Ultrasound-guided percutaneous non-contact thermal ablation for sub-capsular hepatocellular carcinoma adjacent to abdominal wall

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Objective To evaluate the clinical efficacy of ultrasound-guided percutaneous non-contact thermal ablation in the treatment of sub-capsular hepatocellular carcinoma (HCC) adjacent to abdominal wall. Methods Clinical data of 30 patients with sub-capsular HCC treated in the Third Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2015 were retrospectively analyzed. Among them, 24 patients were male and 6 were female, aged from 28 to 72 years with a median age of 56 years. The maximum diameter of the lesions ranged from 10 to 40 mm, and the median diameter was 20 mm. The informed consents of all patients were obtained and the local ethical committee approval was received. Ultrasound-guided percutaneous trans-hepatic ablation was performed through the normal liver tissues to the deep side of tumor rather than directly puncturing through the tumors. Lesions involving tumor blood supply arteries were ablated primarily. The complete ablation rate and the incidence of postoperative complications were observed. Results Radiofrequency ablation was performed in 19 cases and microwave ablation in 11 cases with a total of 31 lesions. The residual margin lesion was found in only 1 case. The complete ablation rate was 97%(30/31). Intraoperatively, artificial abdominal ascites were performed in 12 cases, artificial pleural ascites in 1 case, artificial pleural and abdominal ascites in 3 cases, and no auxiliary interventions in 14 cases. No active bleeding occurred at the puncture site during and after operation. No postoperative complications were observed. During the postoperative follow-up, intra-hepatic recurrence occurred in 17 cases. No tumors were found at the peri-liver area or the abdominal cavity. Conclusions For the sub-capsular HCC adjacent to abdominal wall, ultrasound-guided percutaneous thermal ablation through the normal liver tissues in a non-contact way, combined with artificial auxiliary interventions, can achieve a safe and efficacious treatment. Key words: Liver neoplasms; Ultrasonography, interventional; Catheter ablation