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(142) Resection of hepatocellular carcinoma with liver cirrhosis
Hepatocellular carcinoma / Arab Journal of Gastroenterology 10 (2009) AB53–AB60
period of three years (2003–2008). All data concerning the patient, the underlying liver disease and HCC were analysed. The session of radiofrequency ablation was ultrasound-guided under general anaesthesia in a surgical unit. The response of therapy was assessed by CT scan a month after treatment. Results: A total of 17 patients were included (11 men and six women). The mean age was 68 years. All our patients had a liver cirrhosis secondary of chronic hepatitis C; one patient had co-infection B and C. All HCC treated in our serie was mononodular with an average size of 26 mm (range 12–65 mm). The rate of complete necrosis was 76% after a single session of radio frequency. This rate passed to 94% after repeating the percutaneous treatment.In a follow-up period of 2–48 months the local recurrence rates were 5% and 30% recurrence in other location. Some minor complications have been reported in 30% like abdominal pain and fever but no major complication was noted. Survival rate was 94% one year after the treatment. Conclusion: RFA with standard protocol has evolved as a minimally invasive local treatment that could achieve satisfactory outcomes for small liver tumors, and has become an effective and safe therapeutic option. doi:10.1016/j.ajg.2009.07.116
(141) Multipolar radiofrequency ablation using ‘‘no touch’’ technique in patients with cirrhosis and hepatocellular carcinoma up to 5.5 cm safety and short term efficiency B. Oudghiri a, G. NÕKontchou a, O. Seror b, Y. Ajavon b, N. Ganne Carrie a, V. Grando a, J.C. Trinchet a, N. Sellier b, M. Beaugrand a a Liver Unit, Hôpital Jean Verdier, AP-HP, Bondy, France b Radiology unit, Hôpital Jean Verdier, AP-HP, Bondy, France
Background: The multipolar radiofrequency ablation (RA) technique using 2–4 bipolar coaxial electrodes allows the complete ablation of even large tumors. The ‘‘no touch’’ variant is a multipolar RA technique characterized by the insertion of electrodes close but external to the tumor in order to manage a safety margin and to avoid spreading of tumoral cells. This pilot study was aimed to assess the safety and efficiency of this novel technique. Patients methods: Thirty-six patients (34 male, aged 68 ± 2 year) presenting with cirrhosis (Child–Pugh A/B: 28/8) and HCC (n = 41 uninodular = 31 binodular = 5 with a mean diameter = 3 ± 0.9 cm ranging from 1.9 to 5.5 cm) have been treated by a multipolar ‘‘no touch’’ RA technique under general anesthesia. The patients were closely followed and evaluated by triphasic CT and serum AFP measurements at 1 month and every 3 months. Tolerance and short term efficiency were assessed. Results: A complete ablation was obtained in all cases after 1 (n = 33) or 2 (n = 3) procedures. The procedures had a mean 30 mn (16–45 ) duration, used 2–4 electrodes and allowed the delivery of a mean energy of 112 kj (40–220 kj). After a mean follow-up of 9.7 months (superior to 12 in 14 patients) no local recurrence and four distant recurrences were observed. Two patients died during follow-up: one from bacterial peritonitis more than a month after the procedure and patient due to inhalation pneumonitis 2 months after the procedure. Four other patients had post procedure resolving complications: transient ictere (1) or pleural effusion (3). Conclusion: The ‘‘no touch’’ multipolar RA technique allows complete the ablation of tumors up to 5.5 cm without early local recurrence. Tolerance seems to be fair but must be assessed in larger numbers as well as long term results. doi:10.1016/j.ajg.2009.07.117
AB59
(142) Resection of hepatocellular carcinoma with liver cirrhosis A. Belkouchi a, H.O. El Malki a,b, M. Chenna a, Mouaquit a, B.A. Oudrhiri a, B. Serji a, O.M. Soufi a, R. Mohsine a, L. Ifrine a a Clinique Chirurgicale ‘‘A’’, Hôpital Ibn Sina, Rabat, Morocco b Centre de Recherche en Epidémiologie Clinique et Essais Thérapeutiques, Faculté de Médecine et de Pharmacie de Rabat, Morocco
