Radiofrequency tissue ablation: effect of hepatic blood flow occlusion on thermal injuries produced in cirrhotic livers.
BACKGROUND
Radiofrequency thermal ablation has been used as a treatment for several types of hepatic malignancies. Many of these lesions exist in the presence of cirrhosis. Limitations exist to the size of the ablations and, subsequently, the efficacy of treatment. Hepatic vascular inflow occlusion has been advocated as an adjunctive measure to increase the efficacy of the ablation. We present a model in the human cirrhotic liver that demonstrates the advantage of blood flow occlusion during radiofrequency ablation.


METHODS
Five patients with advanced endstage liver disease scheduled to have orthotopic liver transplantation were enrolled in this study. After laparotomy and before hepatectomy, radiofrequency ablation was performed without and with hepatic blood flow occlusion. After hepatectomy, the liver was sectioned, the area of ablation was measured in three dimensions, and the volume of ablation calculated.


RESULTS
Three of the patients had had previously placed transjugular intrahepatic portosystemic shunt. The mean volume of the ablation without blood flow occlusion was 22.5 +/- 7.4 cm(3) and that with blood flow occlusion was 48.4 +/- 24.0 cm(3) (P =.05).


CONCLUSIONS
Ablation area is increased significantly with hepatic blood flow occlusion in the human cirrhotic liver. This result may have application in the treatment of larger (>3 cm) hepatic malignancies.
Washburn
W Kenneth
WK
Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA. Washburn@uthscsa.edu
Dodd
Gerald D
GD
Kohlmeier
Ruth E
RE
McCoy
Victor A
VA
Napier
Dacia H
DH
Hubbard
Linda G
LG
Halff
Glenn A
GA
Esterl
Robert M
RM
Cigarroa
Francisco G
FG
Sharkey
Francis E
FE
D006528:Carcinoma, Hepatocellular / Q000601:surgery; D017115:Catheter Ablation; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008103:Liver Cirrhosis / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery; D012039:Regional Blood Flow