Laparoscopic RFA with splenectomy for hepatocellular carcinoma

World Journal of Surgical Oncology

Research

Purun Lei¹  Chenhu Wang²  Bo Liu³  Kunpeng Hu³  Qingliang Wang³  He Huang³  Shilei Xu³  Zhicheng Yao³  Ruiyun Xu⁴  Meihai Deng⁴  Zhiyong Xiong⁴ 

[1] Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, 510000, Guangzhou, China;Department of General Surgery, Affiliated Hospital of Jiangnan University, 214000, Wuxi, China;Department of General Surgery, The Third Affiliated Hospital, Sun Yat-sen University, 510000, Guangzhou, China;Department of Hepatobiliary Surgery, The Third Affiliated Hospital, Sun Yat-sen University, 510000, Guangzhou, China;

关键词: Hepatocellular carcinoma;    Hypersplenism;    Laparoscopy;    Ablation;    Splenectomy;    Endoscopic variceal ligation;   

DOI  :  10.1186/s12957-016-0954-x

 received in 2016-01-14, accepted in 2016-07-20,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe treatment of hepatocellular carcinoma (HCC) is complicated and challenging because of the frequent presence of cirrhosis. Therefore, we propose a novel surgical approach to minimize the invasiveness and risk in patients with HCC, hypersplenism, and esophagogastric varices.MethodsThis was a retrospective study carried out in 25 patients with HCC and hypersplenism and who underwent simultaneous laparoscopic-guided radio-frequency ablation and laparoscopic splenectomy with endoscopic variceal ligation. Tumor size was restricted to a single nodule of <3 cm. Characteristics of the patients (cirrhosis etiology, liver function, tumor size, spleen size), surgery (complications, blood loss, time of stay), and follow-up (recurrence and survival) were examined.ResultsMean operative time was 128 ± 18 min. Mean blood loss was 206 ± 57 mL. Length of stay was 7.0 ± 1.5 days. Mean total costs were 8064 USD. Cytopenia and thrombocytopenia recovered quickly after surgery. No procedure was converted to open surgery. Two patients showed worsening liver function after surgery, three patients showed worsening of ascites, and five patients suffered from portal vein thrombosis. The 1-year tumor-free survival was 78.8 %, and the 21-month tumor-free survival was 61.4 %. According to a literature review, these outcomes were comparable to those of simultaneous open hepatic resection and splenectomy.ConclusionsLaparoscopic-guided radio-frequency ablation with laparoscopic splenectomy and endoscopic variceal ligation could be an available technique for patients with HCC <3 cm, hypersplenism, and esophagogastric varices. This approach may help to minimize the surgical risks and results in a fast increase in platelet counts with an acceptable rate of complications.

【 授权许可】

CC BY   
© The Author(s). 2016