Percutaneous sonographically guided saline-enhanced radiofrequency ablation of hepatocellular carcinoma.

OBJECTIVE: The purpose of our study was to analyze the efficacy, side effects, and short-term complications of saline-enhanced percutaneous radiofrequency ablation performed under sonographic guidance in a series of cirrhotic patients with hepatocellular carcinoma. SUBJECTS AND METHODS. Between September 2000 and June 2002, 84 patients (55 men and 29 women) with cirrhosis who ranged in age from 48 to 74 years (mean age, 64 years) and who had 95 hepatocellular carcinomas (seven patients had two tumors and two patients had three tumors) were treated with high frequency-induced thermotherapy. The diameters of the tumors ranged from 1.5 to 8.5 cm (mean, 3.6 cm). The efficacy of radiofrequency ablation was evaluated with triphasic contrast-enhanced CT performed 4 weeks after the procedure. RESULTS: Posttreatment CT showed complete necrosis in 73 (77%) of 95 hepatocellular carcinomas in 62 patients. Complete necrosis based on tumor size was seen in 40 (95%) of 42 tumors with diameters equal to or smaller than 3 cm, 32 (71%) of 45 tumors with diameters between 3.1 and 5.0 cm, and one (12%) of eight tumors with diameters larger than 5.0 cm. Twenty-two hepatocellular carcinomas showed incomplete necrosis. None of the patients experienced major complications. Four patients were lost to follow-up. The length of the follow-up period ranged from 4 to 22 months (mean, 10 months). One patient died 8 months after the radiofrequency ablation treatment. All the remaining patients are still alive. During the follow-up period, eight (10%) of 80 patients showed a local recurrence on sonography and CT. CONCLUSION: Our experience suggests that percutaneous radiofrequency ablation of hepatocellular carcinoma with high frequency-induced thermotherapy is safe and effective in the treatment of hepatocellular carcinomas equal to or smaller than 3 cm, fairly effective for hepatocellular carcinomas between 3 and 5 cm, and ineffective for tumors larger than 5 cm.

Complications after interventional sonography of focal liver lesions: a 22-year single-center experience.

OBJECTIVE: To analyze the complications of diagnostic and therapeutic sonographically guided interventional procedures of focal liver lesions observed during a 22-year period in a single center. METHODS: Complications of sonographically guided diagnostic and therapeutic procedures on focal liver lesions, observed during a 22-year period in a single center, were reviewed. From 1979 to 2001, 13,222 patients (age range, 7-89 years; mean, 59 years; 8,688 male and 4,534 female) with 13,777 focal liver lesions underwent 16,648 sonographically guided biopsies and 3,035 therapeutic procedures: pyogenic and amebic abscess aspiration, ethanol injection of hydatid liver cysts, and percutaneous ablative treatments (ethanol injection in either multiple or one-shot sessions, radio frequency ablation, and interstitial laser photocoagulation) of primary and secondary liver tumors. RESULTS: The overall mortality was 0.06%. No death or major complication occurred after diagnostic procedures and liver abscess drainage. In the therapeutic group mortality was 0.6%: 1 patient died of anaphylactic shock during treatment of a hydatid cyst; 7 patients died after liver tumor ablation with ethanol injection (6 after one-shot treatments and 1 after multisession treatments). Major complications after liver tumor ablative procedures included 10 cases of acute liver failure, 2 cases of acute tubular necrosis, 2 cases of self-limiting hemoperitoneum, 2 cases of paralytic ileum, 2 abscesses, and 1 case of cholangitis. One case of a biliary cyst fistula and 1 case of intracystic hemorrhage occurred after treatment of hydatid liver cysts. CONCLUSIONS: Sonographically guided diagnostic biopsy of focal liver lesions and liver abscess drainage are safe procedures. In contrast, liver tumor ablation procedures have a low but definite risk of mortality and major complications. Puncture of hydatid cysts must be performed only in institutions that can treat anaphylactic shock.