Hepatic infarction after radiofreqnency ablation of hepatocellnlar carcinoma with an internally cooled electrode

PURPOSE: To elucidate the attributes of hepatic infarction after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) with an internally cooled electrode. MATERIALS AND METHODS: The authors retrospectively reviewed follow-up computed tomographic (CT) scans (follow-up period, 1-60.1 months; mean, 15.4 months) in 872 consecutive patients (male:female ratio, 672:200; mean age, 59.5 years) who had undergone 1,120 sessions of RFA for 1,335 HCCs with an internally cooled electrode. Diagnosis of hepatic infarction was made on the basis of CT findings. The authors evaluated the frequency of hepatic infarction, clinical features, initial and follow-up CT findings, accompanied complications, and prognosis. Potential risk factors were evaluated with multiple logistic regression analysis. RESULTS: The frequency of hepatic infarction was 1.8% (20 of 1,120 sessions). Common presenting symptoms were abdominal pain (16 of 20 patients) and fever (11 of 20 patients). All infarctions were found at the first follow-up CT examination. Gas collections were noted in 65% of patients. All lesions showed progressive shrinkage. Accompanied complications were biloma (n = 2), abscess (n = 2), and portal vein thrombosis (n = 1). One patient with a lobar infarction died from hepatic failure. Older age (P =.048) and larger tumor size (P =.026) were statistically significant risk factors by multivariate analysis. CONCLUSION: RFA complicated by hepatic infarction is uncommon. Although hepatic infarction can be managed conservatively in most cases, possible extensive involvement should be considered seriously because it may cause mortality.