Laparoscopic radiofrequency ablation of unresectable hepatic malignancies: Indication, limitation and results

Background/Aims: Radiofrequency-ablation (RFA) is an effective therapeutic option for destruction of irresectable primary and secondary liver tumors and has been successfully performed transcutaneously using sonographic or computer tomographic guidance or by laparotomy. The laparoscopic approach combines a minimal invasiveness with optimal diagnosis. Methodology: Between 02/2003 and 10/2005, 14 patiente with a total of 45 unresectable liver tumors were treated with laparoscopic radiofrequency-ablation in our hospital. Laparoscopic RFA was primarily performed in patients' superficial lesions adjacent to neighboring organs that could be displaced by laparoscopic maneuvers, deep-sited lesions with a very difficult or impossible percutaneous approach and in combination with other laparoscopic operations. Results: All intrahepatic tumors could be detected safely by laparoscopic intraoperative ultrasound. Additional liver lesions were identified in 5 (35.7%) of the 14 patients. All 45 tumors of the 14 patients were able to be completely ablated. Laparoscopic RFA yielded no mortality and only one case of postoperative bleeding. During a mean follow-up period of 23.2 months one patient locally recurred, three patients had new malignant nodules and two patients died with disease. Conclusions: Laparoscopic RFA is safe and provides a minimally invasive procedure with the option of simultaneous inflow-occlusion during thermoablation. Even more, neighboring organs can be protected, simultaneous resections can be performed and intraoperative ultrasound is used to gain further diagnosis.