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. 2024 Aug 15;14(16):1783.
doi: 10.3390/diagnostics14161783.

Non-Operating Room Anesthesia (NORA) for Ultrasound-Guided Liver Radiofrequency Ablation

Carlo Felix Maria Jung  1 , Elisa Liverani  1 , Cecilia Binda  1 , Ludovica Cristofaro  2 , Alberto Gori  3 , Luigina Vanessa Alemanni  1 , Alessandro Sartini  1 , Chiara Coluccio  1 , Giulia Gibiino  1 , Chiara Petraroli  1 , Carla Serra  4 , Carlo Fabbri  1
Affiliations

Non-Operating Room Anesthesia (NORA) for Ultrasound-Guided Liver Radiofrequency Ablation

Carlo Felix Maria Jung et al. Diagnostics (Basel). .

Abstract

Introduction: Percutaneous ultrasound-guided radiofrequency ablation (RFA) is a well-studied treatment option for locally non-advanced hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLMs). Sedation is of crucial interest as it enables safe and pain-free procedures. Whether the type of sedation has an impact on procedural outcome is still not well investigated.

Methods: We retrospectively collected data on patients undergoing liver RFA for various oncological conditions. Procedures were conducted in a non-operating room anesthesia (NORA) setting. Procedural-related complications and short-term oncological outcomes were analyzed.

Results: Thirty-five patients (mean age 71.5 y, 80% male) were treated for HCC (26), CRLM (6) and gastric cancer metastases (3). Mean lesion size was 21 mm (SD ± 10.1 mm), and the most common tumor localization was the right hepatic lobe. RFA was performed in a step-up sedation approach, with subcutaneous lidocaine injection prior to needle placement and subsequent deep sedation during ablation. No anesthesia-related early or late complications occurred. One patient presented with pleural effusion due to a large ablation zone and was treated conservatively. Local tumor-free survival after 1 and 6 months was 100% in all cases where a curative RFA approach was intended.

Conclusions: NORA for liver RFA comes with high patient acceptance and tolerance, and optimal postoperative outcomes and oncologic results.

Keywords: deep sedation; hepatocellular carcinoma; non-operating room anesthesia (NORA); percutaneous liver radiofrequency ablation.

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Conflict of interest statement

The authors all declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A): Needle placement into an HCC nodule of the left liver lobe. (B): Thermoablation with RFA in the same patient. Yellow arrow indicates HCC nodule.
Figure 2
Figure 2
CEUS at day one post RFA showing a large ablation zone without contrast enhancement during the arterial phase. The ablated area remains avascular in the portal and late phase.
Figure 3
Figure 3
(A,B) show an example of a CT scan in a patient with a left lobar HCC nodule prior to (A) and at 1 month after (B) RFA (blue arrow indicating the HCC nodule).
See this image and copyright information in PMC

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