Published online May 21, 2015. doi: 10.3748/wjg.v21.i19.5941
Peer-review started: December 24, 2014
First decision: January 8, 2014
Revised: January 16, 2015
Accepted: February 13, 2015
Article in press: February 13, 2015
Published online: May 21, 2015
Processing time: 152 Days and 1.1 Hours
AIM: To compare safety and therapeutic efficacy of laparoscopic radiofrequency (RF) ablation vs computed tomography (CT)-guided RF ablation for large hepatic hemangiomas abutting the diaphragm.
METHODS: We retrospectively reviewed our sequential experience of treating 51 large hepatic hemangiomas abutting the diaphragm in 51 patients by CT-guided or laparoscopic RF ablation due to either the presence of symptoms and/or the enlargement of hemangioma. Altogether, 24 hemangiomas were ablated via a CT-guided percutaneous approach (CT-guided ablation group), and 27 hemangiomas were treated via a laparoscopic approach (laparoscopic ablation group).
RESULTS: The mean diameter of the 51 hemangiomas was 9.6 ± 1.8 cm (range, 6.0-12.0 cm). There was no difference in the diameter of hemangiomas between the two groups (P > 0.05). RF ablation was performed successfully in all patients. There was no difference in ablation times between groups (P > 0.05). There were 23 thoracic complications in 17 patients: 15 (62.5%, 15/24) in the CT-guided ablation group and 2 (7.4%, 2/27) in the laparoscopic ablation group (P < 0.05). According to the Dindo-Clavien classification, two complications (pleural effusion and diaphragmatic rupture grade III) were major in two patients. All others were minor (grade I). Both major complications occurred in the CT-guided ablation group. The minor complications were treated successfully with conservative measures, and the two major complications underwent treatment by chest tube drainage and thoracoscopic surgery, respectively. Complete ablation was achieved in 91.7% (22/24) and 96.3% (26/27) in the CT-guided and the laparoscopic ablation groups, respectively (P > 0.05).
CONCLUSION: Laparoscopic RF ablation therapy should be used as the first-line treatment option for large hepatic hemangiomas abutting the diaphragm. It avoids thermal injury to the diaphragm and reduces thoracic complications.
Core tip: Radiofrequency (RF) ablation is an accepted non-surgical treatment for hepatic hemangiomas. If a tumor is located in the hepatic dome which abuts the diaphragm, complete tumor ablation without injury to the diaphragm or lung is challenging under percutaneous approach. The study preliminarily proved that laparoscopic RF ablation therapy should be used as the first-line treatment option for hepatic hemangiomas abutting the diaphragm, which can avoid thermal injury to the diaphragm effectively and reduce the thoracic complications obviously.