Radiofrequency ablation for hepatic hemangiomas: A consensus from a Chinese panel of experts

Table 1 Indications and contraindications of radiofrequency ablation for hepatic hemangiomas

Indications

The maximum diameter of hemangiomas > 5 cm

Tumor gaining an enlargement of more than 1 cm within 2 yr

Persistent hemangioma-related abdominal pain or discomfort

Consent to receive the RF ablation

Contraindications

Severe bleeding tendency, platelets < 50 × 109/L, international normalized ratio > 1.5, severe platelet function disorders (prothrombin time >18 s and prothrombin activity < 40%)

Malignant tumors

Kasabach-Merritt syndrome

Infection, especially biliary system inflammation

Low immune function

Severe primary organ failure such as the liver, kidney, heart, lung and/or brain

Table 2 Ablation-related complications and preventive measures

Complication	Preventive measures
Bleeding at the electrode entry site	The electrode needs to be advanced via a transhepatic approach to target the tumor and a needle tract ablation needs to be performed while withdrawing the electrode. Radiofrequency (RF) ablation should be launched from the exterior margin of the tumor from the beginning of a lower RF power.
Rupture of hepatic hemangioma	Under the direct view of laparoscopy, hemostasis procedure can be applied to the bleeding site such as applying ablation to stop the bleeding. If it fails, a conversion to open surgery is advocated to achieve the hemostasis.
Puncture injury to adjacent organs	The high visibility of Cool-tip electrodes on computed tomography or ultrasonography images facilitates the insertion of the electrodes in the tumor without causing accidental injury to adjacent organs.
Thermal injury to the pleura and diaphragm	Laparoscopic RF ablation should be used as the first-line treatment for hepatic hemangiomas abutting the diaphragm.
Thermal injury to the lung	Pre-ablation transcatheter arterial embolization as an adjuvant therapy or multiple ablation sessions is recommended to prevent the risk of acute respiratory distress syndrome.
Hemolysis	The patients should be sufficiently hydrated before RF ablation and during the procedure. When any signs or symptoms indicating the hemolysis emerge in the course of ablation, the RF procedure should be terminated and a repeat RF ablation treatment may need to be rescheduled based on a comprehensive evaluation of the tumor.
Liver damage	The ablation-induced liver injury can resolve spontaneously without the need of any medication.
Fever	Physical cooling can be used to alleviate the discomfort of hyperthermia.
Skin burn injury	Multiple grounding pads can be applied or ice pad can be used to cool the skin with the contact of grounding pad.