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Moon-kyu Kwon, il-kwon Han,Ji-sang Jung, Soo-jung Yoon,Je-hoon Yoo, *Ha-jung Joo.

The understanding of Radio frequency Ablation on the primary HCC &th

e metastatic HCC.

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RFA(Radiofrequency Ablation) Of Understanding

RFA is ?The co-relationships of the size and the number of tumor on the therapy.The comparison of percutaneous RFA & The comparison of percutaneous RFA & RFA after an open surgery.RFA after an open surgery.

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RF(Radiofrequency )is?

Radiofrequency라디오 송신 주파수 300-1200Khz

RFA400 -500kHZ 교류전류

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Principles Of RFA

Alternating Electrical Current

Ionic agitation

Coagulation Necrosis

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RF Mechanism Electric circuit

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RF Electrode Mechanism

Roll-Roll-offoff

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Co-relation of Power & Impedance

RadioFrequency AblationIn Vitro Liver (Typical)

Voltage Constant Throughout

0

20

40

60

0 1 2 3 4 5 6 7 8 9 10

Time (Min.)

Pow

er (W

.) &

Impe

danc

e(W

)

Power Rises asImpedance Falls

Power Falls asImpedance Rises

POWER

IMPEDANCE

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Depolyment ofRF Electroid

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US monitoring of Ablation

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Percutaneous RFA of liver metastases

Radiofrequency ablation of the liver: current status

American Journal of Roentgenology. 176:3-16, 2001 Jan

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Major Complication of RF AblationThe Korean Study Group of Radiofrequency Ablation

51 of 1154 patients (3.3%)hepatic abscess (n=13, 0.8%)peritoneal hemorrhage (n=7, 0.5%)ground pad burn (n=6, 0.4%)pneumothorax or hemothorax (n=6, 0.4%)biloma (n=3, 0.2%)sepsis, hepatic infarction, hepatic failure, bile duct injury, vasovagal reflex, massive AV shunt,diaphragmatic injury, renal infarct, gastric ulcer, pseudoaneursym of abdominal wall, transient ischemic attack, colonic perforation

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After Intra-op RF Ablation

Pre-Procesure MRI

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Contraindication of RFA

Prothrombin time: < 50%. Platelet count: <50.000/ℓ.Ascites Patient.Severe lung dysfunctionAcute Infection Symptom.Metastasis to another organ except liver.Portal vein tumor thrombosisHepatic encephalopathyImmunocompromised patientPregnant patient

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Indication of RFA

Primary or Metastatic hepatic tumors5cm or smallerFour fewer number

cf) Severance:5cm(single),3cm(3 ea)

1cm or more deep to liver capsule2cm or away from large vessels(Heat sink Effect)

Dodd et al radiographic2000

15 Primary HCC M/59

Percutaneous RFA

F/U 48 HrsF/U 48 Hrs

Pre CTPre CT Tx SonoTx Sono

F/U 3MF/U 3M

M/50M/50

HCCHCC

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M/62Rectal

ca

Pre Intra-op RFA CT

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M/62Rectal

ca

Intra-op RFA ( (2 weeks f/u)

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M/62Rectal cancer

Intra-op RFA ( (1 Year f/u)

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M/60Rectal cancer with multiple liver metastasis

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Intraoperative RF Ablation After Mile’s op.

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RFA(Radiofrequency Ablation) Of Understanding

RFA is ?The co-relationships of the size and the number of tumor on the therapy.The comparison of percutaneous RFA & The comparison of percutaneous RFA & RFA after an open surgery.RFA after an open surgery.

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Object

Duration: 2002, 3. ~ 2003, 5.Pt: Total : 73 (m/52 , f/21)Average year: 575cm < , 4ea <= : A group5cm >= , 3ea >= : B groupRFA after an open surgery : C groupPercutaneous RFA : D group

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Material

Leveen needle : 2.0cm, 3.0cm, 3.5cm, 4.0cmGenerator: RF3000 (Power 200W)Ground pad : 4ea

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Evaluation of Therapy

High echogenecity on US after RFA.Difficult to Differential diagnosis remaining tumor.

48Hrs & 3M F/U ㅡ sequential Liver CTInitial CT Comparison.DDx by Contrast Media enhancement.

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Procedure of RFA 1

After Open surgery :Grounding pad contact to each on two thigh.Under general anesthesia.Sono guiding puncture.

Percutaneous RFA :Demerol 50mg Im injection(pre 30min).Grounding pad contact to each on two thigh.Fentanyl citrat 100ug Iv inj(start time).Sono guiding puncture.

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Procedure of RFA 2

RF generation :Needle 100c10 min ~ 15 min

Due to size and number of tumorMove & Repeat ablation.

Fully high Echo checkF/u: 48Hrs ,3Months (Sequential Liver CT exam).

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Result 1

0102030405060708090

100

PrimaryHcc

MetastasisHcc

Recur rate

A (5cm<,4ea <=)그룹B (5cm>=, 3ea>=)그룹

5

19

7

42

8.3%

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Conclusion 1

The sizes and the numbers of the lesion were contributing a signicant effect

on the therapy. Size & number ↓ : Therapy effect ↑

Primary HCC> Metastasis HCC

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Result 214

101011

9

11

2 21 1

011

00

2

4

6

8

10

12

14

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OFTEN SURGERY WITH RFA(C group) PERCUTANEOUS WITH RFA(D group)

HCCRECTAL CACOLON CASTOMACHBREST CAGB CAPANCREST CA

N=37 N=36

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Result 2-1Often Surgery With RFAOften Surgery With RFA Percutaneous With RFAPercutaneous With RFA

PainPain LOWLOW HIGHHIGH

ApproachableApproachable EASYEASY DIFFICULTDIFFICULT

Bleeding controlBleeding control EASYEASY DIFFICULTDIFFICULT

ComplicationComplication LOWLOW HIGHHIGH

One-step surgical One-step surgical approach to primary approach to primary

lesionlesion

POSSIBLEPOSSIBLE IMPOSSIBLEIMPOSSIBLE

concentration of operatorconcentration of operator GOODGOOD BADBAD

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Conclusion 2

RFA after an open surgery,father than the percutaneous RFA ,had better result in perfection.

Easy Approaching to lesion.Hemostatic during hemorrhagic situationPatient’ control.The same time,metastastic hematoma in surgical method.

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Perspective of RFA

Reducing blood flow during ablation therapy.Total portal inflow occlusion.Angiographic balloon occlusion.Embolization prior to ablation.

Combining thermal ablation with chemotherapy.Co-access needle use.

(Biopsy,One puncture site channel use RFA)

Lung ca, bone ca, breast, renal…(Primary ca).