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World J Gastroenterol. Jan 28, 2006; 12(4): 608-611
Published online Jan 28, 2006. doi: 10.3748/wjg.v12.i4.608
Computed tomography-guided transpulmonary radiofrequency ablation for hepatocellular carcinoma located in hepatic dome
Mitsuo Toyoda, Satoru Kakizaki, Katsuhiko Horiuchi, Kenji Katakai, Naondo Sohara, Ken Sato, Hitoshi Takagi, Masatomo Mori, Takahito Nakajima
Mitsuo Toyoda, Katsuhiko Horiuchi, Kenji Katakai, Department of Internal Medicine, Isesaki Municipal Hospital, Isesaki, Gunma 372-0817, Japan
Satoru Kakizaki, Naondo Sohara, Ken Sato, Hitoshi Takagi, Masatomo Mori, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan
Takahito Nakajima, Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan
Supported by the grant of Center of Excellence, Biomedical Research Using Accelerator Technology
Correspondence to: Satoru Kakizaki, MD, PhD, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan. kakizaki@showa.gunma-u.ac.jp
Telephone: +81-27-220-8127 Fax: +81-27-220-8136
Received: July 19, 2005
Revised: July 28, 2005
Accepted: August 26, 2005
Published online: January 28, 2006
Abstract

AIM: To determine the feasibility of performing computed tomography (CT)-guided transpulmonary radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) located in the hepatic dome.

METHODS: A total of seven patients with HCC comprising seven nodules located in the hepatic dome were treated from April 2004 to December 2004. CT-guided transpulmonary RFA was performed using a cool-tip type electrode (Radionics Company) based on a standardized energy protocol. All tumors located in the hepatic dome were not detectable by the usual ultrasound (US) methods. The lesion diameters ranged from 15 to 27 mm.

RESULTS: RFA was technically feasible in all the patients. The puncture procedure was performed twice or less and the total average performance time was 40.6 min. Local tumor control was achieved in all the patients. The necrosis diameter ranged from 25 to 35 mm. The mean follow-up period was 9.6 (7-14 mo) mo. There was no local recurrence at the follow-up points. Pneumothorax requiring pleural drainage was the main complication, which was observed in two of the seven patients (28.6%). However, it improved with chest drainage tube, and the tube could be removed within 2-3 d. No other major complications were observed.

CONCLUSION: CT-guided puncture is useful for the treatment of tumors located in the hepatic dome which are hardly detectable by US, even though pneumothorax sometimes may occur as a complication. In the cases with adhesion in the pleura for which artificial pleural effusion methods are not appropriate, CT-guided RFA is thus considered to be an alternative treatment for HCC located in the hepatic dome.

Keywords: Radiofrequency ablation; Hepatocellular carcinoma; Interventional procedures; CT-guided trans-pulmonary RFA