Intraoperative radiofrequency ablation with or without tumorectomy for hepatocellular carcinoma in locations difficult for a percutaneous approach.

BACKGROUND: Although hepatic resection is widely accepted as a proper modality for treating hepatocellular carcinoma (HCC), a majority of patients are unable to undergo surgical resection due to various tumor and patient factors. Radiofrequency ablation (RFA) has mostly been used as a therapeutic alternative to resection for treating HCC. The objective of this study was to evaluate the results of intraoperative RFA for HCCs in locations difficult for a percutaneous approach. METHODS: Eight patients (male, seven; age, 49-67 years) with 8 HCCs in difficult locations were treated by intraoperative RFA. Six of the patients had local tumor progression after initial transarterial chemoembolization or ultrasound (US) guided percutaneous RFA. The locations of the tumors were hepatic dome in six patients, posterior subcapsule in one, and caudate lobe in one. The tumor size was 2.0 to 6.4 cm (mean, 3.9 cm). Intraoperative RFA was performed at the tumor itself and an anticipated resection line under US guidance with 3 cm monopolar single or clustered internally cooled electrodes. Tumor resection was performed in six patients. One month later, treatment response was assessed by contrast material-enhanced computed tomography (CT). CT studies were performed every 2 or 3 months after RFA. RESULTS: RFA was technically successful in all tumors, and the contrast-enhanced CT images acquired one month later showed complete disappearance of tumor enhancement. One pneumothorax occurred. After a median follow-up of 18 months (range, 6-30 months), no tumors showed local progression. During the follow-up period, four new recurrent tumors were observed in three patients. Four patients were alive at the time of this report and the other four died of hepatorenal syndrome, liver failure, and progression of new recurrent tumors. CONCLUSION: Intraoperative RFA with tumor resection can be an alterative treatment option for HCC in locations difficult for a percutaneous approach.