Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: safety and technical efficacy in 143 patients

Abstract

The purpose of this study was to assess the feasibility, safety and efficacy of radiofrequency ablation (RFA) with the use of artificial ascites for hepatocellular carcinoma (HCC) adjacent to the diaphragm and gastrointestinal tract. One hundred forty-three patients with 181 HCCs who underwent US-guided percutaneous RFA with the use of artificial ascites were retrospectively reviewed. Among the 181 HCCs, 148 HCCs were defined as problematic nodules for two major reasons: poor sonic window or possible thermal injury. We artificially induced ascites before performing RFA by dripping 5% dextrose in a water solution. We assessed the technical success of introducing artificial ascites, technical feasibility of the use of artificial ascites and complications. The technical success rate, as well as the primary and secondary technique success rate, was assessed by regular follow-up CT examinations. RFA with artificial ascites was successfully achieved in 130 of 143 patients. The primary technique effectiveness was 85.3%. During follow-up (mean, 20.4 months), remote intrahepatic recurrence occurred in 49 patients and local tumor progression occurred in 15 patients. Three (2.1%) of the 143 patients experienced major complications (hemoperitoneum, lobar infarction and biloma) related to the RFA procedure. The use of artificial ascites is a simple and useful technique to minimize collateral thermal injury and to improve the sonic window.

Current management of hepatocellular carcinoma: An Eastern perspective

“…Nevertheless, PEI is associated with a necrosis rate of 90%-100% in tumors < 2 cm and is still useful in selected patients when RFA is not technically feasible [40][41][42] . Recently, it was reported that in cases where the tumor is located under the diaphragm or near the surface of the liver, creating artificial ascites or pleural effusion is helpful in performing RFA and avoiding burns on adjacent organs [43,44] . This technique is being applied in several Asian countries with good results [43,44] .…”

“…Recently, it was reported that in cases where the tumor is located under the diaphragm or near the surface of the liver, creating artificial ascites or pleural effusion is helpful in performing RFA and avoiding burns on adjacent organs [43,44] . This technique is being applied in several Asian countries with good results [43,44] . Several randomized controlled trials compared the efficacy of RFA with that of resection in Asian patients with HCC meeting the Milan criteria [45,46] .…”

Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors

“…Another technique is creating a barrier between the liver and the colon, the hydrodissection. The use of 5% dextrose and saline solutions has been reported [14,28,39] . The former is preferred due to its properties since it does not conduct electricity and hence provides a thermal barrier around the organ [39] .…”

“…The use of 5% dextrose and saline solutions has been reported [14,28,39] . The former is preferred due to its properties since it does not conduct electricity and hence provides a thermal barrier around the organ [39] . Song et al [39] and Inoue et al [28] used artificial ascites and had no gastrointestinal injuries.…”

Radiofrequency ablation: technique and clinical applications

“…Adjacent visceral organs, such as small bowel or colon, can be displaced away from the tumor through patient positioning or hydrodissection (16). Hydrodissection can also be used to displace the diaphragm to prevent diaphragmatic injury during the ablation of tumors in the liver dome (17).…”