Open AccessLaparoscopic Contrast-Enhanced Ultrasonography for Real Time Monitoring of Laparoscopic Radiofrequency Ablation for Hepatocellular Carcinoma: an Observational Pilot Study
Author(s) -
Adrian Bartoș,
Dana Bartoș,
Zeno Spârchez,
Ioana Iancu,
Lidia Ciobanu,
Cornel Iancu,
Caius Breazu
Publication year - 2019
Publication title -
journal of gastrointestinal and liver diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.641
H-Index - 48
eISSN - 1842-1121
pISSN - 1841-8724
DOI - 10.15403/jgld-263
Subject(s) - medicine , hepatocellular carcinoma , radiofrequency ablation , percutaneous , ablation , radiology , contrast enhanced ultrasound , cirrhosis , ultrasound , ultrasonography , ablative case , radiation therapy
Background and Aims: Laparoscopic radio-frequency ablation (L-RFA) for hepatocellular carcinoma (HCC) is used for unresectable tumors, with difficult location, unfitted for a percutaneous ablation technique. L-RFA has a high incidence of local recurrence. Even if intraoperative-ultrasound is standardized for staging and RFA probe guidance, the role of laparoscopic contrast-enhanced ultrasound (L-CEUS) for the real time monitoring of L-RFA efficacy has not been previously reported. We evaluated in a pilot observational study the efficacy of L-CEUS to assess the necrotic post-ablative area in difficult to treat HCC.
Methods: Eight consecutive patients diagnosed with HCC (peripherally located) on liver cirrhosis were referred for L-RFA between May 2016 and December 2018. For L-RFA a SturBurst XL (AngioDinamics®) internally cooled electrode was used, being placed under ultrasound guidance. L-CEUS was used to assess the necrotic post-ablative area. The median follow up period was 18 months.
Results: L-CEUS real time monitoring of the L-RFA efficacy indicated residual neoplastic tissue in 4 cases (50%). The procedure was repeated by reinserting the needle in the suspected areas indicated by L-CEUS. Complete tumor ablation was achieved in all treated patients. After a median follow-up of 18 months no recurrence of HCC was observed in 7 patients (87.5%).
Conclusions: L-CEUS was a reliable procedure for the immediate assessment of L-RFA efficacy; half of the ablated HCC nodules required a second ablation session. This approach might decrease the local recurrences, but its role must be further investigated in larger cohorts.