Case Study of Hepatic Radiofrequency Ablation Causing a Systemic Inflammatory Response Under Total Intravenous Anesthesia

Abstract

ObjectiveTo investigate the effects of hepatic radiofrequency ablation (RFA) in patients with malignant liver disease with respect to inflammation activation and stress response.Materials and MethodsIn an observational trial, we investigated the physiologic parameters of 17 patients (20 interventions) who underwent percutaneous RFA under general anesthesia after applying total intravenous anesthesia. TNFα, IL-6, IL-8, IL-10, adrenaline and noradrenaline, liver enzymes, lactate and creatine kinase were determined pre-interventionally after induction of anesthesia (T1), 90 minutes after initiation of RFA (T2), immediately after the conclusion of the procedure (T3), and 24 hours after the procedure (T4).ResultsA significant increase in body temperature (p < 0.001), and mean arterial pressure (p = 0.001) were measured intraoperatively (T2) and the day after the procedure (T4). Increased levels of IL-6 were measured at T3 and T4 (p = 0.001). IL-10 increased immediately after the procedure (T3; p = 0.007). IL-6 levels correlated well with the total energy applied (r = 0.837). Significant increases in the levels of adrenaline and noradrenaline were present at T3 and T4 (p < 0.001). The RFA-induced destruction of hepatic tissue was associated with increased levels of AST, ALT, GLDH and LDH.ConclusionPercutaneous RFA of hepatic malignancies causes an inflammatory and endocrine activation, similar to the systemic inflammatory response syndrome. These effects have to be taken in account when dealing with patients susceptible to sepsis or multi-organ failure.

US-guided high-intensity focused ultrasound (HIFU) of abdominal tumors: outcome, early ablation-related laboratory changes and inflammatory reaction. A single-center experience from Germany

“…An increase of lactate dehydrogenase (LDH) as a marker of permeabilization of plasma membrane and thus cell necrosis was evident in both patient groups. We observed that serum LDH increased after 2 h, 5 h and 20 h in PaC patients and after 20 h in patients with uterine fibroids comparable with previous clinical data of percutaneous RFA of patients with malignant liver tumors that show significant LDH increase at 24 h after treatment [40]. Our results indicate a consecutive early and systemic inflammatory reaction after HIFU as an elevation of white blood cells compared to baseline was observed in both patient groups.…”

Irreversible Electroporation versus Radiofrequency Ablation: A Comparison of Local and Systemic Effects in a Small-Animal Model

“…Nevertheless, this issue is becoming ever more important as we become aware of potential systemic effects of what have previously been considered focal ablative treatments (6)(7)(8)(9)(10). Indeed, local hepatic or tumor RF ablation can stimulate proinflammatory factors, including the following: interleukin 6 (IL-6), which activates the NF-kB signaling pathway; the c-Met pathway; and both hypoxia-inducible factor 1a and vascular endothelial growth factor upregulation, which can lead to increased angiogenesis and subsequent tumorigenesis (11)(12)(13)(14)(15)(16). Furthermore, RF ablation of as little as 3% of normal mouse liver can result in sufficient inflammatory changes to induce both global liver regeneration and new tumor formation (17,18).…”

More Than Just Tumor Destruction: Immunomodulation by Thermal Ablation of Cancer

“…Several groups have evaluated the systemic release of cytokines, chemokines, and various stress factors after RF ablation. Serum levels of proinflammatory cytokines like interleukins IL-1 β , -6, and -8, as well as TNF were found to be either increased [ 51 – 54 ] or unchanged [ 133 , 134 ]. In general, changes were modest and transient (several hours to days after ablation) [ 38 , 52 , 53 , 134 ].…”

“…In general, changes were modest and transient (several hours to days after ablation) [ 38 , 52 , 53 , 134 ]. Moreover, IL-10 could be elevated in the serum postinterventionally [ 54 , 133 ]. Over all, no case of severe SIR with multiorgan failure and coagulopathy, but significant increases in body temperature, mean arterial blood pressure, and concomitantly increased serum levels of adrenaline, nor adrenaline or C-reactive protein (CRP) have been reported shortly after RF ablation [ 53 , 54 , 133 , 134 ].…”