Introduction: Hepatocellular carcinoma (CHC) usually develops on a cirrhosis, more rarely on a noncirrhotic chronic hepatopathy, exceptionally on a healthy liver. In the event of cirrhosis, there is thus a cancer. The aim of this work was to report our experience in treatment of CHC in our department and discuss the optional therapeutic and management in these lesions. Drank: The goal of this study is to elucidate the place of the surgery and its results in the treatment of the CHC like in the treatment of the cirrhosis. Methods: The authors report a series of 92 patients reached of CHC on liver of cirrhosis. Over 10 years. They are 60 men and 32 women of 43 years average age. The cirrhosis was of origin post viral hepatitis C in 75% of case. The diagnosis rested on the private clinic and the us of monitoring. The classification of Child and Pugh is used the most and 65% of the patients were child A. The rate of operability and resecability was, respectively, 78% and 77% of the cases. The surgical gesture consisted of an wedge resection in 59% an hepatectomy in 25%, a major hepatectomy in 15%. Results: Mortality rate was 8%, and operational morbidity rate was 22%. The recurrence rate was 16% of the cases. Conclusion: The best treatment option for patients with hepatocellular carcinoma (HCC) and cirrhosis, remains to be established. Transplantation is the treatment of choice, it has the advantage of treating the tumour and its cause. But it keeps precise information, as for the resection, it gives of worse results, it is discussed if the hepatic function allows it and if the hepatic resection necessary is not too significant. doi:10.1016/j.ajg.2009.07.118
(143) Treatment of advanced hepatocellular carcinoma with Sorafenib F. Haddad, J.M. Peron, J.P. Vinel Service dÕHépato-Gastro-Entérologie, Hôpital PURPAN, Toulouse, France
Sorafenib is a multikinase inhibitor. It allows a double inhibition of tumor-cell proliferation and tumor angiogenisis. It is indicated in patients with multinodulaire hepatocellular carcinoma not within a chemoembolization, with a Child–Pugh liver function class A. The aim of our study was to evaluate the efficacy and side effects of sorafenib in patients with advanced hepatocellular carcinoma. Twenty patients were followed between July 2007 and August 2008. The diagnosis of hepatocellular carcinoma was selected on imaging technique and/or histology. The indication of treatment was delivered during a Meeting pluridisciplinary, specifically dedicated to the management of hepatocellular carcinoma. Treatment with sorafenib was issued for a median of 135 days. About 30% of patients had a concession of the dose during treatment, and 50% had a discontinuation of treatment. The median survival was 179 days with an average follow-up period of 152 days. A progression of the tumor is found in 45% of cases, with a stabilization of the tumor in 20% of cases. The actuarial survival rate is 88% at 3 months and 47% at 6 months. Adverse events were dominated by diarrhea (80%), asthenia (75%), hand-foot syndrome (55%) and anorexia (45%). The grade 3–4 adverse events the most frequent were asthenia (35%), hand-foot syndrome (20%) and diarrhea (20%).
period of three years (2003–2008). All data concerning the patient, the underlying liver disease and HCC were analysed. The session of radiofrequency ablation was ultrasound-guided under general anaesthesia in a surgical unit. The response of therapy was assessed by CT scan a month after treatment. Results: A total of 17 patients were included (11 men and six women). The mean age was 68 years. All our patients had a liver cirrhosis secondary of chronic hepatitis C; one patient had co-infection B and C. All HCC treated in our serie was mononodular with an average size of 26 mm (range 12–65 mm). The rate of complete necrosis was 76% after a single session of radio frequency. This rate passed to 94% after repeating the percutaneous treatment.In a follow-up period of 2–48 months the local recurrence rates were 5% and 30% recurrence in other location. Some minor complications have been reported in 30% like abdominal pain and fever but no major complication was noted. Survival rate was 94% one year after the treatment. Conclusion: RFA with standard protocol has evolved as a minimally invasive local treatment that could achieve satisfactory outcomes for small liver tumors, and has become an effective and safe therapeutic option. doi:10.1016/j.ajg.2009.07.116
(141) Multipolar radiofrequency ablation using ‘‘no touch’’ technique in patients with cirrhosis and hepatocellular carcinoma up to 5.5 cm safety and short term efficiency B. Oudghiri a, G. NÕKontchou a, O. Seror b, Y. Ajavon b, N. Ganne Carrie a, V. Grando a, J.C. Trinchet a, N. Sellier b, M. Beaugrand a a Liver Unit, Hôpital Jean Verdier, AP-HP, Bondy, France b Radiology unit, Hôpital Jean Verdier, AP-HP, Bondy, France
