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Early complications after percutaneous radiofrequency ablation for hepatocellular carcinoma: an analysis of 1,843 ablations in 1,211 patients in a single centre: experience over 10 years

  • J.G. Park
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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  • Author Footnotes
    † These authors contributed equally.
    S.Y. Park
    Correspondence
    Guarantor and correspondent: S.Y. Park, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41940, Republic of Korea. Tel.: +82 53 200 5515; fax: +82 53 426 8773.
    Footnotes
    † These authors contributed equally.
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
    Search for articles by this author
  • Author Footnotes
    † These authors contributed equally.
    W.Y. Tak
    Correspondence
    W.Y. Tak, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41940, Republic of Korea. Tel.: 82 53 200 5519; fax: 82 53 426 2046.
    Footnotes
    † These authors contributed equally.
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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  • Y.O. Kweon
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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  • S.Y. Jang
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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  • Y.R. Lee
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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  • K. Hur
    Affiliations
    Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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  • H.J. Lee
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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  • H.W. Lee
    Affiliations
    Department of Pathology, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Republic of Korea
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  • Author Footnotes
    † These authors contributed equally.
Published:March 30, 2017DOI:https://doi.org/10.1016/j.crad.2017.03.001

      Highlights

      • Radiofrequency ablation is a safe and effective locoregional treatment for early stage HCC.
      • Tumor size and the multiple overlapping ablations increase postoperative infection.
      • Post RFA bleeding is associated with low platelets, delay prothrombin time, and low serum albumin level.

      Aim

      To evaluate the incidence of adverse events and associated factors after radiofrequency ablation (RFA) in patients with hepatocellular carcinoma within 30 days.

      Materials and methods

      The early complications that occurred within 30 days after RFA at a single institution from January 2000 to July 2010 were reviewed in order to evaluate the morbidity, mortality, and risk factors associated with the complications. In total, 1,211 patients (845 men, 70.5%) with a mean age of 68 years (range, 27–88 years) underwent 1,843 RFA procedures.

      Results

      The overall incidence rate of complications was 6.8% (125 cases). Major complications (n=36, 2%) included liver abscess (n=15, 0.8%), intraperitoneal bleeding (n=8, 0.4%), liver failure (n=5, 0.3%), variceal bleeding (n=3, 0.2%), haemothorax (n=2, 0.1%), cholecystitis (n=2, 0.1%), and bowel perforation (n=1, 0.1%). Among the minor complications (n=89, 4.8%), the most common was the post RFA syndrome accompanied by pain and fever (n=75, 4.1%). Other minor complications included significant pleural effusion (n=7, 0.4%), skin wound infection (n=4, 0.2%), and thermal injuries to the skin (n=3, 0.2%). Procedural infections significantly increased with tumour size (OR=1.379; 95% confidence interval [CI], 1.191–1.579; p<0.001), and multiple overlapping ablations (OR=1.118; 95% CI, 1.019–1.227, p=0.018). Thrombocytopenia (<50,000/μl), prothrombin time, and serum albumin level were significantly associated with post-RFA bleeding episodes (p=0.041, p=0.021, and p=0.003, respectively). The overall mortality rate was 0.3% (three cases of hepatic failure, two case of sepsis, and one case of renal failure).

      Conclusions

      RFA is a safe and effective local treatment for hepatocellular carcinoma. Careful selection of patients and appropriate RFA planning could decrease procedural mortality and morbidity.
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