Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Hui T.C., Kwan J., Pua U. Advanced Techniques in the Percutaneous Ablation of Liver Tumours. Diagnostics. 2021;11:585. doi: 10.3390/diagnostics11040585. - DOI - PMC - PubMed
    1. Di Martino M., Rompianesi G., Mora-Guzmán I., Martín-Pérez E., Montalti R., Troisi R.I. Systematic review and meta-analysis of local ablative therapies for resectable colorectal liver metastases. Eur. J. Surg. Oncol. 2020;46:772–781. doi: 10.1016/j.ejso.2019.12.003. - DOI - PubMed
    1. Cervantes A., Adam R., Roselló S., Arnold D., Normanno N., Taïeb J., Seligmann J., De Baere T., Osterlund P., Yoshino T., et al. Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann. Oncol. 2023;34:10–32. doi: 10.1016/j.annonc.2022.10.003. - DOI - PubMed
    1. Reig M., Forner A., Rimola J., Ferrer-Fàbrega J., Burrel M., Garcia-Criado Á., Kelley R.K., Galle P.R., Mazzaferro V., Salem R., et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J. Hepatol. 2022;76:681–693. doi: 10.1016/j.jhep.2021.11.018. - DOI - PMC - PubMed
    1. Guiu B. MWA Versus RFA HCC: Superior? Equivalent? Will We Ever Know? Cardiovasc. Interv. Radiol. 2020;43:1619–1620. doi: 10.1007/s00270-020-02635-x. - DOI - PubMed

LinkOut - more resources