TITLE:
Percutaneous Radiofrequency Ablation of Hepatocellular Carcinoma against the Diaphragm: Is Artificial Ascites Necessary?
AUTHORS:
Kathleen Khong, Ho Nguyen, Chin-Shang Li, Danny Cheng, John P. McGahan
KEYWORDS:
Radiofrequency Ablation; Hepatocellular Carcinoma; Hepatoma; Artificial Ascites; Diaphragm
JOURNAL NAME:
Open Journal of Radiology,
Vol.4 No.1,
February
20,
2014
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.