A combination therapy of ethanol injection and radiofrequency ablation under general anesthesia for the treatment of hepatocellular carcinoma

Abstract

Aim: To summarize the effects of laparoscopic ethanol injection and radiofrequency ablation (L-EI-RFA), thoracoscopic (T-EI-RFA) and open-surgery assisted EI-RFA (O-EI-RFA) under general anesthesia for the treatment of hepatocellular carcinoma (HCC).

Methods: Time-lag performance of RFA after ethanol injection (Time-lag PEI-RFA) was performed in all cases. The volume of coagulated necrosis and the applied energy for total and per unit volume coagulated necrosis were examined in the groups treated under general (group G) or local anesthesia (group L).

Results: The results showed that the total applied energy and the applied energy per unit volume of whole and marginal, coagulated necrosis were significantly larger in group G than those in the group L, resulting in a larger volume of coagulated necrosis in the group G. The rate of local tumor recurrence within one year was extremely low in group G.

Conclusion: These results suggest that EI-RFA, under general anesthesia, may be effective for the treatment of HCC because a larger quantity of ethanol and energy could be applied during treatment under painfree condition for the patients.

Figure 1

Relationship between the volume of coagulated necrosis induced and the amounts of ethanol injected or total applied energy or the product of the amounts of ethanol and the total applied energy. All the amounts of ethanol, total applied energy, or the products of the amount of ethanol and total applied energy showed a significant positive correlation with the volume of coagulated necrosis. (Ethanol vs volume, r = 0.54, P = 0.018; energy vs volume, r = 0.61, P = 0.0057; ethanol × energy vs volume, r = 0.61, P = 0.0078).

Figure 2

A case of HCC located on the reverse surface of the liver (S2 of the liver) treated with L-EI-RFA. A HCC (2 cm in diameter) showed an enhancement in early vascular phase of helical dynamic CT (A); RFA electrode and PEI needle were firstly inserted from the surface of the liver (B) and secondly inserted from the reverse surface of the liver (C); After injecting the ethanol containing 15% lipiodol, RFA was performed. Dynamic CT after the treatment showed lipiodol deposit associated with the original tumor and low density area was observed around the tumor (D); Laparoscopic observation of the tumor from the surface (E) and from the reverse surface (F) of the liver after the treatment.