Percutaneous Radiofrequency Ablation with Artificial Ascites for Hepatocellular Carcinoma in the Hepatic Dome: Initial Experience

Abstract

OBJECTIVE. Our objective was to assess the feasibility, safety, and efficacy of percutaneous radiofrequency ablation with artificial ascites for hepatocellular carcinoma (HCC) in the hepatic dome. MATERIALS AND METHODS. Sonographically guided percutaneous radiofrequency ablation with artificial ascites was performed in 25 patients with 34 HCCs using an internally cooled electrode radiofrequency system. At least one hepatic dome tumor in each patient was considered difficult to treat percutaneously because of partially visible tumor (n = 16) or poor electrode path (n = 9) on planning sonography. We artificially induced ascites before radiofrequency ablation by dripping 5% dextrose in water (D/W) solution to improve tumor visibility or electrode path and to separate the radiofrequency ablation zone from the diaphragm. We assessed the technical feasibility, safety, and efficacy of this technique with clinical and CT follow-up for at least 4 months (mean, 281.4 days) RESULTS. Artificial ascites was successfully achieved in 22 (88%) of 25 patients with the administration of a mean of 348 mL of D/W solution for an additional mean time of 9.3 minutes. There was substantial improvement in the visibility in 93.4% (15/16) of the partially visible tumors and in achieving a better path in 77.8% (7/9) of the tumors with a poor electrode path. The primary technique effectiveness rate for hepatic dome tumors was 96% (24/25) at 1-month follow-up CT. There was no diaphragmatic thermal injury in all but one case. No complication related to artificial ascites occurred during the follow-up period. CONCLUSION. Percutaneous radiofrequency ablation with artificial ascites appears a feasible, safe, and effective technique for treating HCC of the hepatic dome.