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Zhao QY, Guo T, Hu JJ, Xie LT, Chai WL, Tian G, Jiang TA. Safety and effectiveness of balloon catheter-assisted ultrasound-guided percutaneous microwave ablation in difficult-site liver cancer. Hepatobiliary Pancreat Dis Int 2025; 24:84-91. [PMID: 39428333 DOI: 10.1016/j.hbpd.2024.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 09/05/2024] [Indexed: 10/22/2024]
Abstract
BACKGROUND Balloon catheter isolation is a promising auxiliary method for thermal ablation treatment of liver cancer. We aimed to explore the safety and effectiveness of balloon catheter isolation-assisted ultrasound-guided percutaneous microwave ablation (MWA) in treating liver cancer in difficult anatomical locations. METHODS Data of 132 patients with 145 difficult-site liver cancer treated with ultrasound-guided percutaneous MWA were retrospectively analyzed. Participants were classified into the isolation (n = 40) and non-isolation (n = 92) groups based on whether the patients were treated using a balloon catheter prior to ablation. The major complication rates, local tumor residuals (LTR), and tumor follow-up for local tumor progression (LTP) at 6 and 12 months post-ablation were compared between the two groups. RESULTS The rates of major postoperative complications did not significantly differ between the isolation and non-isolation groups (2.5% vs. 4.3%, P = 0.609). The postoperative LTR rates were significantly different between the isolation and non-isolation groups (4.8% vs. 17.5%, P = 0.032). Balloon catheter isolation [odds ratio (OR) = 0.225, 95% confidence interval (CI): 0.085-0.595, P = 0.009] and tumor diameter (OR = 2.808, 95% CI: 1.186-6.647, P = 0.019) were identified as independent factors influencing LTR rate. The cumulative LTP rates at 6 and 12 months after ablation showed no significant differences between the isolation and non-isolation groups (2.6% vs. 7.9%, P = 0.661; 4.9% vs. 9.8%, P = 0.676, respectively). Cox proportional hazards regression analysis showed that tumor diameter was an independent risk factor for cumulative LTP rate (OR = 3.445, 95% CI: 1.406-8.437, P = 0.017). CONCLUSIONS Balloon catheter isolation-assisted MWA was safe and effective in the treatment of difficult-site liver cancer. Additionally, tumor diameter significantly influenced LTR and LTP rates after ablation.
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Affiliation(s)
- Qi-Yu Zhao
- Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Teng Guo
- Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Liangzhu Branch, Hangzhou 310003, China
| | - Jing-Jing Hu
- Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Ultrasound Medicine, Ningbo No. 2 Hospital, Ningbo 315010, China
| | - Li-Ting Xie
- Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Wei-Lu Chai
- Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Guo Tian
- Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Tian-An Jiang
- Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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Maruyama H, Minami Y, Sugimoto K, Funaoka A, Numata K. Ablation manual for liver cancer. J Med Ultrason (2001) 2025; 52:27-53. [PMID: 39395134 PMCID: PMC11799107 DOI: 10.1007/s10396-024-01499-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 08/26/2024] [Indexed: 10/14/2024]
Abstract
Because of recent advances in energy device technology, ablation has become popular worldwide. It is less invasive and provides faster postoperative recovery compared to surgery, and therefore, it has come to be applied to a wide range of organs, such as liver, lung, kidney, thyroid, and bone/soft tissue tumors. In order to properly guide the needle to the target area, imaging support is necessary, and ultrasound, which has the advantages of high resolution and real-time capability, is the most frequently used modality. In other words, ablation can be said to be a therapeutic method that makes the most of the advantages of ultrasound. This article outlines the role of ultrasound in ablation for liver cancer and its specific usage.
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Affiliation(s)
- Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, 2-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan.
