Percutaneous Radiofrequency Ablation for the Hepatocellular Carcinoma Abutting the Diaphragm: Assessment of Safety and Therapeutic Efficacy.
- Author:
Tae Wook KANG
1
;
Hyunchul RHIM
;
Eun Young KIM
;
Young Sun KIM
;
Dongil CHOI
;
Won Jae LEE
;
Hyo K LIM
Author Information
- Publication Type:Original Article ; Comparative Study
- Keywords: Hepatocellular carcinoma; Diaphragm; Radiofrequency ablation; Ultrasonography; Computed tomography (CT)
- MeSH: Adult; Aged; Aged, 80 and over; Burns/etiology; Carcinoma, Hepatocellular/pathology/*surgery; Catheter Ablation/*adverse effects; Diaphragm/injuries/pathology; Female; Humans; Liver Neoplasms/pathology/*surgery; Lung Injury/etiology; Male; Middle Aged; Shoulder Pain/etiology; Treatment Outcome; Young Adult
- From:Korean Journal of Radiology 2009;10(1):34-42
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVE: To assess the safety and therapeutic efficacy of a percutaneous radiofrequency (RF) ablation for the hepatocellular carcinoma (HCC) abutting the diaphragm. MATERIALS AND METHODS: We retrospectively assessed 80 patients who underwent a percutaneous RF ablation for a single nodular (< 4 cm) HCC over the last four years. Each patient underwent an ultrasound-guided RF ablation using internally cooled electrodes for the first-line treatment. We divided patients into two subgroups based on whether the index tumor was abutting (less than 5 mm) the diaphragm or not: group A (abutting; n = 31) versus group B (non-abutting; n = 49). We compared the two subgroups for complications and therapeutic efficacy using image and the review of medical records. The statistical assessment included an independent t-test, Fisher's exact test, and chi-square test. RESULTS: The assessment of the diaphragmatic swelling at CT immediately following the procedure was more severe in group A than group B (mean thickness change:1.44 vs. 0.46 mm, p = 0.00). Further, right shoulder pain was more common in group A than B (p = 0.01). Although minor complications (hemothorax 1 case, pleural effusion 1 case) were noted only in group A, no major thoracic complication occurred in either group. The technical success rate was lower in group A than group B (84% vs. 98%, p = 0.03). As well, the primary and secondary technique effectiveness rates in group A and group B were 90% versus 98% (p = 0.29) and 79% versus 91% (p = 0.25), respectively. The local tumor progression rate was higher in group A than in group B (29% vs. 6%, p = 0.02). CONCLUSION: We found that the percutaneous RF ablation for the HCC abutting the diaphragm is a safe procedure without major complications. However, it is less effective with regard to technical success and local tumor control.
