Purpose
To evaluate thoracic complications after percutaneous radiofrequency (RF) ablation for hepatocellular carcinoma (HCC) abutting the diaphragm
Material and methods
Among a total of 627 patients treated with percutaneous RF ablation over recent 4 years, we retrospectively evaluated 42 patients with nodular (<4cm) HCC which was apart less than 5 mm from the diaphragm. All patients underwent RF ablation using internally cooled electrodes, and were followed up with CT for at least 7 months after the ablation. We assessed the incidence and prognosis of the thoracic complications including pain, diaphragmatic swelling, pneumo- or hemothorax, and lung parenchymal changes at follow-up CT and medical records.
Results
Right shoulder pain as side effect was noted in 9 (21 %) of 42 patients and lasted for mean 1.8 days. Analgesics medication was required in five patients. No major complications to require additional hospital stay or treatment were encountered. There were nine cases of minor complications including hemothroax (n=1), pleural effusion (n=1), and transient lung parenchymal changes (n=7). Diaphragmatic swelling was seen at immediate follow-up CT in 39 (93 %) of 42 patients. The difference of diaphragm thickness between pre- and post-ablation CT ranged from 0 mm to 4.9 mm (mean: 1.5 mm). The diaphragmatic swelling showed spontaneous decrease without delayed sequelae during the follow-up.
Conclusion
Percutaneous RF ablation of HCC abutting the diaphragm is a safe procedure with acceptable range of thoracic complications, although substantial thermal effect is inevitable.