Effect of CT fluoroscopy-guided transpulmonary radiofrequency ablation of liver tumours on the lung

Abstract

Objective: We retrospectively evaluated the effect of transpulmonary radiofrequency ablation (RFA) of liver tumours on the lung. Methods: 16 patients (10 males and 6 females; mean age, 65.2 years) with 16 liver tumours (mean diameter 1.5 cm) underwent transpulmonary RFA under CT fluoroscopic guidance. The tumours were either hepatocellular carcinoma (n514) or liver metastasis (n512). All 16 liver tumours were undetectable with ultrasonography. The pulmonary function values at 3 months after transpulmonary RFA were compared with baseline (i.e. values before RFA). Results: In 8 of 16 sessions, minor pulmonary complications occurred, including small pneumothorax (n58) and small pleural effusion (n51). In two sessions, major pulmonary complications occurred, including pneumothorax requiring a chest tube (n52). These chest tubes were removed at 4 and 6 days, and these patients were discharged 7 and 10 days after RFA, respectively, without any sequelae. The pulmonary function values we evaluated were forced expiratory volume in 1 s (FEV1.0) and vital capacity (VC). The mean values of FEV1.0 before and 3 months after RFA were 2.55 l and 2.59 l, respectively; the mean values of VC before and 3 months after RFA were 3.20 l and 3.27 l, respectively. These pulmonary values did not show any significant worsening (p50.393 and 0.255 for FEV1.0 and VC, respectively). Conclusion: There was no significant lung injury causing a fatal or intractable complication after transpulmonary RFA of liver tumours. Percutaneous radiofrequency ablation (RFA) has been established as a local therapy for liver cancers, including both hepatocellular carcinoma (HCC) and liver metastasis [1]; meta-analysis that included a total of 5224 treated liver tumours showed a local progression rate of 12% (647/5224) after one or more RFA sessions [2]. In this procedure, a radiofrequency (RF) electrode is generally inserted using the transabdominal and/or transhepatic route under ultrasonographic guidance. However, depending upon the tumour location, it is often difficult to detect these by ultrasonography (e.g. tumours located in the hepatic dome). In such tumours, certain modified approaches, such as artificial pleural effusion [3], artificial ascites [4], artificial pneumothorax [5] or thoracoscopic guidance [6], are often used.The transpulmonary approach under CT guidance is another method that can be used for needle insertion into such liver tumours. Some investigators have reported the feasibility, effectiveness and safety of transpulmonary RFA of liver tumours [7][8][9][10][11][12]. Further, certain pulmonary complications-such as pneumothorax and pleural effusion caused by puncture of the pleura, lung and/or diaphragm-have been reported too, along with these being common complications of RFA of liver tumours. To our knowledge, however, although there are no reports of fatal or intractable pulmonary complications of this procedure, there are also no reports that evaluate its effect on the lung.The purpose of this study is to retrospectively evaluate th...

CT-guided microwave ablation of hepatic malignancies via transpulmonary approach without ancillary techniques

“…[12] However, the majority of complications were rather minor, ranging from 26.5% to 50%, with a major complication rate of up to 28.6%, and no intractable pneumothorax has been reported. [9,[13][14][15] e pulmonary function tests of patients who underwent transpulmonary RFA of liver lesions at 1-month follow-up were unremarkable, regardless of the occurrence of minor and major complications. [13] No overt loss of lung function was seen during follow-up which is consistent with reported literature and the fact that no significant ablation of lung parenchyma is performed.…”

“…[9,[13][14][15] e pulmonary function tests of patients who underwent transpulmonary RFA of liver lesions at 1-month follow-up were unremarkable, regardless of the occurrence of minor and major complications. [13] No overt loss of lung function was seen during follow-up which is consistent with reported literature and the fact that no significant ablation of lung parenchyma is performed. Results from the present study are consistent with prior reported data: e cumulative pulmonary complication rate was 36.8% with a major complication rate of 14.5%.…”

Imaging guided percutaneous interventions in hepatic dome lesions: Tips and tricks

“…Furthermore, the interventionalist and patient must be prepared for the possibility of a pneumothorax and be aware of the management of such a complication. The technique of pulmonary transgression is of limited value in patients with severe emphysema or coagulopathy[ 25 , 26 ].…”

“…Most dreaded complications during hepatic dome interventions include diaphragmatic and lung injury, pleural effusion, pneumothorax and empyema. Specific maneuvers like CT-guided transpulmonary needle insertion for liver tumors may lead to pneumothorax, lung hemorrhage and hemothorax, pleural effusion, diaphragmatic injury, tumor seeding in the pleura and/or lung parenchyma, lung abscess and systemic air embolism[ 26 ]. Serious complications such as massive pulmonary hemorrhage and systemic air embolism may result from transpulmonary RF needle insertion[ 41 - 43 ].…”

Ablación percutánea de tumores en la cúpula hepática por vía transpulmonar

“…Esto explicaría la alta incidencia de neumotórax en diferentes series [3][4][5] en donde se ha demostrado la presencia de neumotórax entre el 45 % y 71,4 % de los pacientes tratados; sin embargo la necesidad de catéter de drenaje pleural ha sido muy baja. Por otro lado hay otros estudios que concluyen que no hay lesión pulmonar fatal o intratable tras RF por vía transpulmonar 6 . Pese a estos estudios [2][3][4][5][6] se necesita mayor evidencia donde se demuestre la eficacia y seguridad de la TA (RF y MWs) en el manejo de tumores hepáticos con esta localización.…”