Complications of Radiofrequency Ablation for Hepatic Hemangioma: A Multicenter Retrospective Analysis on 291 Cases

Abstract

PurposeTo report the complications of radiofrequency ablation (RFA) for hepatic hemangioma.Patients and MethodsInvestigators from six centers performed RFA for hepatic hemangioma and used a standardized follow-up protocol. Data were collected from 291 patients, including 253 patients with hepatic hemangioma 5 to 9.9 cm in diameter (group A) and 38 with hepatic hemangioma ≥ 10 cm (group B). Technical success, complete ablation, and complications attributed to the RFA procedure were reported. Analysis of variance was used to determine whether the major complication rate was related to tumor size or clinical experience.ResultsA total of 304 lesions were treated in 291 patients. Technical success was achieved without adverse events in all cases. A total of 301 lesions were completely ablated, including 265 of 265 (100%) lesions in group A, and 36 of 39 (92.31%) in group B. The rate of technology-related complications was similar in groups A and B (5.14% (13/253) and 13.16% (5/38), respectively; P = 0.121). Moreover, all technology-related complications occurred during the early learning curve period. The rate of hemolysis-related complications in two groups were 83.40% (211/253) and 100% (38/38) (P =0.007) and the systemic inflammatory response syndrome-related complications in two groups were 33.99% (86/253) and 86.84% (33/38) (P<0.001). There were no delayed complications in either group.ConclusionRFA is minimally invasive, safe, and effective for hepatic hemangiomas 5 to 9.9 cm in diameter. More clinical data are needed to confirm the safety of RFA for hepatic hemangiomas ≥ 10 cm.

Medium and Long-Term Outcome of Superselective Transcatheter Arterial Embolization with Lipiodol–Bleomycin Emulsion for Giant Hepatic Hemangiomas: Results in 241 Patients

“…Of note, to support the effectiveness of these techniques, more trials have to be performed [ 6 ]. In addition, the rates of the complications (hemolysis-related complications and the systemic inflammatory response syndrome) after RFA were high, with 34%–100%, particularly when the tumor was larger than 10 cm in diameter [ 16 , 17 ].…”

Ablation for Benign Liver Tumors: Current Concepts and Limitations

“…[15][16][17][18][19][20][21][22][23][24] There are some possible complications of ablation for hemangioma, most of which are classified as Clavien-Dindo grade 1, with hemoglobinuria, fever, and pain being common events (Tables 4 and 5). [15][16][17][18][19][20][21][22][23][25][26][27][28][29] According to Wu et al, 25 the rates of achieving complete ablation and procedure-related complications were similar in 253 patients with hemangiomas of 5-9.9 cm and 38 patients with hemangiomas of ≥10 cm. 25 However, the rates of hemolysis-related and systemic inflammatory response syndrome-related complications were higher in patients with hemangiomas of ≥10 cm than in those with hemangiomas of 5-9.9 cm.…”

“…[15][16][17][18][19][20][21][22][23][25][26][27][28][29] According to Wu et al, 25 the rates of achieving complete ablation and procedure-related complications were similar in 253 patients with hemangiomas of 5-9.9 cm and 38 patients with hemangiomas of ≥10 cm. 25 However, the rates of hemolysis-related and systemic inflammatory response syndrome-related complications were higher in patients with hemangiomas of ≥10 cm than in those with hemangiomas of 5-9.9 cm. In addition, the postoperative stay was longer in the former than in the latter (9.04 vs. 5.73 days, p<0.001).…”

“…According to recent studies, either the laparoscopic/surgical or percutaneous approach is predominantly used with US guidance (Tables 2 and 3). [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Complete ablation was reported in >86% of patients with RFA and >84.6% with MWA. The resolution of clinical symptoms was achieved by most patients, complete resolution of clinical symptoms in 50-90.9% by RFA, and 50-100% by MWA.…”

Minimally Invasive Image-Guided Procedures for Benign Liver Lesions

“…14,15 Possible complications of all percutaneous procedures include pain, hemorrhage, infection, and injury to adjacent structures. 16,17 TAE is performed by catheterization and occlusion of the arterial vascular supply to the tumor. Lastly, cytotoxic chemotherapy or immunotherapy agents can be directly administered into the lesion through a needle for a direct treatment.…”