 : 61-66, 2017

20 European Association for the Study of the Liver, "EASL clinical practice guidelines : management of hepatocellular carcinoma" 69 : 182-236, 2018

21 Lai ZC, "Do hepatocellular carcinomas located in subcapsular space or in proximity to vessels increase the rate of local tumor progression? A meta-analysis" 207 : 381-385, 2018

22 Della Corte A, "Comparison between percutaneous and laparoscopic microwave ablation of hepatocellular carcinoma" 37 : 542-548, 2020

23 Eun HS, "Advantages of laparoscopic radiofrequency ablation over percutaneous radiofrequency ablation in hepatocellular carcinoma" 62 : 2586-2600, 2017

24 Cha Dong Ik ; Lee Min Woo ; Song Kyoung Doo ; Ko Seong Eun ; Rhim Hyunchul, "Ablative Outcomes of Various Energy Modes for No-Touch and Peripheral Tumor-Puncturing Radiofrequency Ablation: An Ex Vivo Simulation Study" 대한영상의학회 23 (23): 189-201, 2022

25 Korean Liver Cancer Study Group ; National Cancer Center, Korea, "2014 Korean Liver Cancer Study Group-National Cancer Center Korea Practice Guideline for the Management of Hepatocellular Carcinoma" 대한영상의학회 16 (16): 465-522, 2015