| | - Yasunori Minami
- Department of Gastroenterology, Faculty of Medicine, Kindai University, Ohno-Higashi Osaka-Sayama, Osaka, 589-8511, Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-1-1 Shinjuku, Tokyo, 160-8402, Japan
| | - Akihiro Funaoka
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minami, Yokohama, Kanagawa, 232-0024, Japan
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minami, Yokohama, Kanagawa, 232-0024, Japan
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Sugawara S, Sone M, Umino R, Ban D, Itou C, Kimura S, Oshima T, Ozawa M, Tanishima T, Nakama R, Murakami S, Kusumoto M, Mizui T, Takamoto T, Nara S, Esaki M. Safety and feasibility of percutaneous abdominal lavage cytology screening (PACS) prior to surgical resection for pancreatic cancer. Abdom Radiol (NY) 2024; 49:4365-4372. [PMID: 39120716 DOI: 10.1007/s00261-024-04510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/26/2024] [Accepted: 07/27/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE This study aimed to evaluate the feasibility, safety, diagnostic yield, and technical aspects of percutaneous abdominal lavage cytology screening (PACS) in patients with resectable pancreatic cancer. METHODS This single-center, retrospective study included patients with resectable pancreatic cancer who underwent PACS before pancreatectomy between May 2022 and October 2023. The technical success rate, position of the drainage tube, volume of fluid administered, volume of fluid retrieved, fluid retrieval rate, and adverse events were evaluated. The cytological results of PACS were compared with those of surgical peritoneal lavage performed during pancreatectomy. RESULTS Forty-four patients were enrolled in this study. The technical success rate for PACS was 100%. Drainage tube placement was outside the pouch of Douglas in all patients in the right-sided abdominal approach group (n = 10), whereas the placement was in the pouch of Douglas in all patients in the suprapubic approach group (n = 34). The mean volume of fluid administered, mean volume of fluid retrieved, and fluid retrieval rate were 185.0 ± 22.9 ml vs. 97.1 ± 32.0 ml (p < 0.001), 36.8 ± 25.6 ml vs. 50.5 ± 21.6 ml (p = 0.059), and 19.0 ± 12.4% vs. 54.9 ± 21.9% (p < 0.001) in the right abdominal approach and suprapubic approach groups, respectively. No adverse events were reported. The cytological results were benign in 42 patients; no discrepancy was observed in the results of surgical peritoneal lavage (n = 36). CONCLUSION PACS is a feasible and safe procedure that can be performed before pancreatectomy in patients with resectable pancreatic cancer. the suprapubic approach may be ideal and PACS could be a screening method to detect carcinomatous peritonitis.
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Affiliation(s)
- Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Ryosuke Umino
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Daisuke Ban
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Chihiro Itou
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shintaro Kimura
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takumi Oshima
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Mizuki Ozawa
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tomoya Tanishima
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Rakuhei Nakama
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Sho Murakami
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takahiro Mizui
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takeshi Takamoto
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Satoshi Nara
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Minoru Esaki
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Gu K, Kang TW, Han S, Cha DI, Song KD, Lee MW, Rhim H, Park GE. Gastrointestinal tract perforation after radiofrequency ablation for hepatic tumor: Incidence and risk factors. Eur J Radiol 2024; 177:111560. [PMID: 38889601 DOI: 10.1016/j.ejrad.2024.111560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 05/03/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE We analyzed the incidence and mortality rate of gastrointestinal (GI) tract perforation after radiofrequency ablation (RFA) for hepatic tumors and assess its risk factors. METHODS This retrospective cohort study included 4799 patients with malignant tumors who underwent RFA (n = 7206). Sixty-nine cases of thermal injury to the GI tract were identified via a search of the electronic medical record system using index terms and divided into two groups according to the thermal injury with (n = 8) or without (n = 61) GI tract perforation based on follow-up CT reports. The risk factors for GI tract perforation were identified via multivariable logistic regression analysis using clinical, technical, and follow-up CT findings. RESULTS The incidence of thermal injury to the GI tract and GI tract perforation was 0.96 % (69/7206) and 0.11 % (8/7206), respectively. The type of adjacent GI tract and history of diabetes mellitus differed significantly between the two groups (p < 0.05). The index tumor being located around the small intestine was the only significant risk factor for GI tract perforation after ablation (Odds ratio, 22.69; 95 % confidence interval, 2.59-198.34; p = 0.005 [reference standard, stomach]). All perforations were not identified on CT images immediately after RFA. The median time to detection was 20 days (range, 3-41 days). Two patients (25 %, 2/8) died due to perforation-related complications. CONCLUSION GI tract perforation after RFA for hepatic tumors is rare; however, it is associated with high mortality. Thus, careful follow-up is required after RFA if the index tumor is located around the small intestine.
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Affiliation(s)
- Kyowon Gu
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Seungchul Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Go Eun Park
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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Bajestani N, Wu G, Hussein A, Makary MS. Examining the Efficacy and Safety of Combined Locoregional Therapy and Immunotherapy in Treating Hepatocellular Carcinoma. Biomedicines 2024; 12:1432. [PMID: 39062006 PMCID: PMC11274263 DOI: 10.3390/biomedicines12071432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/14/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
More than 800,000 people worldwide are diagnosed with HCC (hepatocellular carcinoma) each year, with approximately 700,000 deaths alone occurring in that same year. Treatment of HCC presents complex therapeutic challenges, particularly in intermediate and advanced stages. LRTs such as transarterial chemoembolization (TACE) and ablations have been the mainstay treatment for early to intermediate-stage HCC, and systemic therapies are used to treat intermediate-late-stage HCC. However, novel literature describing combining LRT with systemic therapies has shown promising results. This review explores recent advances in both liver-directed techniques for hepatocellular carcinoma, including bland transarterial embolization, chemoembolization, radioembolization, and ablative therapies in conjunction as well as with systemic therapies, with a focus on combination therapies, patient selection, procedural technique, periprocedural management, and outcomes. Our findings suggest that LRT combined with systemic therapies is a viable strategy for improving progression-free survival and time to progression for patients with intermediate-to-late-stage HCC. However, further investigation is required to refine treatment protocols and define patient cohorts that would benefit the most.
