Surgically treated diaphragmatic perforation after radiofrequency ablation for hepatocellular carcinoma

Table 1 Clinical characteristics of patients

Case	Age/sex	Tumor location/size (mm)	Time from RFA to DP/DH (mo)	Underlying liver disease/CP sore	Previous intractable pleural effusion	Herniation viscera	Symptom	Treatment for DP/DH	Prognosis after DP/DH treatment
1	49/M	S4/17	17	Alcoholic-LC	Absent	Absent	Absent	Surgical repair (laparotomy)	2 yr
				Child A					alive
2	79/F	S8/19	9	HCV-LC	Present	Present (small intestine)	Abdominal pain	Surgical repair (laparotomy)	3 yr
				Child B					alive
3	68/M	S8/26	21	HCV-LC	Present	Present (mesenteric fat)	Abdominal pain	Surgical repair (laparotomy)	6 mo
				Child C					died by LF
4	70/F	S6/23	8	HCV-LC	Present	Present (large intestine)	Dyspnea	Surgical repair and colectomy (laparotomy)	4 yr
				Child C					died by LF
5	65/M	S8/21	16	HCV-LC	Absent	Present (Large intestine)	Abdominal pain	Surgical repair (laparotomy)	2 yr
				Child B					died by LF
6	76/F	S8/20	6	HCV-LC	Absent	Absent	Absent	Surgical repair (laparotomy)	4 yr
				Child A					alive

LC: Liver cirrhosis; LF: Liver failure; CP score: Child-Pugh score; DP: Diaphragmatic perforation; DH: Diaphragmatic hernia.

Table 2 Findings of dynamic modified discrete cosine transform

Case	Just after RFA				At onset
	Disintegration of diaphragm	Thickening of diaphragm	Ascites	Pleural effusion	Disintegration of diaphragm	Thickening of diaphragm	Ascites	Pleural effusion
1	No	No	No	No	No	No	No	No
2	No	No	No	Yes	Yes	Yes	Yes	Yes
3	No	No	No	Yes	Yes	No	Yes	Yes
4	No	No	No	Yes	Yes	No	Yes	Yes
5	No	No	No	No	Yes	No	No	Yes
6	No	No	No	No	No	No	Yes	Yes

RFA: Radiofrequency ablation.

Table 3 Changes of liver volume between radiofrequency ablation and onset

Case	Just after RFA (mL)	At onset (mL)
1	1005	1055
2
3	653-	539
4	1130	893
5	971	946
6	987	866
Median	987	893

RFA: Radiofrequency ablation.

Table 4 Radiofrequency ablation procedure

Case	Anesthesia	Guidance	Approach	Electrode	Number of session	Max power (W)	Max Temperature (ºC)	Additional RFA	Irradiation duration (min)
1	Local	US	Intercostal	Single cool-tip	1	50	76	Yes	10
2	Local	US	Intercostal	Single cool-tip	1	60	84	Yes	11
3	General	CT	Intercostal	Expansion-type	8	80		No	28
4	Local	US	Intercostal	Single cool-tip	2	80	86	No	16
5	Local	US	Intercostal	Single cool-tip	1	50	87	No	11
6	Local	US	Intercostal	Single cool-tip	2	80	95	Yes	21

RFA: Radiofrequency ablation.