Skip to main content
SpringerLink
Log in

Reducing Pain by Artificial Ascites Infusion During Radiofrequency Ablation for Subcapsular Hepatocellular Carcinoma

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate therapeutic effects of artificial ascites (AA) infusion in patients with subcapsular hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA) and to determine whether this infusion can reduce pain.

Methods and Materials

From 2011 to 2016, 123 patients with treatment-naïve single subcapsular HCC (≤ 2.5 cm) who underwent RFA were retrospectively included. Patients were divided into two groups according to AA infusion. After RFA, medical records were used to analyze pain scores during a 24-h period and to determine the opioid used that compared using Mann–Whitney U test. We also conducted subgroup analysis of the patients with HCCs located adjacent to parietal peritoneum. After follow-up period, we analyzed local tumor progression (LTP) and recurrence-free survival using Kaplan–Meier method.

Results

AA was infused in 76 patients (61.8%, 76/123). Pain score using numeric rating scale (NRS) was significantly lower in AA infusion group than in control group (2.54 ± 2.8 vs. 3.66 ± 3.2, p = 0.048). Dose of opioids used was not significantly different between two groups (1.62 ± 3.4 mg vs. 1.66 ± 3 mg, p = 0.698). However, in subgroup analysis (N = 45), NRS score and dose of opioids used were significantly lower in AA infusion group (p = 0.03, p = 0.032, respectively). LTP rate was not significantly different between two groups (p = 0.673).

Conclusion

AA infusion was an effective and safe way to reduce pain when performing RFA for subcapsular HCC. In particular, in patients with subcapsular HCC adjacent to parietal peritoneum, dose of opioid to use pain control was significantly lower with AA infusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Huang J, Hernandez-Alejandro R, Croome KP, Yan L, Wu H, Chen Z, et al. Radiofrequency ablation versus surgical resection for hepatocellular carcinoma in childs A cirrhotics-a retrospective study of 1,061 cases. J Gastrointest Surg. 2011;15(2):311–20. https://doi.org/10.1007/s11605-010-1372-y.

    Article  PubMed  Google Scholar 

  2. Lei JY, Wang WT, Yan LN, Wen TF, Li B. Radiofrequency ablation versus surgical resection for small unifocal hepatocellular carcinomas. Medicine (Baltimore). 2014;93(29):e271. https://doi.org/10.1097/MD.0000000000000271.

    Article  CAS  Google Scholar 

  3. Kang TW, Kim JM, Rhim H, Lee MW, Kim YS, Lim HK, et al. Small hepatocellular carcinoma: radiofrequency ablation versus nonanatomic resection-propensity score analyses of long-term outcomes. Radiology. 2015;275(3):908–19. https://doi.org/10.1148/radiol.15141483.

    Article  PubMed  Google Scholar 

  4. Llovet JM, Vilana R, Bru C, Bianchi L, Salmeron JM, Boix L, et al. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology. 2001;33(5):1124–9. https://doi.org/10.1053/jhep.2001.24233.

    Article  CAS  PubMed  Google Scholar 

  5. Komorizono Y, Oketani M, Sako K, Yamasaki N, Shibatou T, Maeda M, et al. Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session, single application of percutaneous radiofrequency ablation. Cancer. 2003;97(5):1253–62. https://doi.org/10.1002/cncr.11168.

    Article  PubMed  Google Scholar 

  6. Livraghi T, Lazzaroni S, Meloni F, Solbiati L. Risk of tumour seeding after percutaneous radiofrequency ablation for hepatocellular carcinoma. Br J Surg. 2005;92(7):856–8. https://doi.org/10.1002/bjs.4986.

    Article  CAS  PubMed  Google Scholar 

  7. Yang W, Yan K, Wu GX, Wu W, Fu Y, Lee JC, et al. Radiofrequency ablation of hepatocellular carcinoma in difficult locations: strategies and long-term outcomes. World J Gastroenterol. 2015;21(5):1554–66. https://doi.org/10.3748/wjg.v21.i5.1554.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Meloni MF, Goldberg SN, Moser V, Piazza G, Livraghi T. Colonic perforation and abscess following radiofrequency ablation treatment of hepatoma. Eur J Ultrasound. 2002;15(1–2):73–6.

    Article  Google Scholar 

  9. Onik G, Narayan P, Vaughan D, Dineen M, Brunelle R. Focal, “nerve-sparing” cryosurgery for treatment of primary prostate cancer: a new approach to preserving potency. Urology. 2002;60(1):109–14. https://doi.org/10.1016/s0090-4295(02)01643-6.

    Article  PubMed  Google Scholar 

  10. Raman SS, Lu DS, Vodopich DJ, Sayre J, Lassman C. Minimizing diaphragmatic injury during radio-frequency ablation: efficacy of subphrenic peritoneal saline injection in a porcine model. Radiology. 2002;222(3):819–23. https://doi.org/10.1148/radiol.2223001805.

    Article  PubMed  Google Scholar 

  11. Farrell MA, Charboneau JW, Callstrom MR, Reading CC, Engen DE, Blute ML. Paranephric water instillation: a technique to prevent bowel injury during percutaneous renal radiofrequency ablation. AJR Am J Roentgenol. 2003;181(5):1315–7. https://doi.org/10.2214/ajr.181.5.1811315.

