Ultrasound-guided thermal ablation versus laparoscopic surgery for focal nodular hyperplasia of the liver: A retrospective controlled study

Abstract

PurposeThis study aims to evaluate the value of the clinical application of ultrasound-guided percutaneous thermal ablation in focal nodular hyperplasia (FNH) by comparing its safety, effectiveness, and patient experience to surgery in the treatment of hepatic FNH ≤5 cm.MethodThis retrospective study enrolled 82 patients with hepatic FNH having a maximum diameter of ≤5 cm, confirmed by postoperative pathologic diagnosis or needle biopsy, who underwent thermal ablation or surgery between January 2019 and September 2021. Postoperative efficacy, surgical trauma (operation time, intraoperative bleeding volume, liver function, and lost volume of normal liver tissue), postoperative complications (postoperative infection, pleural effusion, and liver dysfunction), patient experience (degree and time of postoperative pain, postoperative fasting time, indwelling thoracic chest drain, and scar size), and economic indices (postoperative hospitalization and total charges) were compared between both groups.ResultNo significant difference existed in postoperative efficacy between both groups (p > 0.05). No recurrent or new lesions were observed during the 6-month follow-up in both groups. However, significant differences were observed in operation time, intraoperative bleeding volume, and lost volume of normal liver tissue (p < 0.05), with significantly less trauma in the thermal ablation group. No statistically significant differences in ALT, AST, and Hb existed between both groups (p > 0.05); however, albumin was higher in the ablation group compared to the surgery group (38.21 ± 3.32 vs. 34.84 ± 3.71 g/L, p < 0.05), and WBC were lower in the ablation group (11.91 ± 3.37 vs. 13.94 ± 3.65/L, p < 0.05). The incidence of postoperative complications in the ablation group was significantly lower than that in the surgery group (p < 0.05). Patient experiences were significantly better than in the surgical group (p < 0.05), with economic indicators being significantly less in the ablation group (p < 0.05).ConclusionUltrasound-guided percutaneous thermal ablation can treat hepatic FNH ≤5 cm with similar clinical efficacy as surgery and is an economical, safe, and minimally invasive treatment method worthy of recommendation.

Pedunculated Focal Nodular Hyperplasia: When in Doubt, Should We Cut It Out?

“…Recently, Yao et al [ 125 ] suggested US-guided percutaneous microwave ablation for FNH treatment due to the rapid growth of the tumor in a pediatric patient. Some authors recommended US-guided percutaneous thermal ablation as a valuable minimally invasive approach for treating FNH lesions ≤ 5 cm [ 126 , 127 ]. After US-guided percutaneous microwave ablation, Cheng et al [ 124 ] reported the regrowth of a residual and partially ablated FNH lesion, which was finally treated through embolization.…”

Surgical indications for solid hepatic benign tumors: An updated literature review

“…Currently, there is no consensus on the choice of embolization material for TACE (40). RFA has also been reported to be an effective treatment for symptomatic FNH (41,42). Despite the increasing use of TACE and RFA, however, there is currently insufficient evidence to support their use as first-line treatment options.…”

The New Perspectives Journal of Medicine

“…2.4. 治疗方法 在手术方式上，由于病变周围经常存在大血管，肝 切除术优于肿瘤剥除术，肝切除时选择保留更多肝实质 的方法 (13) 。两项小型病例系列报道TACE可以减少成人 和儿童FNH的大小，缓解患者的症状 (35,36) ，但是目前在 TACE中选择何种栓塞材料还没有达成共识 (37) 。射频消融 (RFA)也被报道为治疗症状性FNH的有效方法 (38,39) 。尽 管TACE和经皮射频消融的应用不断增加，但目前还没有 足够的证据支持其作为一线治疗手段。 建议：治疗方式首选肝切除术。 (27) www.npjmjournal.com 图5. FNH典型MRI影像学图像，钆喷替酸葡甲胺(Gd-DTPA)动 脉期明显强化，门静脉期呈等或略高信号，中间可见明显纤维瘢 痕，肝胆期呈高信号和均匀强化 图6.…”