Initial Experience with Laparoscopic Ultrasound-Guided Radiofrequency Thermal Ablation of Hepatic Tumours

Background and Study Aims: Radiofrequency (RF) thermal ablation has been applied almost exclusively through the percutaneous approach under radiological/external ultrasound guidance. We have embarked on a programme of laparoscopic ultrasound-guided RF ablation of hepatic tumours in view of the potential advantages of this approach, i. e. reduced heat sink effect, greater precision and improved assessment of the thermal ablative zone.

Patients and Methods: RF thermal ablation using the Zomed International generator and multielectrode probes in two patients with hepatoma arising on a background of cirrhosis and in eight patients with multiple deposits from primary colorectal cancer.

Results: Total ablation was performed in two patients with hepatoma and 7/8 patients with secondary deposits. Total ablation with a minimum of 0.5-cm margin was achieved in 32 lesions. No complications were encountered postoperatively and all patients were discharged within 2 days of the intervention. One patient in whom thermal ablation was not completed has since died of progressive disease, eight appear to be free of tumour (follow-up 6 - 20 months) but one patient has developed further secondary hepatic deposits.

Conclusions: The initial experience with laparoscopic ultrasound-guided RF ablation of hepatic tumours indicates its safety and therapeutic potential in patients with inoperable hepatic tumours.

References

• 1 Cuschieri A, Crosthwaite G, Shimi S, et al. Hepatic cryotherapy for liver tumours: development and clinical evaluation of a high-efficiency multineedle probe system for open and laparoscopic use.  Surg Endosc. 1995;  9 483-9
• 2 Organ LW. Electrophysiologic principles of radiofrequency lesion making. International Symposium on Radiofrequency Lesion Making Procedures. Chicago, Illinois; Appl Neurophysiol 1977 39: 69-76
• 3 LeVeen HH, Wapnick S, Piccone V, et al. Tumor eradication by radiofrequency therapy. Response in 21 patients.  J Am Med Assoc. 1976;  235 2198-200
• 4 Moffat FL, Falk RE, Calhoun K, et al. Effect of radiofrequency hyperthermia and chemotherapy on primary and secondary hepatic malignancies when used with metranidazole.  Surgery. 1983;  94 536-42
• 5 Hiraoka M, Jo S, Dodo Y, et al. Clinical results of radiofrequency hyperthermia combined with radiation in the treatment of radioresistant cancers.  Cancer. 1984;  54 2898-904
• 6 Moffat FL, Gilas T, Calhoun K, et al. Further experience with regional radiofrequency hyperthermia and cytotoxic chemotherapy for unresectable hepatic neoplasia.  Cancer. 1985;  55 1291-5
• 7 Nagata Y, Hiraoka M, Akuta K, et al. Radiofrequency thermotherapy for malignant liver tumors.  Cancer. 1990;  65 1730-6
• 8 McGahan JP, Schneider P, Brock JM, Tesluk H. Treatment of liver tumours by percutaneous radiofrequency electrocautery.  Semin Intervent Radiol. 1993;  10 143-9
• 9 Rossi S, Di Stasi M, Buscarini E, et al. Percutaneous radiofrequency interstitial thermal ablation in the treatment of small hepatocellular carcinoma.  Cancer J. 1995;  1 73-81
• 10 Nagata Y, Hiraoka M, Nishimura Y, et al. Clinical results of radiofrequency hyperthermia for malignant liver tumours.  Int J Radiat Oncol Biol Phys. 1997;  38 359-65
• 11 Buscarini L, Rossi S, Fornari F, et al. Laparoscopic ablation of liver adenoma by radiofrequency electrocautery.  Gastrointest Endosc. 1995;  41 68-70
• 12 Curley SA, Davidson BS, Fleming RY, et al. Laparoscopic guided bipolar radiofrequency ablation of areas of porcine liver.  Surg Endosc. 1997;  11 729-33
• 13 Odeberg S, Ljungqvist O, Svenberg T. Haemodynamic effects of pneumoperitoneum and the influence of posture during anaesthesia for laparoscopic surgery.  Acta Anaesthesiol Scand. 1994;  38 276-83
• 14 Frank T, Willets GJ, Cuschieri A. Detachable clamps for minimal access surgery.  Proc Inst Mech Eng. 1995;  209 117-20