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Affiliation(s)
- Nojan Bajestani
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (G.W.); (A.H.)
| | - Gavin Wu
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (G.W.); (A.H.)
| | - Ahmed Hussein
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (G.W.); (A.H.)
| | - Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Columbus, OH 43210, USA;
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Ndhlovu E, Zhang BX, Chen XP, Zhu P. Thermal ablation for hepatic tumors in high-risk locations. Clin Res Hepatol Gastroenterol 2024; 48:102300. [PMID: 38367803 DOI: 10.1016/j.clinre.2024.102300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/21/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
Thermal ablative techniques such as radiofrequency and microwave ablation are minimally invasive and cost-effective approaches that are currently being adopted as alternatives to surgical resection for primary and metastatic liver malignancies. However, they are considered to be relatively contraindicated for tumors in high-risk locations due to technical difficulties and a perceived increased risk of perioperative complications. Several techniques, including artificial ascites, non-touch multibipolar ablation, and laparoscopically assisted ablation, can be used to improve the outcomes of ablation for high-risk tumors. This review aims to provide a comprehensive summary of the techniques currently used to improve thermal ablation outcomes for high-risk liver tumors.
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Affiliation(s)
- Elijah Ndhlovu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Bi-Xiang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China.
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Han K, Kim JH, Kim GH, Kim JH, Kim SY, Park SH, Moon S, Kwon JH, Kim GM, Lee SJ, Won HJ, Shin YM. Radiofrequency ablation of subcapsular versus nonsubcapsular hepatocellular carcinomas ≤ 3 cm: analysis of long-term outcomes from two large-volume liver centers. Eur Radiol 2024; 34:1578-1586. [PMID: 37646813 DOI: 10.1007/s00330-023-10165-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES To compare the safety and efficacy of RFA for single HCCs ≤ 3 cm in subcapsular versus nonsubcapsular locations using a propensity score matched analysis. MATERIALS AND METHODS This retrospective study included patients with solitary HCCs ≤ 3 cm in size who underwent percutaneous RFA from 2005 to 2015 as initial treatment at two large-volume liver centers. Patients were divided into two groups, consisting of those with subcapsular and nonsubcapsular tumor locations. Complications, local tumor progression (LTP), and overall survival (OS) were compared in these two groups before and after propensity score matching (PSM). RESULTS The study population consisted of 964 patients (712 men [74%]) of mean age 58.3 years. Of these 964 patients, 561 (58%) had nonsubcapsular and 403 (42%) had subcapsular HCCs. PSM generated 402 pairs of patients. Major complication rate was low, but significantly higher in the subcapscular group (p = 0.047). Rates of technical effectiveness in these two groups were 99% and 98%, respectively (p = 0.315). However, during follow-up, cumulative 1-, 3-, 5-, and 10-year LTP and OS rates did significantly differ in both entire and PSM cohorts, resulting in the latter 8%, 15%, 20%, and 26% in the nonsubcapsular group vs. 13%, 24%, 30%, and 31% in the subcapsular group (p = 0.015), and 99%, 91%, 80%, and 59% vs. 98%, 85%, 73%, and 50% in the two groups (p = 0.004), respectively. CONCLUSION Rates of major complications, LTP, and OS differed significantly following first-line RFA treatment of single HCCs ≤ 3 cm in favor of the nonsubcapsular locations. CLINICAL RELEVANCE STATEMENT This large-scale study provides evidence that radiofrequency ablation for small (≤ 3 cm) hepatocellular carcinomas is safer and more effective in nonsubcapsular location than in subcapsular location. KEY POINTS • There exist conflicting outcomes on the effectiveness of RFA for early HCC depending on tumor location. • Rate of local tumor progression was significantly higher in the subcapsular hepatocellular carcinomas. • Overall survival rate was significantly poorer in the subcapsular hepatocellular carcinomas.
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Affiliation(s)
- Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea.
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Ji Hoon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Sungmo Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Hyung Jin Won
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Yong Moon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea
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Zheng B, Zhang P, Lv Q, Wu T, Liu Y, Tang J, Ma Y, Cheng L, Xu L, Wang Y, Xue Y, Liu J, Ren J. Development and preclinical evaluation of multifunctional hydrogel for precise thermal protection during thermal ablation. Bioact Mater 2024; 31:119-135. [PMID: 37637083 PMCID: PMC10448243 DOI: 10.1016/j.bioactmat.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
Image-guided thermal ablation (TA), which is less invasive, has been widely applied for treating various kinds of tumors. However, TA still poses the potential risk of thermal damage to sensitive tissue nearby. Therefore, an adjunctive thermoprotective hydrodissection technique with constant injection of 5% glucose (5% Glu) has currently been adopted for clinical application, but this may be hazardous to humans. In this study, a multifunctional hyaluronic acid-based hydrogel (HA-Dc) was developed for hydrodissection. Compared with 5% Glu (the most clinically used solution) and the previously reported F127 hydrogel, the HA-Dc hydrogel was studied in vitro in a porcine liver model and in vivo in a rabbit model and showed good injectability and better tissue retention, stability, and thermoprotective properties throughout the TA procedure. Furthermore, in the preclinical evaluation in a Macaca fascicularis (M. fascicularis) model, HA-Dc showed excellent performance in terms of stricter neuroprotection compared with 5% Glu. In addition, the HA-Dc hydrogel with good biocompatibility and controllable degradation behavior in vivo could be a promising platform for thermal protection during clinical TA procedures.
