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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Laparoscopic vs computerized tomography-guided radiofrequency ablation for large hepatic hemangiomas abutting the diaphragm
Jun Gao, Jian Kong, Xue-Mei Ding, Shan Ke, Hai-Gang Niu, Zong-Hai Xin, Chun-Min Ning, Shi-Gang Guo, Xiao-Long Li, Long Zhang, Yong-Hong Dong, Wen-Bing Sun
Jun Gao, Jian Kong, Xue-Mei Ding, Shan Ke, Wen-Bing Sun, Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
Hai-Gang Niu, Department of General Surgery, Fenyang Hospital, Lvliang 032200, Shanxi Province, China
Zong-Hai Xin, Department of General Surgery, Zhanhua People’s Hospital, Zhanhua 256800, Shandong Province, China
Chun-Min Ning, Shi-Gang Guo, Department of General Surgery, Chaoyang Central Hospital, Chaoyang 122000, Liaoning Province, China
Xiao-Long Li, Long Zhang, Department of General Surgery, Affiliated Hospital of Chifeng University, Chifeng 024000, Inner Mongolia Autonomous Region, China
Yong-Hong Dong, Department of General Surgery, Shanxi Provincial People’s Hospital, Taiyuan 032200, Shanxi 032200, China
Author contributions: Gao J and Sun WB designed the research, analyzed and interpreted the data, and drafted the manuscript; Kong J, Ding XM, Ke S, Niu HG, Xin ZH, Ning CM, Guo SG, Li XL, Zhang L and Dong YH performed the study, analyzed the data and helped draft the manuscript; all authors read and approved the final manuscript.
Supported by the Dr. Jieping Wu Medical Foundation, No. 320675007131 and No. 32067501207; Clinical-Basic Medicine Cooperation Fund of Capital Medical University, No. 1300171711; and the Program for Medical Key Discipline of Shijingshan District, No. 20130001.
Ethics approval: The study was reviewed and approved by the four institutional review boards of the four institutions according to the standards of the Declaration of Helsinki.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors have no conflicts of interest to declare.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wen-Bing Sun, MD, Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, No. 5 Jingyuan Street, Beijing 100043, China. cyhswb@qq.com
Telephone: +86-10-51718372 Fax: +86-10-51718017
Received: December 19, 2014
Peer-review started: December 24, 2014
First decision: January 8, 2014
Revised: January 16, 2015
Accepted: February 13, 2015
Article in press: February 13, 2015
Published online: May 21, 2015
AIM: To compare safety and therapeutic efficacy of laparoscopic radiofrequency (RF) ablation vs computed tomography (CT)-guided RF ablation for large hepatic hemangiomas abutting the diaphragm.
METHODS: We retrospectively reviewed our sequential experience of treating 51 large hepatic hemangiomas abutting the diaphragm in 51 patients by CT-guided or laparoscopic RF ablation due to either the presence of symptoms and/or the enlargement of hemangioma. Altogether, 24 hemangiomas were ablated via a CT-guided percutaneous approach (CT-guided ablation group), and 27 hemangiomas were treated via a laparoscopic approach (laparoscopic ablation group).
RESULTS: The mean diameter of the 51 hemangiomas was 9.6 ± 1.8 cm (range, 6.0-12.0 cm). There was no difference in the diameter of hemangiomas between the two groups (P > 0.05). RF ablation was performed successfully in all patients. There was no difference in ablation times between groups (P > 0.05). There were 23 thoracic complications in 17 patients: 15 (62.5%, 15/24) in the CT-guided ablation group and 2 (7.4%, 2/27) in the laparoscopic ablation group (P < 0.05). According to the Dindo-Clavien classification, two complications (pleural effusion and diaphragmatic rupture grade III) were major in two patients. All others were minor (grade I). Both major complications occurred in the CT-guided ablation group. The minor complications were treated successfully with conservative measures, and the two major complications underwent treatment by chest tube drainage and thoracoscopic surgery, respectively. Complete ablation was achieved in 91.7% (22/24) and 96.3% (26/27) in the CT-guided and the laparoscopic ablation groups, respectively (P > 0.05).
CONCLUSION: Laparoscopic RF ablation therapy should be used as the first-line treatment option for large hepatic hemangiomas abutting the diaphragm. It avoids thermal injury to the diaphragm and reduces thoracic complications.
Core tip: Radiofrequency (RF) ablation is an accepted non-surgical treatment for hepatic hemangiomas. If a tumor is located in the hepatic dome which abuts the diaphragm, complete tumor ablation without injury to the diaphragm or lung is challenging under percutaneous approach. The study preliminarily proved that laparoscopic RF ablation therapy should be used as the first-line treatment option for hepatic hemangiomas abutting the diaphragm, which can avoid thermal injury to the diaphragm effectively and reduce the thoracic complications obviously.
