title: Thoracoscopic ethanol injection and radiofrequency ablation for the treatment of hepatocellular carcinoma located immediately under the diaphragm.
abstract: We previously reported that the combination therapy of percutaneous ethanol injection and radiofrequency ablation (PEI-RFA) was more effective than RFA alone in inducing wider coagulated necrosis for the treatment of hepatocellular carcinoma (HCC). In the present study, we thoracoscopically applied the combination therapy to the treatment of HCC located immediately under the diaphragm. RFA electrode and ethanol injection needle were inserted into the tumor through the right side of the diaphragm in 6 patients with HCC close to the diaphragm. In all cases, the tumor was completely ablated with enough safety margin around the tumor. No local tumor recurrence has been observed in a relatively short-time follow-up period. The volume of coagulated necrosis and the energy requirement for coagulation in thoracoscopic ethanol injection and RFA (T-EI-RFA) were comparable to those of PEI-RFA. Although HCC located immediately under the diaphragm is difficult to treat with a percutaneous approach due to the poor visualization by ultrasonography, T-EI-RFA is considered to be an effective treatment modality.
authors.affiliation: Third Department of Internal Medicine, Kagawa University School of Medicine, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Kurokohchi
authors.forename: Shunichi
authors.initials: S
authors.lastname: Hirai
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Ohgi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ono
authors.forename: Akira
authors.initials: A
authors.lastname: Yoshitake
authors.forename: Kazuo
authors.initials: K
authors.lastname: Ebara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kitamura
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kasai
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Maeta
authors.forename: Takaaki
authors.initials: T
authors.lastname: Kiuchi
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
authors.forename: Hirohito
authors.initials: H
authors.lastname: Yoneyama
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Kohi
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kuriyama
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D003964:Diaphragm; D004566:Electrodes; D000431:Ethanol / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D009336:Necrosis; D012008:Recurrence; D013906:Thoracoscopy / Q000379:methods*
chemical_list: D000431:Ethanol