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poor liver function status also preclude liver resection thrombosis and extra-hepatic metastasis; (4) performance
in majority of patients, with only 9-29% of HCC patients status Eastern Cooperative Oncology Group 0 or 1; and
being suitable for partial hepatectomy. [3] (5) platelet count > 50,000/mL. Exclusion criteria were:
(1) poor or absent visualization of nodules on ultrasound
Over the years, local ablation including percutaneous (US); (2) any previous treatments aimed at HCC nodules.
ethanol injection, radiofrequency ablation (RFA), and
microwave ablation have gained more interests. Among RFA procedures and techniques
these techniques, RFA was the most widely applied All RFA sessions were performed by the same team who
due to its low mortality, minimal invasiveness, high had more than 30 years of experience in interventional
effectiveness, outpatient-use, and repeatability for radiology. The Cool-Tip Radiofrequency System
[3]
recurrence. It was reported that RFA was the most (Radionics, Burlington, Massachusetts, USA) contains a
effective treatment for unresectable liver cancer. Some generator, a monopolar-array needle electrode (LeVeen,
[4]
lines of evidence also indicated that RFA can be used as RadioTherapeutics), which has a 2 or 3 cm exposed tip and
a bridge to LT. The therapeutic goal of RFA is complete a dispersive electrode pad. The radiofrequency electrode
[5]
necrosis. For patients who had incomplete necrosis, RFA is 17-gauge which contains internal channels and the five
[6]
can be repeated. However, a series of studies showed hook-shaped expandable electrode tines with a diameter
that multiple-session RFA would increase the incidence of 2.0-, 3.0- or 3.5-expansion. For nodules < 1.5 cm in
of complications such as bleeding, hollow organ injury, diameter, an electrode with 2.0-cm expanded tines; for
and tumor diffusion. Meanwhile, the cost-effectiveness nodules 1.5-2.5 cm in diameter, an electrode with 3.0-cm
[7]
of a standardized percutaneous RFA treatment was expanded tines; and for nodules larger than 2.5 cm in
[8]
$20,424. In China, about 75% of the population has no diameter, and an electrode with 3.5-cm expanded tines
insurance to guarantee their basic health care and nearly were used.
30% of poor families suffered financially due to illness.
Therefore, most patients in China cannot afford to take Prior to the operation, pethidine 100 mg and
many sessions of RFA. anisodamine hydrochloride (654-2) 10 mg were given
through intra-muscular injection as a basal anesthesia.
Herein, we adopted a new terminology named “one-off Tumor localization detection was under real-time
” ablation, which was proposed by Jiang et al. [9-11] and US. Patient’s posture would be changed according
defined as achieving complete necrosis after a single- to the tumor location. The insertion site of the skin
session of RFA with no local residual or recurrent tumor depends on the biggest cross-section of tumors in US.
within 6 months. The present retrospective study tried to Local anesthesia with 1% lidocaine was given from the
investigate the predictive factors related to the success insertion site down to the peritoneum along the planned
of “one-off ” ablation. puncture track, and conscious analgesia-sedation was
induced by intravenous administration of 0.1 mg of
METHODS Tramadol (SanJiu Pharmaceutical Ltd., Zhejiang, China).
During the puncture procedure, damage to the visceral
Patients organs, such as gallbladder, bowels, and stomach, was
The Healthcare Ethics Committee and Institutional avoided by keeping 1 cm away from adjacent organ so
Review Board of our hospital have approved that we could that we can place the needle into nodules easily. After
use the data of patients for this retrospective study. We the electrode was placed into the center of the nodule
reviewed the data of a single center database (Eastern under the guidance of US, the hooks then expanded.
Hepatobiliary Surgery Hospital, Shanghai, China) and The initial output was 30-50 W with an increase of 10
screened all patients with single HCC from February 2010 W every 60 s till the power of about 60-90 W, which was
to December 2013. HCC was diagnosed according to the maintained for 5 min, and then, increasing the power
guidelines of American Association for the Study of the again to the maximum level (90-130 W) step by step.
Liver Disease (AASLD), that is, a positive result in biopsy The selection of the power level depended on the size
or concordant results of at least two imaging techniques of tumor. Ablation was maintained for at least 15 min.
[8]
or positive finding on one imaging study together with During ablation, water was administered at a base rate of
alpha fetal protein (AFP) > 400 ng/mL. Clinical data 20 mL/10 min by the syringe pump to cool the electrode
[12]
were collected including demographic characteristics, tip to reduce injury to the surrounding tissue. For larger
imaging examinations, intra-RFA parameters, and tumors (≥ 3.0 cm), the RF probe with 3.5-cm expanded
laboratory tests results. tines was introduced into a 0.5-1.0 cm deep position
from the center of the nodule to create overlapping
Inclusion and exclusion criteria coagulation zones with adequate ablation margin of 0.5-
The inclusion criteria were as follows: (1) single HCC 2.0 cm. At the end of the procedure, the needle track was
nodule measuring 5.0 cm or less in diameter; (2) liver cauterized for 15 s to prevent possible tumor seeding or
function of Child-Pugh Class A or B; (3) no macrovascular bleeding.

48 Hepatoma Research | Volume 2 | Issue 2 | February 29, 2016