Intraoperative US-guided large volume ethanol injection for hepatocellular carcinoma greater than 4 cm

BACKGROUND: Percutaneous ethanol injection has been successfully used for hepatocellular carcinomas (HCC) smaller than 5 cm in size. For larger lesions large volume ethanol injection has not been well explored. AIM: Evaluate the results of intraoperative Ultrasonographic-guided large volume ethanol injection for HCC larger than 4 cm in size. PATIENTS AND METHODS: Ten patients were candidates for this treatment between June 1999 and July 2003. A retrospective review of the clinical files was performed. Absolute ethanol, average of 100 mL (range 80-120 mL) was administered intraoperatively. Follow-up evaluation included alpha-fetoprotein (AFP) and ultrasound or computed tomography. RESULTS: There were six women and four men, the median age was 62 years (range 56-80). The median lesion size was 8 cm (range 4-15 cm). Hepatitis C liver cirrhosis was the most common associated chronic liver disease (70%). A significant reduction of AFP levels after treatment was observed (Initial 966 ng/dL, post treatment levels: 42 ng/dL) US and CT scan showed tumor necrosis. Morbidity was 40%. No operative mortality was recorded. The one and four year survival rate was 60% and 20%. CONCLUSION: Intraoperative US-guided large volume ethanol injection is a safe palliative therapy for cirrhotic patients with HCC lesions greater than 5 cm in size. The impact on survival should be compared in a controlled double blind study.