Surgical radiofrequency ablation for treatment of hepatocellular carcinoma: an endoscopic or open approach

Radiofrequency ablation (RFA) is widely used for the treatment of unresectable hepatocellular carcinoma (HCC) with cirrhosis, however, unexpected injuries to the adjacent organs remains the most critical problem after endoscopic radiofrequency ablation (RFA) using a percutaneous approach. The endoscopic RFA is a minimally invasive treatment for HCC with difficultly in the location due to limited percutaneous access. In this study, it was used an endoscopic approach or an open surgical approach for the treatment of 46 patients with unresectable HCC. There was difficulty in ablating the lesions due to limited percutaneous access. The endoscopic approach was assessed for 26 patients with primary HCC, and the open approach was used for 18 patients of recurrent HCC after surgical resection as well as the other 2 patients with multiple HCCs. The endoscopic RFA was performed using a laparoscopic approach for 20 cases and a thoracoscopic approach for 6 cases. The endoscopic RFA had significantly less intraoperative blood loss compared to the open RFA (56 g vs. 277 g; p < 0.001) as well as a reduced postoperative hospital stay (13 days vs. 16 days; p < 0.05). The occurrence of postoperative complications did not different between the two groups; 5 of 26 cases of the endoscopic RFA, and in 3 of 20 cases of the open RFA. The local recurrence of HCC occurred in only 1 case for each group, and the patient survival did not differ significantly between the groups. Endoscopic RFA is a feasible and reliable therapy for unresectable primary HCCs in the patients with cirrhosis.