title: Laparoscopic vs computerized tomography-guided radiofrequency ablation for large hepatic hemangiomas abutting the diaphragm.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Jun
authors.initials: J
authors.lastname: Gao
authors.affiliation: 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.
authors.forename: Jian
authors.initials: J
authors.lastname: Kong
authors.affiliation: 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.
authors.forename: Xue-Mei
authors.initials: XM
authors.lastname: Ding
authors.affiliation: 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.
authors.forename: Shan
authors.initials: S
authors.lastname: Ke
authors.affiliation: 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.
authors.forename: Hai-Gang
authors.initials: HG
authors.lastname: Niu
authors.affiliation: 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.
authors.forename: Zong-Hai
authors.initials: ZH
authors.lastname: Xin
authors.affiliation: 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.
authors.forename: Chun-Min
authors.initials: CM
authors.lastname: Ning
authors.affiliation: 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.
authors.forename: Shi-Gang
authors.initials: SG
authors.lastname: Guo
authors.affiliation: 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.
authors.forename: Xiao-Long
authors.initials: XL
authors.lastname: Li
authors.affiliation: 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.
authors.forename: Long
authors.initials: L
authors.lastname: Zhang
authors.affiliation: 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.
authors.forename: Yong-Hong
authors.initials: YH
authors.lastname: Dong
authors.affiliation: 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.
authors.forename: Wen-Bing
authors.initials: WB
authors.lastname: Sun
mesh_terms: D000328:Adult; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D003964:Diaphragm; D005260:Female; D006391:Hemangioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000009:adverse effects; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Computed tomography; Diaphragm; Hepatic hemangioma; Laparoscopy; Radiofrequency ablation