Details

Autor(en) / Beteiligte

• Genov, JG
• Grigorov, N
• Mitova, R
• Golemanov, B
• Dinkov, L
• Donov, M
• Tzoneva, D

Titel

GOOSE BUMPS DURING RADIOFREQUENCY ABLATION OF HEPATIC TUMORS

Ist Teil von

• Ultraschall in der Medizin - European Journal of Ultrasound, 2005

Erscheinungsjahr

2005

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Purpose: To estimate the rate of major complications (MC) during radiofrequency ablation (RFA) of hepatocellular (HCC) and metastatic hepatic lesions. Methods and Materials: 196 patients with 354 tumors (63 pts. with 78 HCC, 133 pts. with 276 metastases, age 29–81, tumor size 0.5–14cm) were treated with percutaneous RFA under i.v. or general anesthesia. As contraindications were regarded incorrigible coagulation disorders (platelets <40 G/l, prothrombin time <40%), cirrhosis class C (Child-Pugh), advanced disease with biliary obstruction or portal vein thrombosis, active infection and renal failure. Antibiotic prophylaxis was used in all cases. 1–3 sessions per lesion were performed with 20–130min duration per session. Overall 2.4–7.5 kJ/ml neoplastic tissue were applied with overlapping insertions. The patients were discharged 1–3 days after RFA. The achieved destruction was assessed using power-Doppler, contrast-enhanced Doppler, CT and cytological analysis. Patients were followed-up for 1–46 months. As MC were considered those that induced a significant worsening of the clinical condition and required substantial care with delayed discharge or renewed hospitalization. Results: Complete destruction was achieved in 88.4% of lesions<3.0cm (89.3% of HCC, 88.3% of metastases), in 60.7% of tumors sized 3.0–5.0cm (71.8% of HCC, 56% of metastases) and in 18.8% of tumors>5.0cm (27.3% of HCC, 13.3% of metastases), with overall 27% local recurrence rate. MC occurred in 13 cases. In 2 pts. with metastases of colorectal cancer (CRC) abscesses developed. One was treated with percutaneous drainage and 1– surgically. In 1 pt. with 2 breast cancer metastases, a biliary fistula with consequent peritonitis on the day 28 after RFA presented and the patient was operated on. 3 weeks later a phlegmon of the abdominal wall developed and surgical drainage was applied. In 3 pts. with metastases close to the gallbladder, acalculous cholecystitis was observed. Antibiotics, analgesics and fasting were applied with complete resolution. In 2 cases with CRC metastases not having a track ablation performed, a seeding appeared. In 2 pts. with HCC a large intrahepatic haematoma manifested and gradually resolved. In an 80-years-old patient with HCC and cerebrovascular disease (CVD), after blood pressure fluctuations during RFA, a transient ischemic attack presented. The patient was managed medically with vasodilators and antiaggregants. In 1 pt. with coronary heart disease (CHD) 2 CRC metastases were treated, 1 of them located in the left lobe near the heart. Immediately after RFA a non-Q anteroseptal myocardial infarction presented. The patient was treated successfully with beta-blockers and nitrates. In 1 pt. with 4 neuroendocrine metastases directly after RFA a carcinoid syndrome appeared with flush, asthma, arterial hypertension and unstable angina, requiring intensive cares with endotracheal ventilation for 24h. RFA of the rest 2 untreated metastases was performed safely with somatostatin prophylaxis. Thus MC presented in 6.6% of the patients with no procedure-related death. As minor complications were manifested pain, fever, biloma, pleural effusion, s.c. haematoma, rash, pad burns. Aminotransferases and LDH increased 1.4–3.2 times in 24h and normalized until 96h. Conclusions: RFA represents a low-risk procedure. Lesions adjacent to the gallbladder are unsafe for manipulation. Patients with CVD and CHD are at risk of stroke and infarction. Ablation of carcinoid tumors should be protected with somatostatin.