Background: The multipolar radiofrequency ablation (RA) technique using 2–4 bipolar coaxial electrodes allows the complete ablation of even large tumors. The ‘‘no touch’’ variant is a multipolar RA technique characterized by the insertion of electrodes close but external to the tumor in order to manage a safety margin and to avoid spreading of tumoral cells. This pilot study was aimed to assess the safety and efficiency of this novel technique. Patients methods: Thirty-six patients (34 male, aged 68 ± 2 year) presenting with cirrhosis (Child–Pugh A/B: 28/8) and HCC (n = 41 uninodular = 31 binodular = 5 with a mean diameter = 3 ± 0.9 cm ranging from 1.9 to 5.5 cm) have been treated by a multipolar ‘‘no touch’’ RA technique under general anesthesia. The patients were closely followed and evaluated by triphasic CT and serum AFP measurements at 1 month and every 3 months. Tolerance and short term efficiency were assessed. Results: A complete ablation was obtained in all cases after 1 (n = 33) or 2 (n = 3) procedures. The procedures had a mean 30 mn (16–45 ) duration, used 2–4 electrodes and allowed the delivery of a mean energy of 112 kj (40–220 kj). After a mean follow-up of 9.7 months (superior to 12 in 14 patients) no local recurrence and four distant recurrences were observed. Two patients died during follow-up: one from bacterial peritonitis more than a month after the procedure and patient due to inhalation pneumonitis 2 months after the procedure. Four other patients had post procedure resolving complications: transient ictere (1) or pleural effusion (3). Conclusion: The ‘‘no touch’’ multipolar RA technique allows complete the ablation of tumors up to 5.5 cm without early local recurrence. Tolerance seems to be fair but must be assessed in larger numbers as well as long term results. doi:10.1016/j.ajg.2009.07.117
AB59
(142) Resection of hepatocellular carcinoma with liver cirrhosis A. Belkouchi a, H.O. El Malki a,b, M. Chenna a, Mouaquit a, B.A. Oudrhiri a, B. Serji a, O.M. Soufi a, R. Mohsine a, L. Ifrine a a Clinique Chirurgicale ‘‘A’’, Hôpital Ibn Sina, Rabat, Morocco b Centre de Recherche en Epidémiologie Clinique et Essais Thérapeutiques, Faculté de Médecine et de Pharmacie de Rabat, Morocco
Introduction: Hepatocellular carcinoma (CHC) usually develops on a cirrhosis, more rarely on a noncirrhotic chronic hepatopathy, exceptionally on a healthy liver. In the event of cirrhosis, there is thus a cancer. The aim of this work was to report our experience in treatment of CHC in our department and discuss the optional therapeutic and management in these lesions. Drank: The goal of this study is to elucidate the place of the surgery and its results in the treatment of the CHC like in the treatment of the cirrhosis. Methods: The authors report a series of 92 patients reached of CHC on liver of cirrhosis. Over 10 years. They are 60 men and 32 women of 43 years average age. The cirrhosis was of origin post viral hepatitis C in 75% of case. The diagnosis rested on the private clinic and the us of monitoring. The classification of Child and Pugh is used the most and 65% of the patients were child A. The rate of operability and resecability was, respectively, 78% and 77% of the cases. The surgical gesture consisted of an wedge resection in 59% an hepatectomy in 25%, a major hepatectomy in 15%. Results: Mortality rate was 8%, and operational morbidity rate was 22%. The recurrence rate was 16% of the cases. Conclusion: The best treatment option for patients with hepatocellular carcinoma (HCC) and cirrhosis, remains to be established. Transplantation is the treatment of choice, it has the advantage of treating the tumour and its cause. But it keeps precise information, as for the resection, it gives of worse results, it is discussed if the hepatic function allows it and if the hepatic resection necessary is not too significant. doi:10.1016/j.ajg.2009.07.118
(143) Treatment of advanced hepatocellular carcinoma with Sorafenib F. Haddad, J.M. Peron, J.P. Vinel Service dÕHépato-Gastro-Entérologie, Hôpital PURPAN, Toulouse, France
Sorafenib is a multikinase inhibitor. It allows a double inhibition of tumor-cell proliferation and tumor angiogenisis. It is indicated in patients with multinodulaire hepatocellular carcinoma not within a chemoembolization, with a Child–Pugh liver function class A. The aim of our study was to evaluate the efficacy and side effects of sorafenib in patients with advanced hepatocellular carcinoma. Twenty patients were followed between July 2007 and August 2008. The diagnosis of hepatocellular carcinoma was selected on imaging technique and/or histology. The indication of treatment was delivered during a Meeting pluridisciplinary, specifically dedicated to the management of hepatocellular carcinoma. Treatment with sorafenib was issued for a median of 135 days. About 30% of patients had a concession of the dose during treatment, and 50% had a discontinuation of treatment. The median survival was 179 days with an average follow-up period of 152 days. A progression of the tumor is found in 45% of cases, with a stabilization of the tumor in 20% of cases. The actuarial survival rate is 88% at 3 months and 47% at 6 months. Adverse events were dominated by diarrhea (80%), asthenia (75%), hand-foot syndrome (55%) and anorexia (45%). The grade 3–4 adverse events the most frequent were asthenia (35%), hand-foot syndrome (20%) and diarrhea (20%).