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Affiliation(s)
- Bowen Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Peng Zhang
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Qijun Lv
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Tao Wu
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Yadong Liu
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Junjie Tang
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Yanping Ma
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Lili Cheng
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Langtao Xu
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Yizhen Wang
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Yifan Xue
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Jie Liu
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Jie Ren
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
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Tawara S, Miyazaki T, Kiyota R, Maegawa Y, Shimizu T, Yamai T, Kawai S, Inoue T, Komatsu H, Tomokuni A, Motoori M, Yakushijin T. Comparison of percutaneous ablation and hepatectomy for liver metastasis: A single center retrospective study. Cancer Med 2024; 13:e6957. [PMID: 38379325 PMCID: PMC10831916 DOI: 10.1002/cam4.6957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/18/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024] Open
Abstract
AIM To investigate the current treatment for liver metastasis and clarify the indications for percutaneous thermal ablation for liver metastasis. METHODS Ninety-two patients were enrolled and retrospectively analyzed. The patients underwent hepatectomy and/or percutaneous thermal ablation for liver metastases between January 2012 and December 2018. Twenty-six patients who underwent ablation treatment and seven patients who underwent both ablation and hepatectomy were included in the ablation treatment group (group A). We compared these patients with 59 patients who underwent hepatectomy only (group H). Subgroup analyses were performed between ablation (group AC) for colorectal liver metastasis and hepatectomy (group HC) for colorectal liver metastasis in 17 and 53 patients, respectively. RESULTS The percentage of liver metastases other than colorectal cancer in group A was higher than that in the group H. Maximum tumor size in group A was significantly smaller than that in group H. Similarly, the patients in group AC were significantly older and demonstrated higher total bilirubin, lower serum albumin, and lower platelet counts than those in group HC. Overall survival was poorer in the AC group than that in the HC group. However, no differences were observed at metastasis ≤2 cm in size. CONCLUSIONS Percutaneous thermal ablation was performed for many cancer types than hepatectomy. It is performed in elderly patients. We suggested that ablation for colorectal liver metastasis sized ≤2 cm is a suitable indication.
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Affiliation(s)
- Seiichi Tawara
- Department of Gastroenterology and HepatologyOsaka General Medical CenterOsakaJapan
| | - Tetsuro Miyazaki
- Department of Gastroenterology and HepatologyOsaka General Medical CenterOsakaJapan
| | - Ryosuke Kiyota
- Department of Gastroenterology and HepatologyOsaka General Medical CenterOsakaJapan
| | - Yuki Maegawa
- Department of Gastroenterology and HepatologyOsaka General Medical CenterOsakaJapan
| | - Takeshi Shimizu
- Department of Gastroenterology and HepatologyOsaka General Medical CenterOsakaJapan
| | - Takuo Yamai
- Department of Gastroenterology and HepatologyOsaka General Medical CenterOsakaJapan
| | - Shoichiro Kawai
- Department of Gastroenterology and HepatologyOsaka General Medical CenterOsakaJapan
| | - Takuya Inoue
- Department of Gastroenterology and HepatologyOsaka General Medical CenterOsakaJapan
| | - Hisateru Komatsu
- Department of Gastrointestinal SurgeryOsaka General Medical CenterOsakaJapan
| | - Akira Tomokuni
- Department of Gastrointestinal SurgeryOsaka General Medical CenterOsakaJapan
| | - Masaaki Motoori
- Department of Gastrointestinal SurgeryOsaka General Medical CenterOsakaJapan
| | - Takayuki Yakushijin
- Department of Gastroenterology and HepatologyOsaka General Medical CenterOsakaJapan
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10
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Biondetti P, Ierardi AM, Casiraghi E, Caruso A, Grillo P, Carriero S, Lanza C, Angileri SA, Sangiovanni A, Iavarone M, Guzzardi G, Carrafiello G. Clinical Impact of a Protocol Involving Cone-Beam CT (CBCT), Fusion Imaging and Ablation Volume Prediction in Percutaneous Image-Guided Microwave Ablation in Patients with Hepatocellular Carcinoma Unsuitable for Standard Ultrasound (US) Guidance. J Clin Med 2023; 12:7598. [PMID: 38137667 PMCID: PMC10743619 DOI: 10.3390/jcm12247598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE to evaluate the clinical impact of a protocol for the image-guided percutaneous microwave ablation (MWA) of hepatocellular carcinoma (HCC) that includes cone-beam computed tomography (CBCT), fusion imaging and ablation volume prediction in patients with hepatocellular carcinoma unsuitable for standard ultrasound (US) guidance. MATERIALS AND METHODS this study included