Percutaneous ultrasound-guided ‘three-step’ radiofrequency ablation for giant hepatic hemangioma (5–15 cm): a safe and effective new technique

Figures & data

Figure 1. CONSORT diagram for the study.

Figure 2. Percutaneous ultrasound-guided ‘three-step’ radiofrequency ablation of hepatic hemangioma located in the right lobe. (A) Contrast-enhanced ultrasonography is used to locate the tumor (the tumor was 7.66 cm in diameter) and its feeding artery. (B) The first step is to ablate the feeding artery. (C) The second step is to aspirate blood from the tumor (the diameter of the tumor after the blood was drawn was 4.11 cm). (D) The third step is to ablate the lesion.

Table 1. Patient and tumor characteristics between the two study groups.

Characteristics	TS-RFA (n = 52)	C-RFA (n = 54)	p value
Age (years)	42.6 ± 1.1	43.5 ± 1.1	0.574
Sex (men/women)	10/42	19/35	0.065
Concomitant liver disease
Chronic hepatitis B	7	4	0.242
Fatty liver	4	5	0.524
Gallbladder stones	2	1	0.486
Gallbladder polyps	6	7	0.823
Hepatic cysts	9	5	0.221
Laboratory data
Hemoglobin (g/L)	131.6 ± 1.8	127.2 ± 1.8	0.094
Platelet count (10^9/L)	189.1 ± 8.4	192.5 ± 6.9	0.758
ALB (g/L)	43.3 ± 0.8	42.0 ± 0.7	0.264
Tbil (μmol/L)	13.6 ± 0.7	14.0 ± 0.5	0.245
ALT (IU/L)	23.6 ± 2.2	21.1 ± 1.4	0.957
AST (IU/L)	25.7 ± 1.6	22.3 ± 0.9	0.077
PT (s)	11.0 ± 0.1	11.4 ± 0.1	0.053
Creatinine (μmol/L)	61.6 ± 1.8	63.3 ± 1.9	0.536
Reasons for radiofrequency ablation
Enlargement of hemangioma/abdominal  pain or discomfort/abdominal  pain and enlargement of hemangioma	30/13/9	34/15/5	0.473
Characteristics of hemangioma
Size of hemangiomas (cm)≥5 cm (1/2/3/4/5)	6/16/18/4/3	18/10/11/4/7	0.252
Size of hemangioma (cm)<10/≥10	47/5	50/4	0.685
Diameter (cm)	7.3 ± 0.2	7.1 ± 0.2	0.112
Location of hemangioma
Left lobe/right lobe/bilateral lobe	4/41/7	10/36/8	0.232

Data are shown as means ± standard error unless otherwise specified. Comparisons were made using T test or Fisher’s exact test or χ² test or Mann–Whitney U test as appropriate. ALB: albumin; TB: total bilirubin; ALT: alanine transaminase; AST: aspartate aminotransferase; PT: prothrombin time.

Table 2. Intraoperative information and postoperative outcomes.

Treatment outcomes	TS-RFA (n = 52)	C-RFA (n = 54)	p value
Therapeutic response
Duration of damaging blood supply (min)	3.8 ± 0.1 (1.4–6.4)	–
Volume of blood extracted (ml)	143.6 ± 10.3 (20–340)	–
Diameter before RFA	5.3 ± 0.2 (2.8–9.7)	7.1 ± 0.2 (5–12.8)	<0.001
Duration of RFA (min)	19.2 ± 0.8	44.5 ± 2.8	<0.001
Number of RFA
Single RFA session	41	15	<0.001
Two RFA sessions	11	39
Complete ablation	45 (86.5%)	22 (40.7%)	<0.001
Diameter of residue (cm)	1.5 ± 0.2	2.1 ± 0.1	0.026
Number of puncture	3.2 ± 0.1	4.7 ± 0.3	0.002
Hospital stay (d)	9.0 ± 0.5	11.5 ± 0.7	0.013
Maximum pain score	2.5 ± 1.3	4.1 ± 2.0	<0.001
Clinical response
Disappearance of symptoms	20/22	13/20	0.04
Improvement of symptoms	2/22	6/20
Persistent symptoms	0	1/20

Data are shown as means ± standard error unless otherwise specified. Comparisons were made using T test or Fisher’s exact test or χ² test or Mann–Whitney U test as appropriate.

Figure 3. Comparison of preoperative and postoperative liver function, renal function and hemoglobin indexes.

Table 3. Postoperative morbidity.

Complications	Clavien grade	TS-RFA (n = 52)	C-RFA (n = 54)	p value
Fever^a	II	3	6	0.489
Pleural effusion	I	2	6	0.271
Hemoglobinuria	II	1	2	1.000
Moderate anemia^b	II	0	2	0.495
Acute renal insufficiency^c	II	1	2	1.000
Jaundice^d	II	4	13	0.033
Abdominal Hemorrhage	III	0	1	1.000

Comparisons were made using Fisher’s exact test.

^a Fever ≥38 °C.

^b HGB ≥60 g/L and <70 g/L.

^c Creatinine >200 μmol/L.

^dTotal bilirubin >51.3 μmol/L.