Feasibility Study Of Radiofrequency Ablation Of Primary Hepatic Carcinoma In The Hepatic Dome Area With The CT-guided Three Dimensional Orientation Approach

Objective:Ultrasonography(US) guided radio frequency ablation(RFA) was one of the most effective local treatments for primary hepatic cancer. However,the usage of US-RFA was not practical for liver cancer in the hepatic dome area(LCHD)due to the high location, shed of lung air or poor visualization. Computer tomography (CT)-guided three dimensional orientation extrathoracic trans-hepatic RFA (CET-RFA), on the other hand, had overcome the disadvantage of US-RFA and improved the visualization of primary liver cancer next to the diaphragm. In this study, the detailed treatment procedure, safety and local efficacy of RFA for primary liver cancers with CET-RFA approach were investigated.Methods’. A retrospective study was conducted in13patients received CET-RFA following INCLUSION from September1st2003to August31st,2011in the Department of Medical Oncology of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine.The detailed treatment procedure of LCHD with CET-RFA,the geometry roadmap and mathematic formula were summarized. RFA technical success rate, complete necrosis rate, postoperative complications,postoperative hospitalization time and relapse-free survival were evaluated by descriptive statistical analysis.In addition, the safety of the new established CET-RFA were investigated,the causes of severe complication were summarized and prevention managements were suggested.Results:A kind of new puncture path,as so-called"cube" model,and RFA method of CET-RFA for PLC was investigated. Total16lesions of13patients withmean diameter of16.8mm+8. lmm (9mm～40mm) were included. The RFA technical success rate and complete necrosis rate were100%, and the local progress free survival was41.7+6.5months. One case (6.25%,1/16) developed severe pleural effusion and ascites after RFA, which was released after drainage of plural cavity, albumin infusing and diuresis. Others developed minor complications, which were recovered with anti-symptom managements.The overall mean time for hospitalization was7.1days,while in patients with minor complications the number decreased to5.6days.In addition,the feasibility of another kind of puncture path of CET-RFA based on"triangle"was future analysed.Conclusions:CET-RFA for lesions in the hepatic dome area was safe, effective, practical.Strictly following RAF indications,choosing the suitable guiding images and puncture paths, and early diagnosing and treating severe complication were the keys to the success of radiofrequency ablation.