all patients with HCC treated with MWA between January 2021 and June 2022 in a tertiary institution. Patients were divided into two groups: Group A, treated following the protocol, and Group B, treated with standard ultrasound (US) guidance. Follow-up images were reviewed to assess residual disease (RD), local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Ablation response at 1 month was also evaluated according to mRECIST. Baseline variables and outcomes were compared between the groups. For 1-month RD, propensity score weighting (PSW) was performed. RESULTS 80 consecutive patients with 101 HCCs treated with MWA were divided into two groups. Group A had 41 HCCs in 37 patients, and Group B had 60 HCCs in 43 patients. Among all baseline variables, the groups differed regarding their age (mean of 72 years in Group A and 64 years in Group B, respectively), new vs. residual tumor rates (48% Group A vs. 25% Group B, p < 0.05) and number of subcapsular tumors (56.7% Group B vs. 31.7% Group A, p < 0.05) and perivascular tumors (51.7% Group B vs. 17.1% Group A, p < 0.05). The protocol led to repositioning the antenna in 49% of cases. There was a significant difference in 1-month local response between the groups measured as the RD rate and mRECIST outcomes. LTP rates at 3 and 6 months, and IDR rates at 1, 3 and 6 months, showed no significant differences. Among all variables, logistic regression after PSW demonstrated a protective effect of the protocol against 1-month RD. CONCLUSIONS The use of CBCT, fusion imaging and ablation volume prediction during percutaneous MWA of HCCs provided a better 1-month tumor local control. Further studies with a larger population and longer follow-up are needed.
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Affiliation(s)
- Pierpaolo Biondetti
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy (A.C.); (M.I.); (G.C.)
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
| | - Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
| | - Elena Casiraghi
- AnacletoLab, Computer Science Department “Giovanni degli Antoni”-DI, Università degli Studi di Milano, 20133 Milan, Italy;
- CINI National Laboratory in Artificial Intelligence and Intelligent Systems, 00185 Rome, Italy
| | - Alessandro Caruso
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy (A.C.); (M.I.); (G.C.)
| | - Pasquale Grillo
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Carolina Lanza
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Salvatore Alessio Angileri
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
| | - Angelo Sangiovanni
- Department of Gastroenterology and Hepatology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy;
| | - Massimo Iavarone
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy (A.C.); (M.I.); (G.C.)
- Department of Gastroenterology and Hepatology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy;
| | - Giuseppe Guzzardi
- Department of Radiology, Unit of Interventional Radiology, Ospedale Maggiore della Carità, Corso Giuseppe Mazzini 18, 28100 Novara, Italy;
| | - Gianpaolo Carrafiello
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy (A.C.); (M.I.); (G.C.)
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda—Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (A.M.I.); (P.G.); (S.A.A.)
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11
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Yoon EJ, Kim JW, Hong JH, Song SG, Kim HC, Hur YH, Kim HJ. Thermal Injury to the Subhepatic Appendix Following Percutaneous Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report. Diagnostics (Basel) 2023; 13:3322. [PMID: 37958216 PMCID: PMC10647334 DOI: 10.3390/diagnostics13213322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/25/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
We present the first documented case of a fistula between the treated zone and the appendix after RFA in a patient with HCC. Contrast-enhanced CT and MRI revealed a subcapsular hepatic nodule with image findings of HCC located adjacent to the ascending colon and cecum. An ultrasound-guided core needle biopsy was subsequently performed to distinguish between hepatic metastasis and HCC. Post-RFA imaging identified a low-attenuating ablated area adjacent to an air-filled appendix. The patient later experienced complications, including increased liver enzymes and an abscess at the ablation site. Imaging revealed a fistulous tract between the RFA zone and the appendix. Over the following months, the patient underwent conservative treatment involving intravenous antibiotics and repeated percutaneous drainage, exhibiting eventual symptom relief and an absence of the fistulous tract upon subsequent imaging. This case highlights the rare complications that can arise during RFA due to peculiar anatomical variations, such as a subhepatic appendix, resulting from midgut malrotation and previous surgery. It is imperative for operators to be cognizant of potential anatomical variations when considering RFA treatment, ensuring comprehensive pre-procedural imaging and post-procedure monitoring. This case also emphasizes the potential viability of nonoperative management in complex scenarios in which surgical interventions pose significant risks.
