Percutaneous Radiofrequency Ablation Treatment of Hepatocellular Carcinoma in Caudate Lobe Using Expandable Electrodes

Abstract

Objective: To evaluate the outcome of radiofrequency (RF) ablation using expandable electrodes in the treatment of hepatocellular carcinoma (HCC) located in the caudate lobe.Materials and Methods: Between January 2011 and April 2017, 29 consecutive patients with HCC at the caudate lobe were treated with RF ablation using expandable electrodes. The electrodes were placed on the targeted tumor under combined ultrasound and computed tomography (CT) guidance for each tumor in all the patients. Out of the 29 cases, 19 (65.5%) were accessed via the left hepatic lobe. The technical success, primary efficacy, local tumor progression, secondary efficacy, overall survival, and complications were evaluated. Univariate analysis was performed of the various prognostic factors for technical success, primary efficacy, and local tumor progression.Results: The technical success rate was 86.2%, primary efficacy was 89.7%, and secondary efficacy was 82.8%. The local tumor progression (LTP) rate was 12.3% at one year and 31.5% at two years. The median time of LTP was 6.9 months. The overall survival rate was 85.8% at one year and 57.1% at two years. Ten patients died during the follow-up period (mean 22.5 months; with a range of 3.6–53.2 months). A minor complication of asymptomatic biloma was found in one patient (3.5%). Small-sized tumors (≤2 cm) and Spiegel’s lobe location had significantly better treatment outcomes (p = 0.007 and 0.045, respectively).Conclusion: Radiofrequency ablation using expandable electrodes is feasible and safe in treating HCCs located in the caudate lobe, especially for small-sized tumors (≤2 cm).

Laparoscopic Microwave Ablation of Hepatocellular Carcinoma at Liver Surface: Technique Effectiveness and Long-Term Outcomes

“…For example, the local recurrence rate is higher in tumors located at liver surface due to insufficient ablation than in tumors deep in the liver after percutaneous ablation. 12,13,17,18 Moreover, subphrenic tumors unable to be delineated clearly under percutaneous ultrasound are also unsuitable for percutaneous ablation. 14 -16…”

“…For example, the local recurrence rate is higher in tumors located at liver surface due to insufficient ablation than in tumors deep in the liver after percutaneous ablation. 12,13,17,18 Moreover, subphrenic tumors unable to be delineated clearly under percutaneous ultrasound are also unsuitable for percutaneous ablation. [14][15][16] In these cases, laparoscopic ablation can serve as an alternative option because it possesses several advantages over percutaneous ablation while retaining the minimal invasiveness.…”

“…Tumor progression/recurrence were defined according to the International Working Group on Image-Guided Tumor Ablation. 13 Briefly, in patients of CA, local tumor progression was defined as reappearance of enhancement within or contacting the ablation zone on follow-up imagines. Intrahepatic distant recurrence (IDR) was defined as the occurrence of tumor lesions within the liver but not contacting the ablation zone.…”