Efficacy of radiofrequency ablation of hepatocellular carcinoma associated with chronic liver disease without cirrhosis.

BACKGROUND: Hepatocellular carcinoma is one of the leading causes of death for compensated chronic liver disease. AIM: The evaluation of technical success as primary ablation rate, local tumor progression, safety, and long--term patients outcome of radiofrequency ablation in single (less than 3.5 cm in diameter) or multiple nodules (up to 3, sized less than 3 cm) of hepatocellular carcinoma associated to chronic liver disease without cirrhosis. MATERIALS AND METHODS: 25 consecutive patients, mainly chronic hepatitis C, with surgical unresectable hepatocellular carcinoma due to comorbidity or tumor location recruited from a local sonographic screening, were treated. RESULTS: Primary ablation was obtained in 96% of patients (24 out of 25) and in 93 % of nodules (27 out of 29). 1, 3, and 5-year local tumor progression rates after treatment were 4, 14, and 14%. Survival rates at 1,3, and 5-year were 92, 72, and 64%. No treatment-related deaths and severe complications were recorded.Conclusions. Radiofrequency ablation is effective with 96% of primary ablation with few tumoral recurrence and limited morbidity in patients with hepatocellular carcinoma associated with chronic liver disease without cirrhosis, it could represent a valid alternative treatment whenever surgical therapy is not safe.

Long-term effectiveness of radiofrequency ablation for hepatocellular carcinoma of 3.5 cm or less.

BACKGROUND/AIMS: Hepatocellular carcinoma is one of the leading causes of death for cirrhosis, and patients are often not eligible for surgery. To evaluate the effectiveness of radiofrequency ablation in single (less than 3.5cm in diameter) or multiple nodules (up to 3, sized less than 3cm) in respect of acceptability, applicability, primary ablation rate, local recurrence, complications, and long-term patients outcome. METHODOLOGY: 184 hepatic nodules detected in 156 consecutive patients recruited from a local sonographic screening were treated. In 10.2% of patients under study, a laparoscopic or laparotomy guided technique was preferred to the percutaneous approach. Overall and tumor-free survivals were estimated by Kaplan-Meier method. For the multivariate analysis, the hazard ratios and their 95 percent confidence intervals were computed by Cox model regression analysis. RESULTS: No treatment-related deaths and a severe complication rate of 3.2% were recorded. Primary complete ablation was obtained in 83.7% of nodules (87.1% of patients), and in a significantly higher rate for nodules up to 2cm (91.3%; p<0.013). Acceptability was 100%, and eligibility was very high (156 out of 160 cases). Local recurrence rate at 1 and 3 years was 10% and 25% respectively. The overall 3- and 5-year survival rates after treatment were 69.3% and 34.6%. Higher survival rates were obtained in the Child A cirrhosis subgroup (p<0.03) after complete response (p<0.001) and in the absence of new lesions (p<0.023). CONCLUSIONS: Radiofrequency ablation has great acceptability and applicability, and is a safe and effective treatment to be used after sonographic screening for small hepatocellular carcinomas.

[Gallbladder adenoma with focal adenocarcinoma: a case report]. / Adenoma con focale adenocarcinoma della colecisti: descrizione di un caso.

Gallbladder polyps represent a frequent and asymptomatic finding on abdominal sonography. We describe the ultrasound features of an asymptomatic 13-mm gallbladder polyp in a 29-year-old male. Video-laparoscopic cholecystectomy was performed, and histological examination of the lesion revealed a severely dysplastic tubular adenoma and chronic cholecystitis. To our knowledge, this is the first report of a gallbladder polyp already presenting severe dysplasia in a young Caucasian male without risk factors.