Clinical application of hepatic wedge ablation for treating liver malignancies of the inferior margin: a new ablation technique

Figures & data

Figure 1. Schematic diagram of tumour locations at the inferior margin of the liver including portions of segments 2, 3, 4 on the left, segments S5 and S6 on the right, where the thickness of liver is less than 5 cm. For tumours in this location, the distance between the tumour and hepatic surface is less than 5 mm.

Table 1. Patient characteristics (n = 77).

Variable	Hepatic wedgeablation group(n = 32)	Conventional tumourablation group(n = 45)	p Value
Age (year)	57 ± 13	62 ± 11	.114
Gender (male/female)	22/10	29/16	.694
Tumour size (cm)	2.9 ± 1.1	2.9 ± 0.9	.985
Ablation cycle	1.6 ± 0.9	1.2 ± 0.4	.042
Ablation duration (min)	30.2 ± 18.5	22.5 ± 8.5	.031
Hydrodissection fluid volume (ml)	240.3 ± 170.5	164.2 ± 143.2	.036
Ablation area (cm)	4.2 ± 0.9	3.7 ± 1.2	.032

Figure 3. A 77-year old man with liver metastasis of colon cancer received percutaneous conventional tumour RFA. Local tumour progression occurred one year after tumour ablation. (A) Arterial phase in enhanced CT before RFA: the hypo-enhanced metastasis tumour was located the inferior margin of Segment 6. (B) The tumour was directly coagulated by simultaneous RF application with three electrodes. (C) Enhanced CT one month after RFA showed no tumour residue was found in the coagulated area. (D) Enhanced MRI (T1WI in arterial phase) one year after treatment showed tumour local progression at the inferior of coagulated area (arrow).

Table 2. Comparison of clinical outcomes after RFA.

Variable	Hepatic wedgeablation(%) (n = 32)	Conventional tumourablation (%)(n = 45)	p Value
Technical success	32 (100.0)	41 (91.1)	.232
Local tumour progression^a	0 (0)	8 (17.8)	.038
Intrahepatic distant recurrence	14 (43.8)	22 (48.9)	.656

^aThe local tumour progression rate of hepatic wedge ablation was significantly lower than conventional tumour ablation (0% vs. 17. 8%, p = .038).

Figure 4. Overall survival of hepatic wedge ablation (HWA) group and conventional tumour ablation (CTA) group for HCC. The one, two and three-year overall survival in HWA group and CTA group was 100.0%, 92.3%, 76.9% and 85.4%, 80.4%, 80.4%, respectively (p = .942).

Figure 5. Overall survival of hepatic wedge ablation (HWA) group and conventional tumour ablation (CTA) group for liver metastases. The one, two and three-year overall survival in HWA group and CTA group was 84.4%, 73.9%, 59.1% and 83.6%, 75.2%, 37.6%, respectively (p = .811).