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Affiliation(s)
- Eun Ju Yoon
- Department of Radiology, Chosun University Hospital and Chosun University College of Medicine, Gwangju 61453, Republic of Korea (S.G.S.); (H.C.K.)
| | - Jin Woong Kim
- Department of Radiology, Chosun University Hospital and Chosun University College of Medicine, Gwangju 61453, Republic of Korea (S.G.S.); (H.C.K.)
| | - Jun Hyung Hong
- Department of Radiology, Chosun University Hospital and Chosun University College of Medicine, Gwangju 61453, Republic of Korea (S.G.S.); (H.C.K.)
| | - Sang Gook Song
- Department of Radiology, Chosun University Hospital and Chosun University College of Medicine, Gwangju 61453, Republic of Korea (S.G.S.); (H.C.K.)
| | - Hyun Chul Kim
- Department of Radiology, Chosun University Hospital and Chosun University College of Medicine, Gwangju 61453, Republic of Korea (S.G.S.); (H.C.K.)
| | - Young Hoe Hur
- Department of Hepato-Biliary-Pancreas Surgery, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Hyung Joong Kim
- Department of Biomedical Engineering, Kyung Hee University, Seoul 02447, Republic of Korea
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12
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Han S, Lee MW, Lee YJ, Hong HP, Lee DH, Lee JM. No-Touch Radiofrequency Ablation for Early Hepatocellular Carcinoma: 2023 Korean Society of Image-Guided Tumor Ablation Guidelines. Korean J Radiol 2023; 24:719-728. [PMID: 37500573 PMCID: PMC10400366 DOI: 10.3348/kjr.2023.0423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 07/29/2023] Open
Abstract
Radiofrequency ablation (RFA) has been widely used to manage hepatocellular carcinomas (HCCs) equal to or smaller than 3 cm. No-touch RFA has gained attention and has recently been implemented in local ablation therapy for HCCs, despite its technical complexity, as it provides improved local tumor control compared to conventional tumor-puncturing RFA. This article presents the practice guidelines for performing no-touch RFA for HCCs, which have been endorsed by the Korean Society of Image-Guided Tumor Ablation (KSITA). The guidelines are primarily designed to assist interventional oncologists and address the limitations of conventional tumor-puncturing RFA with describing the fundamental principles, various energy delivery methods, and clinical outcomes of no-touch RFA. The clinical outcomes include technical feasibility, local tumor progression rates, survival outcomes, and potential complications.
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Affiliation(s)
- Seungchul Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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13
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Hayashi M, Abe K, Fujita M, Takahashi A, Ohira H. Combination of psoas muscle mass index and neutrophil-to-lymphocyte ratio as a noninvasive prognostic marker in hepatocellular carcinoma patients undergoing radiofrequency ablation. Eur J Gastroenterol Hepatol 2023; 35:568-574. [PMID: 37115983 DOI: 10.1097/meg.0000000000002532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
AIM The psoas muscle index (PMI) and neutrophil-to-lymphocyte ratio (NLR) have been reported as useful noninvasive prognostic markers in patients with hepatocellular carcinoma (HCC). The usefulness of the combination of the PMI and NLR as a prognostic marker in HCC patients undergoing radiofrequency ablation (RFA) is unclear. METHODS We retrospectively analyzed the PMI and NLR in 112 patients undergoing RFA, including 40 patients aged 75 years and older (36%). The influence of the PMI and NLR on disease-free survival and overall survival (OS) was analyzed. RESULTS There were 66 patients with high PMI and low NLR values (58%), 36 patients with a low PMI or high NLR value (32%), and 10 patients with low PMI and high NLR values (9%). The combination of the PMI and NLR did not show a significant association with the disease-free survival rate. For patients aged ≥75 years, those with both low PMI and high NLR values showed significantly shorter OS periods (log-rank: P < 0.001). In the multivariate analysis, the combination of a low PMI value and high NLR value was significantly associated with shorter survival periods (hazard ratio: 19.72; 95% confidence interval, 4.933-78.8; P < 0.001). CONCLUSION In this study, the combination of PMI and NLR was associated with prognosis in patients with early HCC and preserved liver function. The combination of the PMI and NLR may be a useful and noninvasive prognostic marker in HCC patients aged 75 years and older, as well as in younger patients.
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Affiliation(s)
- Manabu Hayashi
- Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan
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14
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Ramtohul T, Vilgrain V, Soubrane O, Bouattour M, Luciani A, Kobeiter H, Mule S, Tacher V, Laurent A, Amaddeo G, Regnault H, Bulsei J, Nault JC, Nahon P, Durand-Zaleski I, Seror O. Impact of Extended Use of Ablation Techniques in Cirrhotic Patients with Hepatocellular Carcinoma: A Cost-Effectiveness Analysis. Cancers (Basel) 2022; 14:2634. [PMID: 35681618 PMCID: PMC9179352 DOI: 10.3390/cancers14112634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/22/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To evaluate the cost-effectiveness of the extended use of ablation for the treatment of hepatocellular carcinoma (HCC) with cirrhosis in an expert ablation center when compared to the non-extended use of ablation in equivalent tertiary care centers. METHODS Consecutive cirrhotic patients with non-metastatic HCC, no prior treatment, and referred to three tertiary care centers between 2012 and 2016 were retrospectively identified. The Bondy group, including all of the patients treated at Jean Verdier Hospital, where the extended use of ablation is routinely performed, was compared to the standard of care (SOC) group, including all of the patients treated at the Beaujon and Mondor Hospitals, using propensity score matching. A cost-effectiveness analysis was carried out from the perspective of French health insurance using a Markov model on a lifetime horizon. RESULTS 532 patients were matched. The Bondy group led to incremental discounted lifetime effects of 0.8 life-years gained (LYG) (95% confidence interval: 0.4, 1.3) and a decrease in lifetime costs of EUR 7288 (USD 8016) (95% confidence interval: EUR 5730 [USD 6303], EUR 10,620 [USD 11,682]) per patient, compared with the SOC group, resulting in a dominant mean incremental cost-effectiveness ratio (ICER). A compliance with the Barcelona Clinic Liver Classification (BCLC) guidelines for earlier stage contributed to the greater part of the ICER. CONCLUSION The extended use of ablation in cirrhotic patients with HCC was more effective and less expensive than the non-extended use of the ablation strategy.
