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Radiofrequency Ablation for Subcapsular Hepatocellular Carcinoma

From the Centre for the Study of Liver Disease and the Departments of Surgery (RT-PP, KK-CN, C-ML, S-TF) and Radiology (VA, JY), The University of Hong Kong, Pokfulam, Hong Kong, China.

Correspondence: Address correspondence and reprint requests to: Ronnie Tung-Ping Poon, MS, FRCS (Edin), FACS, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China; Fax: 852-28-17-5475; E-mail: poontp{at}hkucc.hku.hk

Background: Limited data from recent studies suggested an increased risk of bleeding complications, needle-track seeding, and local recurrence after radiofrequency ablation (RFA) of subcapsular hepatocellular carcinoma (HCC).

Methods: Between May 2001 and October 2002, 80 patients underwent RFA of 104 HCC nodules. Forty-eight patients had subcapsular HCC (group I), whereas the other 32 patients did not have subcapsular HCC (group II). RFA was performed via celiotomy, laparoscopy, or a percutaneous approach. Subcapsular HCCs were ablated by indirect puncture through nontumorous liver, and the needle track was thermocoagulated.

Results: There were no significant differences between groups in treatment morbidity (14.6% vs. 15.6%; P = .898), mortality (2.1% vs. 0%; P = 1.000), complete ablation rate after a single session (89.4% vs. 96.9%; P = .392), local recurrence rate (4.3% vs. 12.5%; P = .216), recurrence-free survival (1 year: 60.9% vs. 49.2%; P = .258), or overall survival (1 year: 88.3% vs. 79.4%; P = .441). After a median follow-up of 13 months, no needle-track seeding or intraperitoneal metastasis was observed.

Conclusions: This study shows that the results of RFA for subcapsular HCCs are comparable to those of RFA for nonsubcapsular HCCs. Subcapsular HCC should not be considered a contraindication for RFA treatment.

Key Words: Hepatocellular carcinoma • Radiofrequency ablation • Complications • Subcapsular carcinoma

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