Intraoperative radiofrequency ablation with or without tumorectomy for hepatocellular carcinoma in locations difficult for a percutaneous approach

BACKGROUND:Although hepatic resection is widely accepted as a proper modality for treating hepatocellular carcinoma(HCC),a majority of patients are unable to undergo surgical resection due to various tumor and patient factors.Radiofrequency ablation(RFA)has mostly been used as a therapeutic alternative to resection for treating HCC.The objective of this study was to evaluate the results of intraoperative RFA for HCCs in locations difficult for a percutaneous approach.METHODS:Eight patients(male,seven;age,49-67 years) with 8 HCCs in difficult locations were treated by intraoperative RFA.Six of the patients had local tumor progression after initial transarterial chemoembolization or ultrasound(US)guided percutaneous RFA.The locations of the tumors were hepatic dome in six patients,posterior subcapsule in one,and caudate lobe in one.The tumor size was 2.0 to 6.4 cm(mean,3.9 cm).Intraoperative RFA was performed at the tumor itself and an anticipated resection line under US guidance with 3 cm monopolar single or clustered internally cooled electrodes.Tumor resection was performed in six patients.One month later,treatment response was assessed by contrast material-enhanced computed tomography(CT).CT studies were performed every 2 or 3 months after RFA.RESULTS:RFA was technically successful in all tumors,and the contrast-enhanced CT images acquired one month later showed complete disappearance of tumor enhancement.One pneumothorax occurred.After a median follow-up of 18 months(range,6-30 months),no tumors showed local progression.During the follow-up period,four new recurrent tumors were observed in three patients.Four patients were alive at the time of this report and the other four died of hepatorenal syndrome,liver failure,and progression of new recurrent tumors.CONCLUSION:Intraoperative RFA with tumor resection can be an alterative treatment option for HCC in locations difficult for a percutaneous approach.

Outcome of laparoscopic cholecystectomy is not influenced by chronological age in the elderly

AIM:To evaluate the outcome of laparoscopic cholecystectomy(LC)in patients aged 80 years and older. METHODS:A total of 353 patients aged 65 to 79 years(group 1)and 35 patients aged 80 years and older(group 2)underwent LC.Patients were further classified into two other groups:those with uncomplicated gallbladder disease(group A)or those with complicated gallbladder disease(group B). RESULTS:There were no significant differences between the age groups(groups 1 and 2)with respect to clinical characteristics such as age,gender,comorbid disease,or disease presentation.Mean operative time,conversion rate,and the incidence of major postoperative complications were similar in groups 1 and 2.However,the percentage of high-risk patients was significantly higher in group 2 than in group 1 (20.0%vs 5.7%,P<0.01).Group A comprised 322 patients with a mean age of 71.0±5.3 years,and group B comprised 51 patients with a mean age of 69.9±4.8 years.In group B,mean operative time (78.4±49.3 min vs 58.3±35.8 min,P<0.01),mean postoperative hospital stay(7.9±6.5 d vs 5.0±3.7 d, P<0.01),and the incidence of major postoperative complications(9.8%vs 3.1%,P<0.05)were significantly greater than in group A.The conversion rate tended to be higher in group B,but this difference was not significant. CONCLUSION:Perioperative outcomes in elderly patients who underwent LC seem to be influenced by the severity of gallbladder disease,and not by chronologic age.In octogenarians,LC should be performed at an earlier,uncomplicated stage of the disease whenever possible to improve perioperative outcomes.

Surgical palliation of unresectable pancreatic head cancer in elderly patients

AIM: To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer. METHODS: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life. RESULTS: Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively). The median hospital-free survival period and themedian overall survival were also signifi cantly longer in Group A (P = 0.001 and P < 0.001, respectively). CONCLUSION: Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer.