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Radiofrequency Tissue Ablation: Effect of Hepatic Blood Flow Occlusion on Thermal Injuries Produced in Cirrhotic Livers

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Abstract

Background: Radiofrequency thermal ablation has been used as a treatment for several types of hepatic malignancies. Many of these lesions exist in the presence of cirrhosis. Limitations exist to the size of the ablations and, subsequently, the efficacy of treatment. Hepatic vascular inflow occlusion has been advocated as an adjunctive measure to increase the efficacy of the ablation. We present a model in the human cirrhotic liver that demonstrates the advantage of blood flow occlusion during radiofrequency ablation.

Methods: Five patients with advanced endstage liver disease scheduled to have orthotopic liver transplantation were enrolled in this study. After laparotomy and before hepatectomy, radiofrequency ablation was performed without and with hepatic blood flow occlusion. After hepatectomy, the liver was sectioned, the area of ablation was measured in three dimensions, and the volume of ablation calculated.

Results: Three of the patients had had previously placed transjugular intrahepatic portosystemic shunt. The mean volume of the ablation without blood flow occlusion was 22.5 ± 7.4 cm3 and that with blood flow occlusion was 48.4 ± 24.0 cm3 (P = .05).

Conclusions: Ablation area is increased significantly with hepatic blood flow occlusion in the human cirrhotic liver. This result may have application in the treatment of larger (>3 cm) hepatic malignancies.

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Authors and Affiliations

  1. Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas

    W. Kenneth Washburn MD, Glenn A. Halff MD, Robert M. Esterl MD & Francisco G. Cigarroa MD

  2. Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas

    Gerald D. Dodd III MD, Victor A. McCoy MD, Dacia H. Napier MD & Linda G. Hubbard RN

  3. Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, Texas

    Ruth E. Kohlmeier MD & Francis E. Sharkey MD

  4. University of Texas Health Science Center at San Antonio, Organ Transplantation, MC 7858, San Antonio, TX, 78229

    W. Kenneth Washburn MD

Authors
  1. W. Kenneth Washburn MD
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  2. Gerald D. Dodd III MD
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  3. Ruth E. Kohlmeier MD
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  4. Victor A. McCoy MD
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  5. Dacia H. Napier MD
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  6. Linda G. Hubbard RN
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  7. Glenn A. Halff MD
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  8. Robert M. Esterl MD
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  9. Francisco G. Cigarroa MD
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  10. Francis E. Sharkey MD
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Correspondence to W. Kenneth Washburn MD.

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Washburn, W.K., Dodd, G.D., Kohlmeier, R.E. et al. Radiofrequency Tissue Ablation: Effect of Hepatic Blood Flow Occlusion on Thermal Injuries Produced in Cirrhotic Livers. Ann Surg Oncol 10, 773–777 (2003). https://doi.org/10.1245/ASO.2003.09.013

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  • DOI: https://doi.org/10.1245/ASO.2003.09.013

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