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| |  Laparoscopic Management of Liver Cancer Is Feasible in Cirrhotic Patients: Presented at SSO By Wayne Kuznar PHOENIX, Ariz -- March 9, 2009 -- Patients with hepatocellular carcinoma and cirrhosis can be managed laparoscopically with low mortality, researchers noted here at the Society of Surgical Oncology (SSO) 62nd Annual Cancer Symposium. Laparoscopic radiofrequency ablation and partial hepatectomy are acceptable options in staging and treating cirrhotic patients, according to a retrospective review of laparoscopic restaging and ultrasound-guided needle biopsy in such patients, said Adrian Legaspi, MD, 21st Century Oncology, Miami Beach, Florida. "We feel that this is a very useful technique, has low mortality, and can offer good survival in patients with [a] low Model End-Stage Liver Disease [MELD] score and single tumours," explained Dr. Legaspi, speaking here at a poster session on March 7. To characterise the role of laparoscopy in the treatment of cirrhotic patients with hepatocellular carcinoma Dr. Legaspi and colleagues assessed the results of 221 procedures in 161 patients. Histologic diagnosis of hepatocellular carcinoma was established by frozen sections in 200 procedures. The rest of the cases were treated with laparoscopic radiofrequency ablation based on an elevated alfa-fetoprotein. Five patients underwent partial hepatectomy and simultaneous laparoscopic radiofrequency ablation for a separate lesion or lesions. Six patients underwent laparoscopic hepatectomy only. "Laparoscopy can detect stage IV hepatocellular carcinoma not identified by radiologic staging," said Dr. Legaspi. Preoperative radiologic staging failed to identify stage IV disease in 10 patients (4.5%). Extrahepatic metastatic hepatocellular carcinoma was found at laparoscopy to establish stage IV disease. "We can do this operation with really low mortality," said Dr. Legaspi. Only four operative deaths occurred in this cohort, he noted, for an operative mortality of 1.8%. "The second important thing is that we identified some of the factors that are traditionally associated with good survival," he continued. "One [factor] is patients that undergo liver transplant." Other favourable prognostic indicators were a MELD score less than 10, early stage of disease, American Society of Anesthesiologists score of 1 or 2, and an alpha-fetoprotein level less than 50 ng/mL. Survival was 80% at a median follow-up at 11 months, "which is very good when you compare it with resection and with survival with transplantation itself," said Dr. Legaspi. In nontransplant patients, survival was improved significantly in patients with a MELD score less than 10 or a single focus of hepatocellular carcinoma. Resection is indicated in highly select patients with adequate hepatic functional reserve, whereas liver transplant is the standard of care for patients with stage II disease. Unfortunately, these groups represent only a small fraction of patients with hepatocellular carcinoma. Additional surgical techniques useful for the treatment of cirrhotic patients with hepatocellular carcinoma need to be developed to increase the cohort of patients that will benefit from expanded therapeutic options, concluded Dr. Legaspi. [Presentation title: Laparoscopic Management of Hepatocellular Carcinoma. Staging, Radiofrequency Ablation and Resection. Abstract P276]
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