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Recurrent Hepatocellular Carcinoma: Percutaneous Radiofrequency Ablation after Hepatectomy¹

¹ From the Department of Radiology and Center for Imaging Science (D.C., H.K.L., M.J.K., S.H.L., S.H.K., W.J.L., J.H.L.) and the Department of Surgery (J.W.J., Y.I.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135–710, Korea. Received September 17, 2002; revision requested November 26; final revision received April 27, 2003; accepted June 16. Address correspondence to H.K.L. (e-mail: hklim@smc.samsung.co.kr).

View larger version (99K): [in a new window]   Figure 1a. Transverse contrast-enhanced arterial-phase helical CT scans show intrahepatic HCC in a 59-year-old man. (a) Scan obtained before hepatectomy shows a 2.4-cm-diameter HCC (arrows) in the left lateral segment and a cyst (arrowheads) in the right lobe of the liver. (b) Scan obtained before RF ablation, 6 months after left lateral segmentectomy, shows 1.3-cm-diameter recurrent HCC (arrow) in liver segment VI. (c) Scan obtained 1 month after RF ablation shows round ablated lesion (arrow) with low attenuation. Absence of contrast enhancement indicates technical success of the ablation procedure. (d) Scan obtained at 10-month follow-up after RF ablation shows nonenhanced ablated lesion (arrow) substantially decreased in size since 1-month follow-up scanning. The patient was still living at the end of our study and had no further recurrence of HCC.

View larger version (126K): [in a new window]   Figure 1b. Transverse contrast-enhanced arterial-phase helical CT scans show intrahepatic HCC in a 59-year-old man. (a) Scan obtained before hepatectomy shows a 2.4-cm-diameter HCC (arrows) in the left lateral segment and a cyst (arrowheads) in the right lobe of the liver. (b) Scan obtained before RF ablation, 6 months after left lateral segmentectomy, shows 1.3-cm-diameter recurrent HCC (arrow) in liver segment VI. (c) Scan obtained 1 month after RF ablation shows round ablated lesion (arrow) with low attenuation. Absence of contrast enhancement indicates technical success of the ablation procedure. (d) Scan obtained at 10-month follow-up after RF ablation shows nonenhanced ablated lesion (arrow) substantially decreased in size since 1-month follow-up scanning. The patient was still living at the end of our study and had no further recurrence of HCC.

View larger version (128K): [in a new window]   Figure 1c. Transverse contrast-enhanced arterial-phase helical CT scans show intrahepatic HCC in a 59-year-old man. (a) Scan obtained before hepatectomy shows a 2.4-cm-diameter HCC (arrows) in the left lateral segment and a cyst (arrowheads) in the right lobe of the liver. (b) Scan obtained before RF ablation, 6 months after left lateral segmentectomy, shows 1.3-cm-diameter recurrent HCC (arrow) in liver segment VI. (c) Scan obtained 1 month after RF ablation shows round ablated lesion (arrow) with low attenuation. Absence of contrast enhancement indicates technical success of the ablation procedure. (d) Scan obtained at 10-month follow-up after RF ablation shows nonenhanced ablated lesion (arrow) substantially decreased in size since 1-month follow-up scanning. The patient was still living at the end of our study and had no further recurrence of HCC.

View larger version (132K): [in a new window]   Figure 1d. Transverse contrast-enhanced arterial-phase helical CT scans show intrahepatic HCC in a 59-year-old man. (a) Scan obtained before hepatectomy shows a 2.4-cm-diameter HCC (arrows) in the left lateral segment and a cyst (arrowheads) in the right lobe of the liver. (b) Scan obtained before RF ablation, 6 months after left lateral segmentectomy, shows 1.3-cm-diameter recurrent HCC (arrow) in liver segment VI. (c) Scan obtained 1 month after RF ablation shows round ablated lesion (arrow) with low attenuation. Absence of contrast enhancement indicates technical success of the ablation procedure. (d) Scan obtained at 10-month follow-up after RF ablation shows nonenhanced ablated lesion (arrow) substantially decreased in size since 1-month follow-up scanning. The patient was still living at the end of our study and had no further recurrence of HCC.

View larger version (118K): [in a new window]   Figure 2a. Transverse contrast-enhanced arterial-phase helical CT scans show intrahepatic HCC in a 31-year-old woman. (a) CT hepatic arteriogram obtained before initial hepatectomy reveals 5.0-cm-diameter HCC (arrows) in liver segment V. (b) Scan obtained before RF ablation, 18 months after segmentectomy, shows 3.4-cm-diameter recurrent HCC (arrows) in left lateral segment. (c) Scan obtained 1 month after ablation shows oval ablated area (arrow) with low attenuation. Note absence of contrast enhancement in treated area. (d) Scan obtained 7 months after ablation shows semicircular enhancing area (arrows) in the anterior part of the ablated area, which indicates local tumor progression. The patient subsequently underwent repeat hepatectomy (left lobectomy) for recurrent HCC. (e) Scan obtained 5 months after repeat hepatectomy shows two small HCC tumors (arrows) in liver segment VIII. The patient underwent TACE and was still living at the end of our study.

