Research Article: Impact of Radiofrequency Ablation-Induced Glisson’s Capsule-Associated Complications in Patients with Hepatocellular Carcinoma

Date Published: January 18, 2017

Publisher: Public Library of Science

Author(s): Toru Wakamatsu, Sadahisa Ogasawara, Tetsuhiro Chiba, Masayuki Yokoyama, Masanori Inoue, Naoya Kanogawa, Tomoko Saito, Eiichiro Suzuki, Yoshihiko Ooka, Akinobu Tawada, Osamu Yokosuka, Gianfranco D. Alpini.


Radiofrequency ablation (RFA) is commonly used to locally treat hepatocellular carcinoma (HCC). However, when tumors are close to the Glisson’s capsule, RFA may induce injury in this region, complicating therapeutic efforts. We investigated the impact of RFA-induced Glisson’s capsule-associated complications on liver function and prognosis of HCC patients.

We retrospectively reviewed our patient database and found 170 early-stage HCC patients treated via RFA from April 2004 to December 2012. We defined RFA-induced Glisson’s capsule-associated complication as lasting hepatic arterioportal (AP) fistula, major intrahepatic bile-duct dilatation (affecting two or more subsegments), or hepatic infarction. We also defined liver failure as initial occurrence of either total bilirubin increase (>3.0 mg/dL), uncontrolled ascites, or encephalopathy.

In our cohort, 15 patients had RFA-induced Glisson’s capsule-associated complications (incidence of related complications, with some overlap: lasting AP fistula, n = 9; major intrahepatic bile-duct dilatation, n = 7; and hepatic infarction, n = 2). The cumulative incidence of liver failure before stage progression was significantly higher and the median overall survival (OS) was significantly lower (52.3 months) in HCC patients with Glisson’s capsule-associated complications than in those without Glisson’s capsule-associated complications (95.0 months). In addition, multivariate analysis demonstrated that Glisson’s capsule-associated complication was a significant independent factor associated with OS.

In this study, we have shown that early-stage HCC patients with RFA-induced Glisson’s capsule-associated complications may have higher risks in poor prognosis.

Partial Text

Approximately 700,000 people annually die due to hepatocellular carcinoma (HCC), and HCC is the third most common cause of cancer mortality [1]. Radiofrequency ablation (RFA) is frequently used for the local treatment of HCC [2–4]. It is the best treatment alternative in patients with early-stage HCC who are not eligible for surgical resection. RFA extends survival by >60 months [5].

In this study, we aimed to assess the effect of RFA-induced Glisson’s capsule-associated complication on HCC prognosis. Our results show that HCC patients with RFA-induced Glisson’s capsule-associated complications are at a higher risk for liver failure and a poor prognosis compared with patients without Glisson’s capsule-associated complications.




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