Background/Objectives Intraoperative (open or laparoscopic) cryosurgery and radiofrequency tumor ablation (RFA) have become important options for patients with malignant liver lesions not amenable to resection. The purpose of this study is to evaluate laparoscopic accessibility of these lesions, identify any technical limitations to the various segments of the liver and to report our outcomes.
Methods We retrospectively reviewed charts on 17 patients who underwent ultrasound-guided cryosurgery or RFA for malignant liver lesions. Ablation was performed on a total of 28 lesions in 7 patients. Cryosurgery was performed on a total of 20 lesions in 12 patients. Two patients underwent both RFA and cryosurgery. All experience with cryosugery was early in this series of patients. The charts were evlauated to see if the procedure was intended to be performed laparoscopically and if so was it successfully completed or was conversion to open required. Technical limitations were analyzed.
Results Laparoscopic RFA was completed successfully on lesions in segments 1,2,3,5,6,7 and 8. One patient was converted to open in order to address tumor extending into an adjacent segment of colon. Another patient underwent planned trans-diaphragmatic ablation of a lesion in the dome of the liver during thoracotomy for a synchronous lung lesion. There were no immediate or late complications. After a mean follow-up of 6.4 months there were no recurrences. One port site metastasis occurred and one patient had 4 new lesions discovered eight months after surgery. Laparoscopic cryosurgery was completed on lesions in segments 2,3,4,6,7 and 8. Two patients required conversion from laparoscopy; one for dense adhesions and the other for safe exposure of a segment 6 lesion abutting the stomach. Three patients suffered complications from cryosurgery including two post-operative deaths. After a mean follow-up of 9.3 months there was one recurrence. The average length of hospitalization (LOH) was greatest for those who underwent open surgery at 8.0 days. For cryosurgery performed laparoscopically the average LOH was 4.4 days, and for laparoscopic RFA 1.8 days.
Conclusions Every segment of the liver is accessible to laparoscopic tumor destruction. In experienced hands and under ultrasound guidance laparoscopic RFA can be performed with excellent results, short hospitalization and minimal complicaions.
