Abstracts
1999 Digestive Disease Week

# 2118 LAPAROSCOPIC-GUIDED LARGE VOLUME ETHANOL INJECTION FOR ENCAPSULATED EPATOCELLULAR CARCINOMA IN PATIENTS WITH CIRRHOSIS
Santiago Horgan, Thomas C. Winter, Univ of Washington, Seattle, WA; William S. Helton, Univ of Illinois at Chicago, Chicago, IL

Percutaneous ethanol injection (PEI) under conscious sedation is a common way of treating small (<3 cm) hepatocellular carcinoma (HCC) in pts with cirrhosis. PEI is difficult for surface tumors, those under the diaphram and is limited by the volume that can be injected in a single session. The purpose of this study was to evaluate the effectiveness of injecting a large volume of PEI for HCC in a single session under general anesthesia using laparoscopic ultrasound (LUS) guidance. 17 cirrhotic pts (Child A or B) with HCC (mean tumor size, 4.5 +/- 0.5 cm) were treated over 3 years.15/17 pts had Hepatitis B and/or C. 98% ethanol (35-80 cc) was injected into the lesion(s) in a single setting under LUS. PEI was administered until tumor blood flow disappeared by power doppler. Pts were followed with US,CT and serum alpha fetal protein. There was no mortality, minimal post op pain, and 3 complications (intoxication in 1 pt, DIC and post op bleeding in 1 pt). Local recurrence occurred in 3 pts at an average of 6 months post op but no pt has died as the result of the primary HCC. 3 pts expired from liver failure within 1 year of treatment. Hospital stay was <24 hr in 16 pts and 6 days in the pt with DIC. 11 pts (65%) developed multiple HCC at sites remote from the primary tumor. Conclusions: LUS-guided PEI injection is a safe and effective means of treating cirrhotic pts with unresectable HCC. Advantages of this approach compared to PEI under conscious sedation are its simplicity, ability to treat large lesions in difficult locations, high pt satisfaction and the need for a single treatment session. Prospective trials comparing large volume, LUS-guided PEI with other non-resection forms of therapy for HCC are indicated.

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