Thoracoscopic ethanol injection and radiofrequency ablation for the treatment of hepatocellular carcinoma located immediately under the diaphragm

Abstract

Abstract. We previously reported that the combination therapy of percutaneous ethanol injection and radiofrequency ablation (PEI-RFA) was more effective than RFA alone in inducing wider coagulated necrosis for the treatment of hepatocellular carcinoma (HCC). In the present study, we thoracoscopically applied the combination therapy to the treatment of HCC located immediately under the diaphragm. RFA electrode and ethanol injection needle were inserted into the tumor through the right side of the diaphragm in 6 patients with HCC close to the diaphragm. In all cases, the tumor was completely ablated with enough safety margin around the tumor. No local tumor recurrence has been observed in a relatively short-time followup period. The volume of coagulated necrosis and the energy requirement for coagulation in thoracoscopic ethanol injection and RFA (T-EI-RFA) were comparable to those of PEI-RFA. Although HCC located immediately under the diaphragm is difficult to treat with a percutaneous approach due to the poor visualization by ultrasonography, T-EI-RFA is considered to be an effective treatment modality.

Efficacy of Laparoscopic Radiofrequency Ablation for Hepatocellular Carcinoma Compared to Percutaneous Radiofrequency Ablation With Artificial Ascites

“…Some problems have been identified in using RFA for larger HCC close to the liver surface. To ablate these nodules, LRFA, 14,15 thoracoscopy 17 and open surgery 18 have been used. Another approach, PRFA, has also recently been carried out for ablation of such nodules.…”

“…As these patients were under anesthesia, ablation could be continued because pain and other subjective symptoms did not hinder treatment. The efficacy of other methods such as RFA assisted by laparoscopy, 14,15 thoracoscopy 17 and open surgery 18 has been reported.…”

Transthoracic radiofrequency ablation for hepatic tumor located beneath the diaphragm under one-lung ventilation

“…A transthoracic approach has been proposed to be an alternative for hepatic tumors located beneath the diaphragm that are difficult to access by conventional percutaneous or laparoscopic approaches. [6–8] When the transthoracic approach is performed, there are some anesthetic considerations. However, there has been no report regarding the anesthetic management of the transthoracic RFA for hepatic tumor.…”

Thoracoscopic radiofrequency ablation for the treatment of hepatocellular carcinoma over the last decade

“…In contrast, LAT with the thracoscopic surgical method (TLAT) is one of the beneficial techniques of choice for the treatment of liver tumors under the diaphragm 5) . The thoracoscopic technique is able to avoid the lung on the puncture line with one-lung ventilation under general anesthesia, so the ablation is safer than the percutaneous ablation method, and the direct observation can possibly reduce the risk of injury of other organs and bleeding.…”