COMPLICATIONS OF LASER THERMAL ABLATION (LTA) FOR HEPATOCELLULAR CARCINOMA: A MULTICENTRIC STUDY ON 520 ITALIAN PATIENTS

Purpose: LTA has been demonstrated a safe and effective image guided ablation technique for HCC only in small series and in selected centers. Aim of this multicentric study was to assess the incidence of LTA complications and associated risk factors in a large population of HCC. Methods and Materials: Retrospective observational study from march 1996 to march 2005 on consecutive HCC patients (9 centers of radiology, internal medicine, gastroenterology) with different experience in LTA and other ablation techniques. An internet based public registry for liver tumor treatments was setup on march 2004 with the collaboration of all the participating centers under the management of one coordinating author (V.A.). Inclusion criteria for this study were: diagnosis of HCC (non surgical), HCC of anynumber and size, ablation treatments with LTA (Pacella CM, Radiology 2001). Demographic characteristics and items related to the patient (Child, prothrombin time, and platelet count,portal hypertension), to HCC nodule (size, site and ease of approach), to LTA procedure (n. of needles/fibers introduced, total energy delivered, necrosis induced) together with the number and type of complications were recorded. Complications were classified as major (death or any condition requiring surgery, interventional procedure or intensive care to be resolved) and minor. Fisher exact, Chi square or Mann-Whitney tests were used for statistic evaluation of association between complications and centers, patients/nodule or LTA characteristics. Results: A total of 520 patients (males 68%, mean age 67.2±7.9% range 24–86yrs; Child score A: 63.4%, B: 30.7%, C: 5.9%) with 652 nodules (single: 69.8%, two: 18.7%, three: 8.6%, four or more: 2.9%; mean diameter 32,3±16.9mm range 6–99mm) were tyreated by 1011 LTA sessions. Major complications were 10/1011 (0.99% with 4 (0.34%) deaths: 3 liver failure and 1 intestinal perforation) not associated with center experience, patient characteristics, nodule features or LTA procedure. Minor complications were 519/1011 (53.1%) LTA sessions and the most frequent were pleural effusion (32.6%), fever (4.9%), pain (4%) and ascites (3.9%). Conclusions: LTA is a safe ablative technique for HCC with low incidence of major complications.