Hepatocellular carcinoma (HCC) on cirrhosis: Are patients with portal invasion eligible for percutaneous ablation?

Objectives: Untreated HCC with portal vein tumor thrombus has poor prognosis. The aim of our study is to report preliminary results of RF ablation of liver tumor and portal neoplastic thrombus in cirrhotic patients.

Methods: Ten cirrhotic patients with HCC (37–49mm) and neoplastic thrombus of portal vein, underwent RF ablation. Diagnosis of neoplastic thrombus was achieved by fine-needle biopsy. RF ablation was performed firstly on the thrombus and then on the tumor.

Complete efficacy was defined by complete necrosis of HCC evaluated using enhanced-CT and complete recanalization of portal vein analyzed using color-Doppler. RF was performed under US-guidance using a perfused electrode-needle.

Results: The mean number of RF sessions was 2. Complete necrosis of the HCCs with complete recanalization of portal vessels were observed in 7 patients. In the 3 remaining patients necrosis of HCCs and the recanalization of portal vessels were not complete. No deaths occurred after procedure. In 2 cases ascites and increased transaminases were observed and they returned in the normal range in few days. All patients were discharged the day after procedure.

The follow-up ranges from 4 to 20 months. The 7 successful patients are alive, the portal system is still patent and no recurrences were observed. Two patients died three months later, and one presents multiple recurrences.

Conclusions: Our results show that RF ablation can destroy HCC and the accompanied portal thrombus on cirrhosis with high rate of efficacy and low rate of complications. Nevertheless these results need further confirmation and longer follow-up.