Changes in acid-base balance and blood lactate levels during radio frequency ablation conducted for the treatment of hepatocellular carcinomata in patients with liver cirrhosis

Background: Radio frequency ablation (RFA) has recently received increasing attention as an effective minimally invasive approach for the treatment of hepatocellular carcinomata (HCCs). However, we experienced a patient with liver cirrhosis (LC, Child-Pugh class B) in whom severe lactic acidosis developed during RFA conducted for the treatment of a HCC (-4.5 cm in diameter). This case prompted us to reevaluate possible injurious effects of RFA on non-tumorous liver tissues in the vicinity of its target in LC patients. Methods: Intraoperative changes in acid-base balance and blood lactate levels, and postoperative changes in serum transaminases were investigated in LC (Child-Pugh class A) patients undergoing either laparotomic RFA (for the treatment of HCCs [diameter<3cm]) or partial hepatectomy (with the aid of the Pringle's manuever), and non-LC patients undergoing pancreatectomy. Results: During the intraoperative period, significant lactic acidosis developed only in the patients undergoing hepatectomy. Core temperature significantly increased following the RFA. Postoperative increases in the transaminases observed in the patients undergoing hepatectomy were far larger than those observed in the patients undergoing either RAF or pancreatectomy. Conclusion: RFA, conducted for the treatment of smaller HCCs, appears to be minimally invasive even in the presence of LC (Child-Pugh class A).