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Affiliation(s)
- Toulsie Ramtohul
- AP-HP, Health Economics Research Unit, 75004 Paris, France; (T.R.); (J.B.); (I.D.-Z.)
- AP-HP, Department of Radiology, Jean Verdier Hospital, 93140 Bondy, France
| | - Valérie Vilgrain
- AP-HP, Department of Radiology, Beaujon Hospital, 92110 Clichy, France;
- INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, 75018 Paris, France
| | - Olivier Soubrane
- AP-HP, Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, 92110 Clichy, France;
| | - Mohamed Bouattour
- AP-HP, Department of Digestive Oncology, Beaujon Hospital, 92110 Clichy, France;
| | - Alain Luciani
- INSERM IMRB Unit U 955, Equipe 18, 94010 Créteil, France; (A.L.); (S.M.); (V.T.); (A.L.); (G.A.); (H.R.)
- AP-HP, Department of Radiology, Henri Mondor Hospital, 94000 Créteil, France;
| | - Hicham Kobeiter
- AP-HP, Department of Radiology, Henri Mondor Hospital, 94000 Créteil, France;
| | - Sébastien Mule
- INSERM IMRB Unit U 955, Equipe 18, 94010 Créteil, France; (A.L.); (S.M.); (V.T.); (A.L.); (G.A.); (H.R.)
- AP-HP, Department of Radiology, Henri Mondor Hospital, 94000 Créteil, France;
| | - Vania Tacher
- INSERM IMRB Unit U 955, Equipe 18, 94010 Créteil, France; (A.L.); (S.M.); (V.T.); (A.L.); (G.A.); (H.R.)
- AP-HP, Department of Radiology, Henri Mondor Hospital, 94000 Créteil, France;
| | - Alexis Laurent
- INSERM IMRB Unit U 955, Equipe 18, 94010 Créteil, France; (A.L.); (S.M.); (V.T.); (A.L.); (G.A.); (H.R.)
- AP-HP, Department of Liver Surgery, Henri Mondor Hospital, 94000 Créteil, France
| | - Giuliana Amaddeo
- INSERM IMRB Unit U 955, Equipe 18, 94010 Créteil, France; (A.L.); (S.M.); (V.T.); (A.L.); (G.A.); (H.R.)
- AP-HP, Department of Hepatology, Henri Mondor Hospital, 94000 Créteil, France
| | - Hélène Regnault
- INSERM IMRB Unit U 955, Equipe 18, 94010 Créteil, France; (A.L.); (S.M.); (V.T.); (A.L.); (G.A.); (H.R.)
- AP-HP, Department of Hepatology, Henri Mondor Hospital, 94000 Créteil, France
| | - Julie Bulsei
- AP-HP, Health Economics Research Unit, 75004 Paris, France; (T.R.); (J.B.); (I.D.-Z.)
| | - Jean-Charles Nault
- AP-HP, Department of Hepatology, Jean Verdier Hospital, 93140 Bondy, France; (J.-C.N.); (P.N.)
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, 75010 Paris, France
| | - Pierre Nahon
- AP-HP, Department of Hepatology, Jean Verdier Hospital, 93140 Bondy, France; (J.-C.N.); (P.N.)
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, 75010 Paris, France
- French League Against Cancer, Education and Research in Health Medicine and Human Biology, University Paris 13, Sorbonne Paris Cité, 75005 Paris, France
| | - Isabelle Durand-Zaleski
- AP-HP, Health Economics Research Unit, 75004 Paris, France; (T.R.); (J.B.); (I.D.-Z.)
