Feasibility, safety, and efficacy of artificial carbon dioxide pneumothorax for computed tomography fluoroscopy-guided percutaneous radiofrequency ablation of hepatocellular carcinoma

Abstract

Purpose: To retrospectively assess the feasibility, safety, and efficacy of artificial carbon dioxide (CO₂) pneumothorax for computed tomography (CT) fluoroscopy-guided percutaneous radiofrequency (RF) ablation of hepatocellular carcinoma (HCC).

Materials and methods: This study included 26 sessions of 24 patients in whom the creation of artificial CO₂ pneumothorax was attempted to avoid the transpulmonary route during CT fluoroscopy-guided percutaneous RF ablation of HCC between April 2011 and December 2017. In these 26 sessions, 29 HCCs (mean tumor diameter: 12 mm, range: 6-22 mm) were treated.

Results: Adequate lung displacement after induction of artificial CO₂ pneumothorax was achieved in 23 of the 26 sessions (88.5%). In the remaining three sessions, transpulmonary RF ablation, transthoracic extrapulmonary RF ablation after switching to an artificial pleural effusion procedure, or RF ablation with electrode insertion in the caudal-cranial oblique direction was performed. No major complications were found. Among the 29 treated tumors, one (3.4%) showed local progression, and the other 28 (96.6%) were completely ablated at the last follow-up (mean follow-up period: 39.3 months, range: 7-78 months).

Conclusion: Artificial CO₂ pneumothorax for CT fluoroscopy-guided percutaneous RF ablation appeared to be a feasible, safe, and useful therapeutic option for HCC.

Keywords: Artificial pneumothorax; Carbon dioxide; Computed tomography; Hepatocellular carcinoma; Radiofrequency ablation.