Maeda Masaki, Saeki Issei, Sakaida Isao, Aikata Hiroshi, Araki Yasuyuki, Ogawa Chikara, Kariyama Kazuya, Nouso Kazuhiro, Kitamoto Mikiya, Kobashi Haruhiko, Sato Shuichi, Shibata Hiroshi, Joko Kouji, Takaki Shintaro, Takabatake Hiroyuki, Tsutsui Akemi, Takaguchi Koichi, Tomonari Tetsu, Nakamura Shinichiro, Nagahara Takakazu, Hiraoka Atsushi, Matono Tomomitsu, Koda Masahiko, Mandai Mari, Mannami Tomohiko, Mitsuda Akeri, Moriya Takashi, Yabushita Kazuhisa, Tani Joji, Yagi Takahito, Yamasaki Takahiro
aDepartment of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
cDepartment of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
Liver Cancer. 2020 Jan;9(1):50-62. doi: 10.1159/000502744. Epub 2019 Oct 22.
Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is considered a safe and minimally invasive procedure. We previously reported that the mortality and complication rates for RFA were 0.038% (5/13,283 patients) and 3.54% (579 complications/16,346 procedures), respectively, from 1999 to 2010 (previous period). In this study, we investigated the clinical criteria for RFA and the mortality and complication rates from 2011 to 2015 (recent period).
Data were collected from 25 centers by using a questionnaire developed by the Chugoku-Shikoku Society for Local Ablation Therapy of HCC. The criteria for RFA, RFA modification, use of image-guidance modalities, mortality, and complications during the previous and recent periods were compared.
We evaluated 11,298 procedures for 9,411 patients, including those that involved new devices (bipolar RFA and internally adjustable electrode system). The criterion of hepatic function for RFA increased from a Child-Pugh score ≤8 during the previous period to ≤9 during the recent period. The criteria regarding the tumor location and other risk factors have been expanded recently because of the increased use of several modifications of the RFA procedure and image-guidance modalities. The mortality rate was 0.064% (6/9,411 patients), and the complication rate was 2.92% (330 complications/11,298 procedures). There was no difference in mortality rates between the 2 periods ( = 0.38), but the complication rates was significantly lower during the recent period ( = 0.038).
Our findings confirmed that RFA, including the use of new devices, is a low-risk procedure for HCC, despite the expansion of the criteria for RFA during the recent period.
肝细胞癌（HCC）的射频消融（RFA）被认为是一种安全且微创的手术。我们之前报道过，1999年至2010年（前期），RFA的死亡率和并发症发生率分别为0.038%（5/13283例患者）和3.54%（579例并发症/16346例手术）。在本研究中，我们调查了2011年至2015年（近期）RFA的临床标准以及死亡率和并发症发生率。
通过使用由中国四国地区肝癌局部消融治疗协会制定的问卷，从25个中心收集数据。比较了前期和近期RFA的标准、RFA改良、图像引导方式的使用、死亡率和并发症情况。
我们评估了9411例患者的11298例手术，包括那些涉及新设备（双极RFA和内部可调电极系统）的手术。RFA的肝功能标准从前期的Child-Pugh评分≤8增加到近期的≤9。由于RFA手术和图像引导方式的几种改良使用增加，关于肿瘤位置和其他危险因素的标准最近有所扩大。死亡率为0.064%（6/9,411例患者），并发症发生率为2.92%（330例并发症/11,298例手术）。两个时期的死亡率没有差异（P = 0.38），但近期的并发症发生率显著更低（P = 0.038）。
我们的研究结果证实，尽管近期RFA标准有所扩大，但包括使用新设备在内的RFA对于HCC来说是一种低风险手术。
