Abstract
ObjectivesAchievement of adequate treatment margins may be challenging when the target is either difficult to visualize, awkward to access, or situated adjacent to vulnerable structures. Treatment of tumors located close to the diaphragm in the hepatic dome is challenging for percutaneous radiofrequency (RF) ablation for these reasons. The purpose was to assess the feasibility, safety, and clinical outcome of multi-probe stereotactic RF ablation (SRFA) of liver tumors in the subdiaphragmatic area.MethodsBetween 2006 and 2018, 177 patients (82 HCCs, 6 ICCs, and 89 metastatic tumors) underwent SRFA of 238 tumors abutting the diaphragm in the hepatic dome. For comparison, 177 patients were randomly selected from our database by the R package “MatchIt” for propensity score matching to compare treatment safety and efficacy in this retrospective, single-center study.ResultsMedian treated tumor size was 2.2 cm (range 0.5 to 10 cm). SRFA was primarily successful for 232/238 (97.5%) tumors. Five tumors were successfully retreated, resulting in a secondary technical efficacy rate of 99.6%. Local tumor recurrence developed in 21 of 238 tumors (8.8%). The major ablation complication rate was 10.7% (22 of 204). Twelve (55%) of 22 major complications could be successfully treated by the interventional radiologist in the same anesthesia session. There was no significant difference in adverse events or disease control rates between the subdiaphragmatic tumors and matched controls.ConclusionsSRFA is a safe and feasible option in the management of difficult-to-treat tumors abutting the diaphragm in the hepatic dome, with similar safety profile compared with matched controls.Key Points• RFA was primarily successful for 232/238 (97.5%) subdiaphragmatic dome tumors. Local tumor recurrence developed in 21 of 238 tumors (8.8%).• The major complication rate directly related to ablation of the hepatic dome tumors was 10.7% (22 of 204). 12/22 (55%) of major complications could be successfully treated in the same anesthesia session.• There was no significant difference in adverse events or disease control rates between the subdiaphragmatic tumors and matched controls.
Highlights
RF ablation has been increasingly accepted as a curative alternative to surgical resection in the management of primary or metastatic liver tumors [1, 2]
The major complication rate directly related to ablation of the hepatic dome tumors was 10.7% (22 of 204). 12/22 (55%) of major complications could be successfully treated in the same anesthesia session
There was no significant difference in adverse events or disease control rates between the subdiaphragmatic tumors and matched controls
Summary
RF ablation has been increasingly accepted as a curative alternative to surgical resection in the management of primary or metastatic liver tumors [1, 2]. Common strategies include angulated approach sparing the pleura [5] or transthoracic or transpleural access [6,7,8] Hydrodissection is another possible protective method in the hepatic dome [9]. These tumors located posteriorly and superiorly pose a significant technical challenge for laparoscopic liver resection, demanding special approaches and techniques [10]. There are several studies reporting limited local tumor control in subcapsular locations with conventional RF ablation [11], higher complication rates (mainly bleeding), as well as tumor recurrence [12, 13]. Difficult access routes may be facilitated and more precise coverage of the target tumor and safety margin accomplished with frameless stereotactic navigation systems [14]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
