Source: Pediatrics  |  Posted 5 years ago

By Chris Berrie

VENICE, ITALY -- December 6, 2006 -- Laparoscopic radiofrequency ablation (RFA) is preferable to open RFA by laparotomy for patients with hepatic malignancies, according to a prospective study presented here at the 13[^]th[] Congress of the European Society of Surgical Oncology (ESSO).

Surgical RFA of hepatic malignancies is associated with superior clinical and oncological outcome as compared to percutaneous RFA, said co-investigator Daphne Hompes, MD, surgical trainee, abdominal surgery, University Hospital Gasthuisberg, Leuven, Belgium. However, he indicated, the recently reported rates of local recurrence were 16.4% with percutaneous RFA in patients not fit for surgery, while the rate with laparoscopic RFA was 5.8% and with open RFA it was 4.4%.

To determine which procedure would be preferable in patients with liver cancer, Dr. Hompes and colleagues conducted a prospective study that assessed the morbidity and mortality of both laparoscopic and open RFA, she said in a presentation on December 1[^]st[].

The analysis encompassed 115 consecutive patients with a mean age of 62 years (male, 62.6%) from 1999 to 2005 diagnosed with hepatic tumours. The tumour types were hepatocellular carcinomas in 55, colorectal metastases in 125, and others in 41. Of these, 11 patients underwent treatment by percutaneous RFA, 70 by laparoscopic RFA (60.9%) and 34 by open RFA (29.6%).

Liver cirrhosis was more prevalent in the laparoscopic RFA group (45.7% vs 20.6%; []P[] = .0108), and there were no significant differences in mean tumour diameters, segments and number of segments.

Total blood loss was significantly greater in the open RFA group than the laparoscopic RFA grouop ([]P[] = .0077), operation duration was also greater with open RFA ([]P[] < .0001) as was RFA duration ([]P[] = .0008).

Total RFA-associated morbidity was 7.7%, and occurred in 4.3% of the laparoscopic RFA group (no intraoperative, 3 postoperative) and 14.7% of the open RFA group (1 intraoperative, bleeding/ splenectomy; 5 postoperative). The differences were not significant.

The RFA-associated morbidityrate was 7.7% across the combined patient groups; while the differences between LRFA and ORFA did not reach significance, there was a beneficial trend for lower RFA-associated morbidity in the LRFA group compared with ORFA(4.3% vs 14.7%). There were no intraoperative complications in the LRFA group and 1 ORFA patient (2.9%); postoperative complications were seen in 4.3% versus 14.7% of patients, respectively.

Total non-RFA-associated morbidity in the combined patient groups was 12.5%, and 5.7% of patients having postoperative complications in the LRFA group and 26.5% in the ORFA group ([]P[] = .0037). Length of hospital stay for LRFA was 4 days, significantly lower than the 9 days for the ORFA group ([]P[] < .0001). There was also one non-RFA-associated death, which occurred in the LRFA group (NS).

When additional surgical procedures were considered, the colorectal resections needed for laparoscopic RFA were significantly lower than for open RFA (5.7% vs 32.4%, respectively; []P[] = .0004), with non-significant differences seen for hepatic resections (10.0% vs 17.7%) and other minor procedures (35.7% vs 20.6%).

As indicated, patients with liver cirrhosis mainly fell into the laparoscopic RFA group (82.1%). When the need for additional procedures was compared, patients with cirrhosis required significantly fewer procedures compared with patients who did not have cirrhosis (25.6% vs 61.5%, respectively; []P[] = .0004). Similarly, there were significantly fewer complications in patients with cirrhosis ([]P[] = .0002).

While there is potential for selection bias due to the nonrandomised nature of the sampling, Dr. Hompes indicated that the main point were that laparoscopic RFA showed low postoperative morbidity. In addition, he said, open RFA was often associated with colorectal resections, giving further significant postoperative complications, and with cirrhosis patients laparoscopic RFA showed clear benefits.

Overall, this analysis indicates that laparoscopic RFA is the preferable procedure for RFA in patients with liver cancer, he said.

[Presentation title: Radiofrequency Ablation for Hepatic Malignancies: Laparoscopy or Laparotomy? Abstract 235]