Intrahepatic radiofrequency ablation versus electrochemical treatment ex vivo
Ralf Czymek1, Stefan Loeffler, Dorothea Dinter
1Department of Surgery, University of Luebeck Medical School, Luebeck, Germany. ralf_czymek@web.de
Background:
Radiofrequency ablation (RFA) and electrochemical treatment (ECT) are two methods of local liver tumor ablation. A reproducible perfusion model allowed us to compare these methods when applied in proximity to vascular structures.
Material And Methods:
In a porcine liver perfusion model, we used RFA (group A) and ECT (group B) to perform ablations under ultrasound guidance within 10 mm of a vessel and examined the induced necrosis macroscopically and histologically.
Results:
We created 83 lesions (RFA: 59, ECT: 24) in 27 livers. In group A (mean liver weight: 2046 g), perfusion was macroscopically found to limit necrosis in 52.5% of the procedures. Histology demonstrated the destruction of only 30.4% of the vessel walls within the ablation areas. In group B (mean liver weight: 1885 g), we detected reproducible and sharply demarcated ablation areas both macroscopically and histologically. Necrosis was unaffected by nearby vessels. No viable cells were found perivascularly. Histology showed destruction of the vascular endothelium without any discontinuities. We measured pH values of 0.9 (range: 0.6-1.8) at the anode and 12.2 (range: 11.4-12.6) at the cathode. Treatment time was 100 min when a charge of 300 coulombs was delivered.
Conclusions:
Electrochemical treatment is a method of ablation that creates reproducible and predictable volumes of necrosis. It produces sharply demarcated areas of complete necrosis also in perivascular sites. ECT, however, requires much longer treatment times than RFA. In our model, the effects of RFA were considerably limited by perfusion, which caused incomplete areas of necrosis in proximity to vessels.
