Short-term Results of Laparoscopic Transthoracic Transdiaphragmatic Intraoperative Radiofrequency Ablation for Liver Tumors Located Beneath the Diaphragm

Kimitaka Tanaka, Tetsufumi Kojima, Etsuo Hiraguchi, Hideaki Hashida, Eiji Tamoto, Jun Mitsui, Takashi Ueno

Hakodate Central General Hospital

Introduction
It is often difficult to perform percutaneous Radio-frequency ablation (RFA) for liver tumors located beneath the diaphragm. Diaphragmatic hernia is among the fatal late complications of transdiaphragmatic RFA with an incidence of <1%. This study investigated whether laparoscopic transthoracic transdiaphragmatic intraoperative RFA is feasible, safe, and minimally invasive.
Methods and Procedures
We investigated the short-term results of 10 patients (5 men, 5 women; age range 60–78 years; 11 tumors) who underwent laparoscopic transthoracic transdiaphragmatic intraoperative RFA since 2009. Two cases underwent concurrent partial hepatectomy, while 1 case underwent RFA for 2 tumors contemporaneously. The diagnosis was hepatocellular carcinoma in 8 cases and metastatic liver tumor in 2. The tumor was located at segment 8 in 7 cases, segment 7 in 3 cases, and segment 4 in 1 case. Tumor diameter was <20 mm in 9 cases. The value of ICG 15 min was >20% in 2 cases.
The operative procedure was as follows. General anesthesia was performed with single lumen tube intubation, half left lateral decubitus position, and an average of 4 abdominal port placements. A 12-mm port was inserted into the chest cavity at the fourth or fifth intercostal space of the anterior axillary line by optical viewing. The diaphragm was punctured by the port following lung collapse. The tumor was ablated by an RFA needle running through the port. Following ablation, the diaphragm was sutured laparoscopically and a chest drain was placed.
Results
The median operation duration of the 7 patients, who underwent RFA with a 2-cm needle for only 1 tumor, was 137 min (range, 105–187 min). The median number of times ablation was performed was 3. Postoperative complications observed were pleural effusion, bleeding from the chest cavity, and right upper limb paralysis (1 case each). No local recurrence was observed. The median length of postoperative hospital stay was 16 days. Recurrent tumors subsequently developed in other areas of the liver in 4 patients. One patient died from a disease, which was not associated with liver tumor. The observation period ranged from 28 to 1050 days, with a median of 516 days.
Conclusions
In this study, the duration of postoperative hospital stay was relatively long in many cases but there were very few postoperative complications directly attributable to RFA. High local ablation rates can be obtained by multiple ablation. Laparoscopic transthoracic transdiaphragmatic intraoperative RFA should be considered as a substitute for percutaneous RFA for liver tumors located beneath the diaphragm.


Session: Poster Presentation

Program Number: P345

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