Percutaneous laser ablation (PLA) in cirrhotic patients with hepatocellular carcinoma (HCC) submitted to liver transplantation (OLT): Assessment of effectiveness at explant analysis
Purpose: To analyse the effectiveness of PLA in cirrhotic patients with HCC submitted to OLT.
Methods: Data of 10 cirrhotic patients (all males, mean age 52,8yrs; Child-Pugh class A/B/C=5/4/1; 6 cases with a single tumor nodule) undergoing OLT between 2002 and 2006 were reviewed. Twelve biopsy-proven HCC tumors (mean diameter 2cm, range 1,5–3cm) underwent PLA treatments carried out by inserting 300 nm optical fibers through 21-g needles (from two to four) positioned under US guidance into the target lesions. A continuous wave Nd:YAG laser operating at a wave length of 1,064 nm was used. Seven tumors underwent a single PLA session. A single session of Transarterial chemoembolization (TACE) prior to OLT was carried in three incompletely ablated nodules.
Results: The mean waiting time for OLT was 10,9 months (range 1–28 mo). Complete necrosis at histological examination of the explanted livers was found in 7 nodules (58%, all treated exclusively with PLA), partial necrosis >50% in 3 nodules (25%, 2 treated with a combination of PLA and TACE), partial necrosis <50% in 1 nodule, absent necrosis in 1 nodule (treated with both PLA and TACE). In the latter case the final histological diagnosis was that of a yolk sac tumor. Mean follow-up length was 22.2 months: 5 patients are alive without tumor recurrence whereas the remaining 5 were dead (only one with recurrent intrahepatic HCC).
Conclusions: Our preliminary data suggest that PLA is an effective bridge treatment in cirrhotic patients with HCC smaller than 3cm listed for OLT.