Pneumothorax induced by radiofrequency ablation for hepatocellular carcinoma beneath the diaphragm under real-time computed tomography-fluoroscopic guidance

Miura, Hiroshi; Yamagami, Takuji; Terayama, Koshi; Yoshimatsu, Rika; Matsumoto, Tomohiro

doi:10.3109/02841851003786001

Cited by 20 publications

(14 citation statements)

References 16 publications

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“…Although the physician may hesitate before selecting the transpulmonary approach to treat the liver tumours because the unaffected lung is injured, there were no fatal pulmonary complications in previous reports [7][8][9][10][11][12] or in our results. In addition, although the incidence of pulmonary complications was high (10 of 16 RFA sessions; 62.5%), most of our complications were asymptomatic and there was no effect on the pulmonary function at 3 months after transpulmonary RFA.…”

Section: Discussionsupporting

confidence: 36%

“…Some investigators have reported that transpulmonary RFA of liver tumours might be an acceptable treatment based on their results, including the feasibility, effectiveness and safety [7][8][9][10][11][12]. This procedure was technically feasible and its technique effectiveness was similar to other results of RFA of liver tumours.…”

Section: Discussionmentioning

confidence: 90%

“…In previous studies, as well as ours, the most common complication of transpulmonary RFA of liver tumours was observed to be pneumothorax (the incidence of pneumothorax and chest tube placement for pneumothorax was 37.5-71.4% and 0-28.6%, respectively) [7][8][9][10][11][12]. However, there are no reports of intractable pneumothorax and other pulmonary complications following transpulmonary RFA of liver tumours.…”

Section: Discussionmentioning

confidence: 99%

“…In this procedure, the reason for the high incidence of pneumothorax may be that the pleura was penetrated twice on both the chest wall and diaphragmatic sides in the transpulmonary approach to liver [7]. Miura et al reported that the main risk factors for pneumothorax after transpulmonary RFA of liver tumours were increased length of needle trajectory through the aerated lung and multiple transpulmonary approaches in one session [9]. Conversely, Park et al reported that the relationship between the occurrence of pneumothorax and the RF electrode length in the lung parenchyma was not statistically significant [8].…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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

Iguchi¹,

Inoue²,

Yabushita³

et al. 2012

The British Journal of Radiology

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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...

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