235 HEPATOCELLULAR CARCINOMA AND UNDERLYING LIVER CIRRHOSIS; INFLUENCE ON TREATMENT OR A PROGNOSTIC VALUE?

Background: Despite its benign nature, hepatocellular adenomas (HA) have a potential for malignant degeneration or spontaneous rupture and bleeding. Therefore, surgical resection is the treatment of choice in selected patients. However, radio frequency ablation (RFA) could offer a viable alternative, and might prevent these patients from undergoing major hepatic surgery with associated morbidity and costs. Aim: To investigate the safety and efficacy of RFA for the treatment of HA. Methods: From 2000 to 2009, 168 patients diagnosed with HA in a tertiary hepato-biliary centre were included in a database. For patients undergoing RFA, clinicopathologic data with regard to diagnosis, treatment and outcome were collected. RFA was considered successful if no residual HA tissue was visualized on contrast enhanced CT or MRI 4–6 weeks post-RFA. Results: Of 61 patients undergoing treatment for HA, 17 patients (28%) underwent RFA. Mean age was 29 years. All patients were female with a history of hormonal contraceptive use. Nine patients (53%) had multiple HA, with a median number of 2 lesions (range 1–10) per patient. Median size of the largest HA at the time of RFA was 3.9 cm (range 1.5–6.7). 39 lesions were ablated in 25 sessions (open n=5, percutaneous n =20). Complete remission was acquired in eight patients after one (n =4) or two (n =4) RFAsessions. Another five patients (29%) had radiological evidence of residual HA tissue (≤15mm) bordering the thermal lesion, but due to low clinical importance no further treatment was administered. All of these lesions have remained stable or regressed during followup. Four patients are currently awaiting further therapy or followup. Post-operatively, one patient developed a liver abscess requiring re-intervention and one patient suffered from amajor but reversible complication related to concomitant hemi-hepatectomy. Median hospital stay was 7 days in the open group and 2 days in the percutaneous group. Conclusion: HA can be safely treated using both open and percutaneous RFA. However, often multiple sessions are required and signs of residual adenoma persist in some patients despite repetitive treatment. RFA might be especially beneficial for patients not amenable for surgery or those that would require major hepatic resection otherwise.