Complications after Radiofrequency Ablation for Hepatocellular Carcinoma: A Multicenter Study Involving 9,411 Japanese Patients

Abstract

<b><i>Introduction:</i></b> Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is considered a safe and minimally invasive procedure. We previously reported that the mortality and complication rates for RFA were 0.038% (5/13,283 patients) and 3.54% (579 complications/16,346 procedures), respectively, from 1999 to 2010 (previous period). In this study, we investigated the clinical criteria for RFA and the mortality and complication rates from 2011 to 2015 (recent period). <b><i>Methods:</i></b> Data were collected from 25 centers by using a questionnaire developed by the Chugoku-Shikoku Society for Local Ablation Therapy of HCC. The criteria for RFA, RFA modification, use of image-guidance modalities, mortality, and complications during the previous and recent periods were compared. <b><i>Results:</i></b> We evaluated 11,298 procedures for 9,411 patients, including those that involved new devices (bipolar RFA and internally adjustable electrode system). The criterion of hepatic function for RFA increased from a Child-Pugh score ≤8 during the previous period to ≤9 during the recent period. The criteria regarding the tumor location and other risk factors have been expanded recently because of the increased use of several modifications of the RFA procedure and image-guidance modalities. The mortality rate was 0.064% (6/9,411 patients), and the complication rate was 2.92% (330 complications/11,298 procedures). There was no difference in mortality rates between the 2 periods (<i>p</i> = 0.38), but the complication rates was significantly lower during the recent period (<i>p</i> = 0.038). <b><i>Discussion and Conclusions:</i></b> Our findings confirmed that RFA, including the use of new devices, is a low-risk procedure for HCC, despite the expansion of the criteria for RFA during the recent period.

Feasibility and outcomes of percutaneous radiofrequency ablation for intrahepatic recurrent hepatocellular carcinoma after liver transplantation: a single-center experience

“…There were two patients occurred major complications after RFA, one developed symptomatic pleural effusion and required percutaneous drainage and of the other developed liver abscess. Liver abscess is a rare complication of RFA for HCC [31]. Patients with Roux-en-Y reconstruction may be at elevated risk of infection [32].…”

A Simple Method to Avoid Bile Duct Injury during Percutaneous Radiofrequency Ablation Therapy for Hepatocellular Carcinoma

“…RFA is considered the standard treatment for HCC worldwide for patients with <3 tumors that are <3 cm in diameter [ 13 , 14 ]. Maeda et al [ 15 ] reported that among 11,298 RFA procedures, only 330 complications (2.92%) were identified. Six patients (0.064%) died from RFA-related complications during the recent period (2011–2015), and according to quality improvement guidelines for RFA of liver tumors, RFA is contraindicated for the treatment of tumors located <1 cm from the main biliary duct or a bilioenteric anastomosis [ 9 ].…”

“…In Japan, the indications for RFA in patients with HCC tumors adjacent to the first or second branches of the bile duct have increased from 15 of 20 centers (75%) during the previous period (1999–2010) to 21 of 25 centers (84%) during the recent period. Indications have also increased for patients with a tumor near a bilioenteric anastomosis or papillary dysfunction from 5 of 20 centers (25%) during the previous period to 10 of 25 centers (40%) during the recent period, which has consequently increased performance of bile duct cooling via a nasobiliary drainage tube from 25 to 32% [ 15 ]. Ohnishi et al [ 10 ] reported the utility of intraductal chilled saline perfusion (ICSP) to prevent bile duct injury during percutaneous RFA for HCC.…”

Diaphragmatic hernia: a rare complication of hepatic ablation

“…2 Similarly, in 2020 Maeda et al reported a complication rate of 2.9% in 9,411 patients. 3 Recognised complications include haemorrhage, abscess formation, biliary fistulation, and hepatic injury. As more cases are performed, rarer complications are being identified, one of which is diaphragmatic injury.…”