Rapid Communication
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2005; 11(43): 6828-6832
Published online Nov 21, 2005. doi: 10.3748/wjg.v11.i43.6828
Scattered and rapid intrahepatic recurrences after radio frequency ablation for hepatocellular carcinoma
Kazuhiro Kotoh, Munechika Enjoji, Eiichirou Arimura, Shusuke Morizono, Motoyuki Kohjima, Hironori Sakai, Makoto Nakamuta
Kazuhiro Kotoh, Munechika Enjoji, Shusuke Morizono, Motoyuki Kohjima, Makoto Nakamuta, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Eiichirou Arimura, Hironori Sakai, Department of Gastroenterol-ogy, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Munechika Enjoji, MD, PhD, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. enjoji@intmed3.med.kyushu-u.ac.jp
Telephone: +81-92-642-5282 Fax: +81-92-642-5287
Received: April 11, 2005
Revised: June 6, 2005
Accepted: June 9, 2005
Published online: November 21, 2005

AIM: To evaluate a series of patients with hepatocellular carcinoma (HCC) treated with several different protocols and devices.

METHODS: We treated 138 patients [chronic hepatitis/liver cirrhosis (Child–Pugh A/B/C), 3/135 (107/25/3)] with two different devices and protocols: cool-tip needle [initial ablation at 60 W (standard method) (n = 37) or at 40 W (modified method) (n = 28)] or; ablation with a LeVeen needle using a standard single-step, full expansion (single-step) method (n = 39) or a multi-step, incremental expansion (multi-step) method.

RESULTS: Eleven patients experienced rapid and scattered recurrences 1 to 7 mo after the ablation. Nine patients were treated by the cool-tip original protocol (60 W) (9/37 = 24%) and the other two by the LeVeen single-step method (2/39 = 5%). The location of the recurrence was surrounding and limited to the site of ablation segment in three cases, and spread over one lobule or both lobules in the other eight cases. There was no recurrence in the patients treated with the modified cool-tip modified method (40 W) or the LeVeen multi-step method.

CONCLUSION: There is a risk of rapid and scattered recurrence after RFA, especially when the standard cool-tip procedure is used. Because such recurrence would worsen the prognosis, we recommend that modified protocols for the cool-tip and LeVeen needle methods should be used in clinical practice.

Keywords: Radio frequency ablation, Hepatocellular carcinoma, Cool-tip needle, LeVeen needle, Recurrence