Percutaneous ablation procedures in cirrhotic patients with hepatocellular carcinoma submitted to liver transplantation: Assessment of efficacy at explant analysis and of safety for tumor recurrence
Open Access
- 25 August 2005
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Liver Transplantation
- Vol. 11 (9), 1117-1126
- https://doi.org/10.1002/lt.20469
Abstract
Aims of this retrospective study were to analyze the efficacy and safety of percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) in cirrhotic patients with hepatocellular carcinoma (HCC) submitted to orthotopic liver transplantation (OLT). We studied 40 patients undergoing OLT in whom 46 HCC nodules had been treated with PEI (13 nodules), RFA (30 nodules), or PEI+RFA (3 nodules). Child-Turcotte-Pugh class was A in 18 cases, B in 18, and C in 4. The mean waiting time for OLT was 9.5 months. The effectiveness of ablation techniques was evaluated by histological examination of the explanted livers. Complete necrosis was found in 19 nodules (41.3%), partial or absent necrosis in 27 nodules (58.7%). Among the 30 nodules treated by RFA, 14 were completely necrotic (46.7%) and 16 demonstrated partial necrosis (53.3%). Considering the 13 neoplasms undergoing PEI, 3 nodules showed complete necrosis (23.1%), 6 partial necrosis (46.1%), and 4 absent necrosis (30.8%). The rate of complete necrosis was 53.1% for nodules smaller than 3 cm and 14.3% for larger lesions (P = 0.033) but increased to 61.9% when considering only the lesions smaller than 3 cm treated by RFA. During the follow up, HCC recurred in 3 patients treated by PEI. No cases of HCC recurrence at the abdominal wall level were recorded. Percutaneous ablation procedures are effective treatments in cirrhotic patients with HCC submitted to OLT and are not associated to an increased risk of tumor recurrence. RFA provides complete necrosis in most nodules smaller than 3 cm, and appears to be the best treatment option in these cases. (Liver Transpl 2005;11:1117–1126.)This publication has 47 references indexed in Scilit:
- Pre‐transplant treatment of hepatocellular carcinoma: assessment of tumor necrosis in explanted liversClinical Transplantation, 2004
- Percutaneous ablation of hepatocellular carcinoma: State-of-the-artLiver Transplantation, 2004
- Percutaneous radiofrequency thermal ablation of hepatocellular carcinoma: A safe and effective bridge to liver transplantationLiver Transplantation, 2002
- Clinical Management of Hepatocellular Carcinoma. Conclusions of the Barcelona-2000 EASL ConferenceJournal of Hepatology, 2001
- Liver Transplantation for Hepatocellular CarcinomaAnnals of Surgery, 2001
- Radiofrequency ablation for hepatocellular carcinoma: Help or hazard?Hepatology, 2001
- A model to predict survival in patients with end-stage liver diseaseHepatology, 2001
- Liver transplantation for hepatocellular carcinoma: a proposal of a prognostic scoring systemJournal of the American College of Surgeons, 2000
- Percutaneous Ethanol Injection in the Treatment of Hepatocellular Carcinoma: A Multicenter Survey of Evaluation Practices and Complication RatesScandinavian Journal of Gastroenterology, 1997
- Transection of the oesophagus for bleeding oesophageal varicesBritish Journal of Surgery, 1973