View larger version (117K): [in a new window]   Figure 2b. Transverse contrast-enhanced arterial-phase helical CT scans show intrahepatic HCC in a 31-year-old woman. (a) CT hepatic arteriogram obtained before initial hepatectomy reveals 5.0-cm-diameter HCC (arrows) in liver segment V. (b) Scan obtained before RF ablation, 18 months after segmentectomy, shows 3.4-cm-diameter recurrent HCC (arrows) in left lateral segment. (c) Scan obtained 1 month after ablation shows oval ablated area (arrow) with low attenuation. Note absence of contrast enhancement in treated area. (d) Scan obtained 7 months after ablation shows semicircular enhancing area (arrows) in the anterior part of the ablated area, which indicates local tumor progression. The patient subsequently underwent repeat hepatectomy (left lobectomy) for recurrent HCC. (e) Scan obtained 5 months after repeat hepatectomy shows two small HCC tumors (arrows) in liver segment VIII. The patient underwent TACE and was still living at the end of our study.

View larger version (113K): [in a new window]   Figure 2c. Transverse contrast-enhanced arterial-phase helical CT scans show intrahepatic HCC in a 31-year-old woman. (a) CT hepatic arteriogram obtained before initial hepatectomy reveals 5.0-cm-diameter HCC (arrows) in liver segment V. (b) Scan obtained before RF ablation, 18 months after segmentectomy, shows 3.4-cm-diameter recurrent HCC (arrows) in left lateral segment. (c) Scan obtained 1 month after ablation shows oval ablated area (arrow) with low attenuation. Note absence of contrast enhancement in treated area. (d) Scan obtained 7 months after ablation shows semicircular enhancing area (arrows) in the anterior part of the ablated area, which indicates local tumor progression. The patient subsequently underwent repeat hepatectomy (left lobectomy) for recurrent HCC. (e) Scan obtained 5 months after repeat hepatectomy shows two small HCC tumors (arrows) in liver segment VIII. The patient underwent TACE and was still living at the end of our study.

View larger version (111K): [in a new window]   Figure 2d. Transverse contrast-enhanced arterial-phase helical CT scans show intrahepatic HCC in a 31-year-old woman. (a) CT hepatic arteriogram obtained before initial hepatectomy reveals 5.0-cm-diameter HCC (arrows) in liver segment V. (b) Scan obtained before RF ablation, 18 months after segmentectomy, shows 3.4-cm-diameter recurrent HCC (arrows) in left lateral segment. (c) Scan obtained 1 month after ablation shows oval ablated area (arrow) with low attenuation. Note absence of contrast enhancement in treated area. (d) Scan obtained 7 months after ablation shows semicircular enhancing area (arrows) in the anterior part of the ablated area, which indicates local tumor progression. The patient subsequently underwent repeat hepatectomy (left lobectomy) for recurrent HCC. (e) Scan obtained 5 months after repeat hepatectomy shows two small HCC tumors (arrows) in liver segment VIII. The patient underwent TACE and was still living at the end of our study.

View larger version (81K): [in a new window]   Figure 2e. Transverse contrast-enhanced arterial-phase helical CT scans show intrahepatic HCC in a 31-year-old woman. (a) CT hepatic arteriogram obtained before initial hepatectomy reveals 5.0-cm-diameter HCC (arrows) in liver segment V. (b) Scan obtained before RF ablation, 18 months after segmentectomy, shows 3.4-cm-diameter recurrent HCC (arrows) in left lateral segment. (c) Scan obtained 1 month after ablation shows oval ablated area (arrow) with low attenuation. Note absence of contrast enhancement in treated area. (d) Scan obtained 7 months after ablation shows semicircular enhancing area (arrows) in the anterior part of the ablated area, which indicates local tumor progression. The patient subsequently underwent repeat hepatectomy (left lobectomy) for recurrent HCC. (e) Scan obtained 5 months after repeat hepatectomy shows two small HCC tumors (arrows) in liver segment VIII. The patient underwent TACE and was still living at the end of our study.

View larger version (15K): [in a new window]   Figure 3. Curves indicate overall and disease-free survival of patients who underwent percutaneous RF ablation for intrahepatic recurrent HCC after hepatectomy. Overall survival rates at 1, 2, and 3 years were 82%, 72%, and 54%, respectively. Disease-free survival rates at 1, 2, and 3 years were 57%, 43%, and 34%, respectively.