Jason Wat1, Vincent Lam1, Kelvin Ng1, Sheung Tat Fan1, Ronnie Poon1
1 Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, China
During the period between April 2001 and October 2006, 14 patients with periductal hepatocellular carcinoma (HCC), defined as tumours situated within 5mm from the central bile ducts, received central bile duct cooling during radiofrequency ablation (RFA) procedures in Queen Mary Hospital. RFA procedures for these patients with periductal HCC were performed by open surgery, with the initial removal of the gallbladder followed by cannulation of the common bile duct via the cystic duct for cold saline irrigation of the bile duct. The common bile duct was irrigated with 4ºC saline continuously during the RFA procedure using a pressure pump system, and the catheter was removed, with the cystic duct stump ligated, upon completion of the procedure. No hospital mortality resulted and only 2 patients suffered from minor complications including pleural effusion and ascites. Computed tomography scan was performed 1 month after the procedure and then every 3 months. All patients had complete ablation of the tumour after the RFA procedures and there was no local recurrence at the RFA treated sites. None of these patients developed liver failure, significant elevation of bilirubin level, clinical evidence of bile duct injury, or radiological evidence of any biliary complications during follow up. We concluded that intraoperative central bile duct cooling during RFA for periductal HCC is a safe and effective method for preventing biliary complications, without compromising the effectiveness of RFA in tumour ablation.