Radio-frequency ablation of hepatocellular carcinoma : influence of the anatomy on the outcome of the procedure

Abstract EN

Purpose : to study the contribution of the morphology and the anatomical relations of a hepatocellular carcinoma (HCC) lesion to the outcome of radiofrequency ablation therapy (RFA) and the expectancy of ablation extent Material and Methods : Twenty-five patients with thirty-seven HCC lesions had undergone RFA therapy.

Of these, twenty-nine lesions were done under conscious sedation or general anesthesia, using an internally cooled electrode.

Lesions were anatomically classified : A) according to size into three groups ; 1) < 2.92 cm, 2) 2.92-5.1 cm and 3) > 5.1 cm ; B) according to margin definition into, ill-defined or well-defined ; C) according to difficulty of accessing the lesion through percutaneous route into 1) difficult and 2) easily accessible ; and D) anatomical relationship to nearby structures into 1) critically, < 1 cm, and non-critically, ≥ 1 cm, away from nearby structures.

Results: Complete ablation was achieved in 15 patients (51.7 %), 90-99 % ablation in 5 patients (17.2 %) ; 50-89 % ablation in 6 patients (20.7 %) and < 50 % in 3 patients (10.3 %).

Factors that contribute to outcome are lesion diameter and anatomical relation to nearby vessels.

Margin ill-definition may lead to misinterpretation of tumor diameter and subsequent sub-optimal results.

Ease of accessibility of the lesion is subjective and has no true contribution.

No major complications related to the procedure were encountered.

One patient died of bleeding esophageal varies, three weeks after the procedure.

Minor complications (twelve patients) included persistent pain, short term fever and local electric burn at the site of the grounding pad.

Conclusion : RFA is an effective modality for treating HCC when a patient is properly selected.

Best outcome is expected-in good hands-with smaller lesions, not related to major vessels with well-defined margins.