    Article  CAS  PubMed  Google Scholar 

  12. Rhim H, Yoon KH, Lee JM, Cho Y, Cho JS, Kim SH, et al. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. Radiographics. 2003;23(1):123–34 (discussion 34–6). doi:https://doi.org/10.1148/rg.231025054.

    Article  PubMed  Google Scholar 

  13. Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003;226(2):441–51. https://doi.org/10.1148/radiol.2262012198.

    Article  PubMed  Google Scholar 

  14. Kang TW, Lim HK, Lee MW, Kim YS, Choi D, Rhim H. First-line radiofrequency ablation with or without artificial ascites for hepatocellular carcinomas in a subcapsular location: local control rate and risk of peritoneal seeding at long-term follow-up. Clin Radiol. 2013;68(12):e641–51. https://doi.org/10.1016/j.crad.2013.07.008.

    Article  CAS  PubMed  Google Scholar 

  15. Chen MH, Yang W, Yan K, Hou YB, Dai Y, Gao W, et al. Radiofrequency ablation of problematically located hepatocellular carcinoma: tailored approach. Abdom Imaging. 2008;33(4):428–36. https://doi.org/10.1007/s00261-007-9283-4.

    Article  PubMed  Google Scholar 

  16. Kang TW, Lim HK, Lee MW, Kim YS, Rhim H, Lee WJ, et al. Long-term therapeutic outcomes of radiofrequency ablation for subcapsular versus nonsubcapsular hepatocellular carcinoma: a propensity score matched study. Radiology. 2016;280(1):300–12. https://doi.org/10.1148/radiol.2016151243.

    Article  PubMed  Google Scholar 

  17. Lee S, Rhim H, Kim Y-S, Choi D, Lee WJ, Lim HK, et al. Percutaneous radiofrequency ablation of hepatocellular carcinomas: factors related to intraprocedural and postprocedural pain. Am J Roentgenol. 2009;192(4):1064–70. https://doi.org/10.2214/AJR.08.1350.

    Article  Google Scholar 

  18. Mercadante S, Bruera E. Opioid switching in cancer pain: from the beginning to nowadays. Crit Rev Oncol Hematol. 2016;99:241–8. https://doi.org/10.1016/j.critrevonc.2015.12.011.

    Article  PubMed  Google Scholar 

  19. Mitchell DG, Bruix J, Sherman M, Sirlin CB. LI-RADS (liver imaging reporting and data system): summary, discussion, and consensus of the LI-RADS management working group and future directions. Hepatology. 2015;61(3):1056–65. https://doi.org/10.1002/hep.27304.

    Article  PubMed  Google Scholar 

  20. Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD 3rd, Dupuy DE, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria. JVIR. 2009;20(7 Suppl):S377–90. https://doi.org/10.1016/j.jvir.2009.04.011.

    Article  PubMed  Google Scholar 

  21. Cardella JF, Kundu S, Miller DL, Millward SF, Sacks D. Society of interventional radiology clinical practice guidelines. JVIR. 2009;20(7 Suppl):S189–91. https://doi.org/10.1016/j.jvir.2009.04.035.

    Article  PubMed  Google Scholar 

  22. Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria–a 10-year update. Radiology. 2014;273(1):241–60. https://doi.org/10.1148/radiol.14132958.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hall H, Leach A. Paravertebral block in the management of liver capsule pain after blunt trauma. Br J Anaesth. 1999;83(5):819–21. https://doi.org/10.1093/bja/83.5.819.

    Article  CAS  PubMed  Google Scholar 

  24. Suzuki M, Narita M, Hasegawa M, Furuta S, Kawamata T, Ashikawa M, et al. Sensation of abdominal pain induced by peritoneal carcinomatosis is accompanied by changes in the expression of substance P and mu-opioid receptors in the spinal cord of mice. Anesthesiology. 2012;117(4):847–56. https://doi.org/10.1097/ALN.0b013e31826a4ac8.

    Article  CAS  PubMed  Google Scholar 

  25. Hinshaw JL, Laeseke PF, Winter TC 3rd, Kliewer MA, Fine JP, Lee FT Jr. Radiofrequency ablation of peripheral liver tumors: intraperitoneal 5% dextrose in water decreases postprocedural pain. AJR Am J Roentgenol. 2006;186(5 Suppl):S306–10. https://doi.org/10.2214/AJR.05.0140.

    Article  PubMed  Google Scholar 

  26. Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, et al. Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41(6):1073–93. https://doi.org/10.1016/j.jpainsymman.2010.08.016.

    Article  PubMed  Google Scholar 

Download references

Funding

This study was not supported by any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea

    Sae-Jin Park, Dong Ho Lee & Joon Koo Han

  2. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea

    Dong Ho Lee & Joon Koo Han

  3. Department of Radiology, Seoul National University College of Medicine, Seoul, Korea

    Joon Koo Han

Authors
  1. Sae-Jin Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dong Ho Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joon Koo Han
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dong Ho Lee.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This retrospective study was approved by the institutional review board (IRB No. H-1906-145-1043) of our institution, and the need for informed consent was waived. The medical records used in this study were created for clinical purposes using the hospital’s routine protocol.

Consent for Publication

For this type of study, consent for publication is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, SJ., Lee, D.H. & Han, J.K. Reducing Pain by Artificial Ascites Infusion During Radiofrequency Ablation for Subcapsular Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 44, 565–573 (2021). https://doi.org/10.1007/s00270-020-02723-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-020-02723-y

Keywords

Search

Navigation