Abstract
Purpose: To evaluate the utility of artificial ascites induction for radiofrequency ablation (RFA) of peridiaphragmatic hepatocellular carcinoma (HCC) through retrospective cohort analysis comparing characteristics and complications of peridiaphragmatic HCC without the use of artificial ascites to non-peridiaphragmatic HCC. Materials and Methods: IRB approval was obtained. From September 2003 to December 2008, 150 consecutive patients with hepatic tumors received percutaneous RFA. 110 patients had presumed HCC, and of those 21 had lesions abutting the diaphragm. Of the remaining 89 patients with non-peridiaphragmatic HCC lesions, 21 were randomly selected for the comparison group. RFA volume, major and minor complication rates, pain, technical success, and recurrence rates were compared between the two groups. Results: There was no statistical difference in RFA volume (P = 0.962), overall major complication rate (P = 0.343) and minor complication rate (P = 0.118) between the two groups. However, the peridiaphragmatic group that underwent RFA with a clustered-needle demonstrated a statistically significant higher proportion of major complications compared to the non-peridiaphragmatic clustered-needle group (P = 0.033). There was no statistical difference in pain severity (P = 0.8802) or pain location (P = 0.15). There was no statistical difference in technical success rates (P = 1), local tumor progression rates (P = 1), or time to local tumor recurrence (P = 0.67). Conclusion: Artificial ascites induction for RFA of HCC lesions adjacent to the diaphragm may not be necessary, although clustered electrode technique should be avoided in this location as they present with a higher complication rate.
Highlights
Radiofrequency ablation (RFA) has proven to be a safe and successful technique for the control and treatment of hepatic tumors [1]-[6]
Similar criteria were used in the nonperidiaphragmatic group defining hepatocellular carcinoma (HCC) by Biopsy (N = 4) or by CT criteria (N = 17)
Previous review of literature reports a rate of diaphragmatic injury in only 0.16% (6/3670) of all hepatic tumor RFA cases [7], [19]
Summary
Radiofrequency ablation (RFA) has proven to be a safe and successful technique for the control and treatment of hepatic tumors [1]-[6]. Diaphragmatic injury during RFA of tumors adjacent to the diaphragm is one of the more commonly discussed complications with both animal and human studies addressing the frequency of injury after RFA [4], [9]-[25]. Some have concluded that RFA adjacent to the diaphragm is contraindicated or that special interventional techniques are necessary to separate the diaphragm from the liver [23]-[25], which include artificial ascites, or hydrodissection [27], through improved visualization of tumor and reduced risk of diaphragmatic thermal injury [24], [27], [31]-[35]
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