Purpose
To assess the feasibility, efficacy, and safety of percutaneous radiofrequency (RF) ablation with artificial ascites for hepatocellular carcinoma (HCC) in hepatic dome
Material and methods
Percutaneous RF ablation procedures with artificial ascites were performed in 24 patients with 31 HCCs in hepatic dome (range, 1.0-3.6 cm; mean, 1.9 cm). At least one tumor in each patient was considered difficult to be treated with conventional RF ablation technique because it was partially visible with poor RF electrode path due to overlapping rib or lungs on planning ultrasonography (US). We artificially induced ascites before US-guided RF ablation in order to improve the visibility of index tumor in hepatic dome by shifting the liver as well as to separate the RF ablation zone from the diaphragm. Artificial ascites was achieved by dripping of 5% dextrose/water solution into the perihepatic space by using gravity via 6 Fr angio-sheath. RF ablations were performed using internally cooled electrodes and 200W RF generator after the hepatic capsule around index tumor was separated at least 1 cm from the diaphragm. We assessed the technical feasibility, efficacy, and safety of RF ablation with artificial ascites on the bases of clinical and imaging follow-up for at least 1 month (range, 30-120 days; mean, 44 days).
Results
Artificial ascites was successfully achieved in 21 (87.5 %) of 24 patients with additional mean time of 9 min 49 seconds in separating the hepatic capsule around index tumor at least 10 mm from the diaphragm. The amount of artificial ascites ranged from 150 ml to 1,000 ml (mean, 364 ml). The mean distance between the tumor-bearing hepatic capsule and the diaphragm increased from 1.6 mm to 14.3 mm after the introduction of artificial ascites. There was substantial improvement in the visibility of index tumor on US in 11 (45.8%) of 24 cases with the tumor in hepatic dome. Twenty nine (94%) of 31 tumors appeared completely necrotic without any incidents at CT obtained immediately after RF ablation. The two residual tumors were completely ablated with second session. No complication related to artificial ascites such as bleeding or peritonitis occurred during the follow-up period. However, two (6%) of 31 tumors showed local tumor progression in RF ablation zone at 4 months follow-up CT.
Conclusion
Percutaneous RF ablation with artificial ascites appears an effective and a safe technique for treating HCC in the hepatic dome.