Thoracoscopic radiofrequency ablation therapy for hepatocellular carcinoma located beneath the doom of the diaphragm

Abstract

Background and Aims: Percutaneous radiofrequency ablation for hepatocellular carcinoma is a safety and effective treatment. However, when the tumor is located just under the top of the diaphragm, visualization of the tumor may be difficult with an extracorporeal conventional ultrasonographic examination. In this report, the efficacy of thoracoscopic radiofrequency ablation (TRFA) for hepatocellular carcinoma located just under the top of diaphragma has been evaluated in patients. Patients and Methods: Five patients underwent thoracoscopic radiofrequency ablation therapy seven times. A thoracoscopic approach with two ports of 12mm in size for a scope and for intraoperative ultrasound, allowed us to obtain additional information regarding liver tumors and a complete treatment for liver lesions. An Lita RFA system (RITA) was applied and a Lita 500PA needle was used. Results: Five patients were positive for HCV and had liver cirrhosis. The average tumor size was 2.4cm with ranging from 2.0 to 3.0cm. The average session was 3.3 (3 to 6) times. The average procedure time was 180 (90-280) min for TRFA, and the average blood loss was 18 (0-50) ml. No severe complications occurred. Dynamic computed tomogrames one week after TRFA demonstrated complete necrosis in all patients. The patients were followed up for 7-33 months (average 21 months). One patient died of cerebral infarction without hepatocellular carcinoma, and the other are well now without disease. Conclusions: Thoracoscopic radiofrequency ablation is a safe and effective technique for hepatocellular carcinoma located just under the top of diaphragm.