2002 Volume 18 Issue 1 Pages 21-30
Aim
Based on our experiences of treating hepatocellular carcinomas (HCC), we discuss some of the techniques that are required in order to gain appropriate outcomes. We also report the clinical significance of different radiofrequency devices.
Methods
One hundred and forty-seven cases with HCC were treated using radiofrequency ablation. Either a percutaneous approach or a laparoscopic approach was selected depending on the location and the size of tumors. A guiding needle technique was routinely applied to the percutaneous approach in order to make it safer and easier to target the tumor. Laparoscopy under general anesthesia was assisted by the ultrasound guidance to locate the tumor.
Two different radiofrequency devices : an expandable electrode with a thermo-controlled generator (Model 30, RITA) and a cool-tip electrode with an impedance-controlled generator (Cooltip-system, Radionics) were compared. The clinical advantages of both devices were assessed.
Results
Of the 94 cases that were treated by RFA as the initial treatment for the tumor, 50 were bearing a single nodule smaller than 30mm. After RFA, most cases of this group were diagnosed as completed ablation, and there were three cases (6%) with local recurrences.
A guiding needle technique was applied to all the percutaneous approaches which not only enabled us to target the tumor precisely, but also offered a safe route for biopsy and hematostatic procedure. For the laparoscopic approach, the ultrasonic guidance was essential when the tumor was located under the liver surface.
Compared to the expandable electrode, the use of the cool-tip electrode resulted in the reduction of the number of punctures by half, thus shortening the operation time by half. This difference may be attributed to the difference in the capacity of the generator power.
Conclusions
Radiofrequency ablation may play a major role in treating hepatocellular carcinoma provided the techniques and procedures are adequate.
