We have previously described thoracoscopic thermal ablation therapy for hepatocellular
carcinoma (HCC) located just beneath the diaphragm, in nine patients with advanced
liver cirrhosis [1]. We report here the application of that technique for HCC which had invaded above
the diaphragm and was accompanied by intractable hemothorax.
In 1996, a 55-year-old man was treated with interferon for chronic hepatitis caused
by hepatitis C virus (HCV), and his liver function test became normal with negative
results for serum HCV-RNA. In 1999, he was diagnosed with HCC on the basis of ultrasonographic
examination and an increased level of serum α-fetoprotein (20 000 ng/ml). The size
of the tumor was 6.8 cm in S8 and 3.3 cm in S2. He was treated with percutaneous radiofrequency
ablation therapy [2] after transcatheter arterial emoblization (TAE). In February 2000, he suffered from
dyspnea, and the chest radiograph showed massive right pleural effusion. Thoracocentesis
also showed the bloody effusion. TAE was carried out, but was not effective. Blood
transfusion and thoracocentesis were repeated for 2 months. In May 2000, thoracoscopy
was carried out under general anesthesia and 2 l of bloody pleural effusion were collected.
After aspiration, the HCC could be seen invading above the diaphragm (Figures [1]
a, b). To stop the bleeding, radiofrequency ablation using a LeVeen needle was carried
out (Figure [1 c]), as described previously [1]. Ablation took about 85 minutes in total. After ablation, the tumor turned black
in colour (Figure [1 d]) and the bleeding was completely stopped. The tumor was too large, and invaded too
deeply into the liver, for complete ablation. However, the hemothorax disappeared
after the procedure. The patient was discharged 3 days after treatment. There was
no complication and no sign of hemothorax after ablation therapy up to the patient's
death, from infiltration of the HCC into the inferior vena cava, in September 2000.
Thoracoscopic thermal ablation therapy can be an optional therapy for HCC located
above the diaphragm and associated with intractable hemothorax.
Figure 1 Thoracoscopic views of the hepatocellular carcinoma above the diaphragm. a Anterior tumor before ablation; b posterior tumor with fresh fibrin deposit, before ablation; c during radiofrequency ablation; d after radiofrequency ablation (the tumor turned black in colour).
