title: Percutaneous radiofrequency ablation of hepatocellular carcinoma in cirrhosis: analysis of complications in a single centre over 20 years.
abstract: OBJECTIVE
  To report on our 20 years' experience on complications after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in patients with cirrhosis.
  
  
  METHODS
  From 1994 to 2014, 1787 RFA procedures were performed percutaneously in 1162 patients with cirrhosis (852 Child A and 310 Child B) with HCC nodules (1.2-7 cm), prothrombin time >50%, platelet count of 50.000 mm3and total bilirubin ranging from 0.80 to 4.5 mg dl-1. In 67 patients, RFA was performed on both intraparenchymal HCC nodule and tumour thrombus extended in the main portal vein and/or its branches.
  
  
  RESULTS
  Four patients (0.3%) died after RFA. 39 patients (3.2%) changed in Child's class: 26 out of 28 Child A patients with cirrhosis changed to Child B and 2 changed to Child C class; 11 Child B patients changed to Child C class. On multivariate analysis, the total bilirubin pre-RFA was the only independent risk factor for impairment of liver function and death. Complications were hemoperitoneum, abscess and intrahepatic haematoma.
  
  
  CONCLUSIONS
  RFA of HCC in patients with cirrhosis is safe, even in case of invasion of the portal venous system. Functional liver reserve should be strictly monitored, mainly when pre-RFA total bilirubin value is >2.5 mg dl-1. The study was approved by our institutional review board. Advances in knowledge: The total bilirubin value >2.5 mg dl-1represents the main marker of functional liver reserve that predicts decompensation of liver cirrhosis in patients undergoing RFA for HCC.
authors.affiliation: 1 Interventional Ultrasound Unit, D Cotugno Hospital, Naples, Italy.|2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Giorgio
authors.affiliation: 2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Merola
authors.affiliation: 2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Montesarchio
authors.affiliation: 2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Merola
authors.affiliation: 2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Gatti
authors.affiliation: 2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Coppola
authors.affiliation: 2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Giorgio
authors.affiliation: 2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Calisti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome