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Adjunctive hydrodissection of the bare area of liver during percutaneous thermal ablation of sub-cardiac hepatic tumours

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A Letter to the Editor to this article was published on 30 September 2021

Abstract

Objective

To report the technique of hydrodissection of the sub-diaphragmatic bare area of the liver, in order to protect the diaphragm/heart during percutaneous thermal ablation (PTA) of sub-cardiac hepatic tumours.

Materials and methods

Between January 2016 and December 2018, five patients (four female, one male; mean age 56.2 years) with five sub-cardiac liver tumours (two hepatocellular carcinoma, three metastases; mean size 39 mm) abutting the bare area (segments II/IVA) with expected ablation zones ≤ 5 mm from the myocardium were treated with PTA and adjunctive hydrodissection. Time to perform hydrodissection, distance between superior hepatic and diaphragmatic/pericardial surfaces before and after hydrodissection, ablation efficacy, complications, and local tumour progression (LTP) at last imaging follow-up were recorded.

Results

Technical feasibility was 100%, with mean hydrodissection-volume of 126 ml (range 80–200 ml) and median hydrodissection-time of 9 min (range 8–45 min). Liver-diaphragmatic and liver-pericardial distance increased, respectively, from 2.4 mm (range 0–8 mm) to 10.8 mm (range 6–19 mm) and from 4 mm (range 1–10 mm) to 12.6 mm (range 8–20 mm) post-hydrodissection. All procedures were performed at full-power with complete tumour ablation and without complications (including peri-procedural haemodynamic/electrocardiographic disturbances, pericardial effusion and diaphragmatic hernia) or evidence of LTP at mean 12.2-month (range 1–26 month) follow-up.

Conclusion

Hydrodissection of the sub-diaphragmatic bare area of the liver is technically feasible and may potentially optimize safety PTA of sub-cardiac hepatic tumours.

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Authors and Affiliations

  1. Department of interventional radiology, Nouvel Hôpital Civil, 1, place de l’hôpital, 67096, Strasbourg Cedex, France

    Julien Garnon, Roberto Luigi Cazzato, Pierre Auloge, Guillaume Koch & Afshin Gangi

  2. UMR 7357, CNRS, INSA Strasbourg, ICube - University of Strasbourg, 1 place de l’Hôpital, 67091, Strasbourg, France

    Julien Garnon

  3. Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK

    Nitin Ramamurthy

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  1. Julien Garnon
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  2. Roberto Luigi Cazzato
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  3. Pierre Auloge
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  4. Nitin Ramamurthy
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  6. Afshin Gangi
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Correspondence to Julien Garnon.

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Garnon, J., Cazzato, R.L., Auloge, P. et al. Adjunctive hydrodissection of the bare area of liver during percutaneous thermal ablation of sub-cardiac hepatic tumours. Abdom Radiol 45, 3352–3360 (2020). https://doi.org/10.1007/s00261-020-02463-0

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