INITIAL RESULTS OF SAFETY AND EFFICACY OF ARTIFICIAL ASCITES – ASSISTED THERMAL ABLATION OF HEPATOCELLULAR CARCINOMA AT HIGH RISK LOCATION
Main Article Content
Abstract
ABSTRACT
Introduction: Primary hepatocellular carcinoma (UTBMTBG) is among the most common malignancies worldwide, causing approximately 500,000 deaths annually. Thermal ablation has long been established as a potentially curative treatment for primary UTBMTBGNP. However, ultrasound-guided thermal ablation of tumors in high-risk locations remains challenging due to limited visualization or suboptimal access caused by overlying structures such as the lungs or ribs. Furthermore, these procedures carry a significant risk of thermal injury to adjacent organs, including the diaphragm and gastrointestinal tract. Artificial ascites has been introduced as a simple, safe, and effective technique to protect surrounding organs from heat damage. This study aimed to evaluate the efficacy and safety of artificial ascites-assisted thermal ablation for UTBMTBGNP in high-risk locations, as well as the local recurrence rate and clinical outcomes.
Methods: We conducted a retrospective case series of patients diagnosed with UTBMTBGNP in high-risk sites who underwent thermal ablation with artificial ascites assistance.
Results: A total of 12 patients with hepatocellular carcinoma underwent thermal ablation. The mean age was 66.5 ± 9.07 years (range, 49–79), with a male-to-female ratio of 2:1. Of these, seven patients were treated with microwave ablation and five with radiofrequency ablation. The mean distance between the tumor and critical adjacent organs was 4.25 ± 2.73 mm (range, 1–8 mm). Artificial ascites was successfully created via a 6F angiosheath in all cases (technical success rate: 100%), with a mean infused volume of 1054.2 ± 423.97 ml (range, 500–2000 ml). No major complications occurred following the procedure.
Conclusion: Artificial ascites-assisted thermal ablation is a safe and effective approach for treating primary UTBMTBGNP in high-risk locations, reducing the risk of collateral injury and improving treatment feasibility.
Keywords: hepatocellular carcinoma, thermal ablation, artificial ascites, high-risk tumor location
Keywords
hepatocellular carcinoma, thermal ablation, artificial ascites, high-risk tumor location
Article Details
References
2. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. Mar-Apr 2005;55(2):74-108. doi:10.3322/canjclin.55.2.74
3. Venook AP, Papandreou C, Furuse J, de Guevara LL. The incidence and epidemiology of hepatocellular carcinoma:a global and regional perspective. Oncologist. 2010;15 Suppl 4:5-13. doi:10.1634/theoncologist.2010-S4-05
4. Buscarini L, Buscarini E, Di Stasi M, Vallisa D, Quaretti P, Rocca A. Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term results. Eur Radiol. 2001;11(6):914-21. doi:10.1007/s003300000659
5. Imai K, Beppu T, Chikamoto A, et al. Comparison between hepatic resection and radiofrequency ablation as firstline treatment for solitary small-sized hepatocellular carcinoma of 3 cm or less. Hepatol Res. Aug 2013;43(8):853-64. doi:10.1111/hepr.12035
6. Li YC, Chen PH, Yeh JH, et al. Clinical outcomes of surgical resection versus radiofrequency ablation in very-earlystage hepatocellular carcinoma: a propensity score matching analysis. BMC Gastroenterol. Nov 8 2021;21(1):418.doi:10.1186/s12876-021-01995-z
7. Yamakado K, Nakatsuka A, Akeboshi M, Takeda K. Percutaneous radiofrequency ablation of liver neoplasms adjacent to the gastrointestinal tract after balloon catheter interposition. J Vasc Interv Radiol. Sep 2003;14(9 Pt 1):1183-6. doi:10.1097/01.rvi.0000086530.86489.05
8. Kondo Y, Yoshida H, Shiina S, Tateishi R, Teratani T, Omata M. Artificial ascites technique for percutaneous radiofrequency ablation of liver cancer adjacent to the gastrointestinal tract. Br J Surg. Oct 2006;93(10):1277-82.doi:10.1002/bjs.5374
9. Kariya S, Tanigawa N, Kojima H, et al. Radiofrequency ablation combined with CO2 injection for treatment of retroperitoneal tumor: protecting surrounding organs against thermal injury. AJR Am J Roentgenol. Oct 2005;185(4):890-3. doi:10.2214/ajr.04.1220
10. Song I, Rhim H, Lim HK, Kim YS, Choi D. Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: safety and technical efficacy in 143 patients. Eur Radiol. Nov 2009;19(11):2630-40. doi:10.1007/s00330-009-1463-x
11. Bhagavatula SK, Chick JF, Chauhan NR, Shyn PB. Artificial ascites and pneumoperitoneum to facilitate thermal ablation of liver tumors: a pictorial essay. Abdom Radiol (NY). Feb 2017;42(2):620-630. doi:10.1007/s00261-016- 0910-9
12. Hsieh YC, Limquiaco JL, Lin CC, Chen WT, Lin SM. Radiofrequency ablation following artificial ascites and pleural effusion creation may improve outcomes for hepatocellular carcinoma in high-risk locations. Abdom Radiol (NY).Mar 2019;44(3):1141-1151. doi:10.1007/s00261-018-1831-6
13. Han S, Sung PS, Park SY, et al. Local ablation for hepatocellular carcinoma: 2024 expert consensus-based practical recommendation of the Korean Liver Cancer Association. J Liver Cancer. Sep 2024;24(2):131-144.doi:10.17998/jlc.2024.08.04
14. Rhim H, Dodd GD, 3rd, Chintapalli KN, et al. Radiofrequency thermal ablation of abdominal tumors: lessons learned from complications. Radiographics. Jan-Feb 2004;24(1):41-52. doi:10.1148/rg.241025144
15. Rhim H, Lim HK, Kim YS, Choi D. Percutaneous radiofrequency ablation with artificial ascites for hepatocellular carcinoma in the hepatic dome: initial experience. AJR Am J Roentgenol. Jan 2008;190(1):91-8. doi:10.2214/ajr.07.2384
16. Kondo Y, Yoshida H, Tateishi R, Shiina S, Kawabe T, Omata M. Percutaneous radiofrequency ablation of liver cancer in the hepatic dome using the intrapleural fluid infusion technique. Br J Surg. Aug 2008;95(8):996-1004.doi:10.1002/bjs.6058
17. Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. Feb 2003;226(2):441-51. doi:10.1148/radiol.2262012198
18. Perrault J, McGill DB, Ott BJ, Taylor WF. Liver biopsy: complications in 1000 inpatients and outpatients.Gastroenterology. Jan 1978;74(1):103-6.
19. Stigliano R, Marelli L, Yu D, Davies N, Patch D, Burroughs AK. Seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma. What is the risk and the outcome? Seeding risk for percutaneous approach of HCC. Cancer Treat Rev. Aug 2007;33(5):437-47. doi:10.1016/j.ctrv.2007.04.001