- ECEVE, UMRS 1123, French National Institute of Health and Medical Research, 75010 Paris, France
- AP-HP, Department of Public Health, Henri Mondor Hospital, 94000 Creteil, France
| | - Olivier Seror
- AP-HP, Department of Radiology, Jean Verdier Hospital, 93140 Bondy, France
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, 75010 Paris, France
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Teng W, Jeng WJ, Chen WT, Lin CC, Lin CY, Lin SM, Sheen IS. Soluble form of CTLA-4 is a good predictor for tumor recurrence after radiofrequency ablation in hepatocellular carcinoma patients. Cancer Med 2022; 11:3786-3795. [PMID: 35435327 PMCID: PMC9582685 DOI: 10.1002/cam4.4760] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A soluble form of cytotoxic-T-lymphocyte-antigen-4 (sCTLA-4) is a prognostic biomarker for several cancers but remains unclear in HCC patients. The aim of study is to evaluate the predictive role of serum sCTLA-4 levels for tumor recurrence of chronic hepatis C (CHC)-HCC patients receiving radiofrequency ablation (RFA). MATERIAL AND METHOD A prospective study recruiting 88 CHC-HCC patients was done between 2013 and 2019. Cox regression analysis was used to determine the predictors of early recurrence. All tests were two-tailed, and the level of statistical significance was set as p < 0.05. RESULTS During a median follow-up of 44.4 months, 53 of the 88 (60.2%) CHC-HCC patients encountered early recurrence within 2 years. The predictability of sCTLA-4 for local recurrence (LR) and intrahepatic metastasis (IHM) by 2-years using AUROC curve analysis were 0.740 and 0.715, respectively. Patients with high sCTLA-4 levels (>9 ng/ml) encountered shorter recurrence-free survival (RFS) for LR (log-rank p = 0.017) but paradoxically longer RFS for IHM (log-rank p = 0.007) compared to those with low levels (≤9 ng/ml). By multivariate Cox regression analysis, sCTLA-4 levels and antiviral therapy were independent prognostic factor of early recurrence both in LR and IHM. A combination of baseline sCTLA-4 and AFP level could improve the predictability of early LR and IHM with specificity of 80.0% and 79.7% and positive predictive value of 63.3% and 67.3%, respectively. CONCLUSIONS sCTLA-4 level is a good predictor for early HCC recurrence with higher levels indicating susceptibility to early LR, but protecting from early IHM.
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Affiliation(s)
- Wei Teng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, TaoYuan, Taiwan.,Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, TaoYuan, Taiwan.,Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Ting Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, TaoYuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Chun Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, TaoYuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yen Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, TaoYuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, TaoYuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Shyan Sheen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, TaoYuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Li X, Zhang X, Shi L, Huang G, Lin M, Xie X, Xu M. Feeding Vessel Ablation: A Novel Subsegmental Devascularization Technique for the Treatment of Hepatocellular Carcinoma Located at the Liver Marginal Angle. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:546-553. [PMID: 34972571 DOI: 10.1016/j.ultrasmedbio.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
This pilot clinical study evaluated primarily the efficacy of feeding vessel ablation (FVA) in the treatment of hepatocellular carcinoma (HCC) located at the liver marginal angle (LMA). Nine patients with nine unresectable HCC lesions were prospectively included in this study. The target tumors (mean: 3.0 cm, interquartile range: 2.4-3.6 cm) were located at the LMA (segment 2/3/6) and adjacent to the gastrointestinal tract. Artificial ascites was attempted and failed. Multimode ultrasound technologies, including 2-D and real-time 3-D contrast-enhanced ultrasound, were used to identify the morphology and structure of the feeding vessels for the target tumors. During the treatment, a unipolar cool-tip electrode was used to ablate the feeding vessels, and the target ablation point was set in subsegmental or more distal vessels to induce a downstream ischemia region. Therapeutic outcomes were assessed after FVA, including the rates of technical success, tumor response, local tumor progression (LTP), overall survival (OS) and major complications. Cumulative LTP and OS were estimated with the Kaplan-Meier method. The technical success rate determined immediately after radiofrequency ablation was 7 of 9 (77.8%). Complete response (CR) was achieved in 7 of 7 tumors (100%) at the 1-mo evaluation. During a median follow-up period of 15.6 mo (range: 4.3-53.3 mo), CR remained in 6 of 7 tumors (85.7%), with LTP observed in 1 of 7 tumors (14.3%) 4.7 mo after treatment. The cumulative 1-, 3- and 5-y LTP-free rates were all 83.3%, and the cumulative 1-, 3- and 5-y OS rates were 42.9%, 28.6% and 0%, respectively. No major complications occurred. We concluded that FVA can induce subsegmental devascularization and has the potential to serve as an effective and safe alternative technique for local control of unresectable HCC located at the LMA when artificial ascites fails.
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Affiliation(s)
- Xiaoju Li
- Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoer Zhang
- Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Shi
- Department of Medical Ultrasonics, Hainan General Hospital, Haikou, China
| | - Guangliang Huang
- Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Manxia Lin
- Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Takata K, Tanaka T, Anan A, Fukunaga A, Nagata T, Fukuda H, Yamauchi R, Kunimoto H, Yokoyama K, Morihara D, Takeyama Y, Iwata K, Shakado S, Sakisaka S, Hirai F. Suppression of Local Tumor Progression in Perivascular Hepatocellular Carcinoma by Combination Therapy with Radiofrequency Ablation and Percutaneous Ethanol Injection: A Propensity Score Matching Analysis. Oncology 2022; 100:303-312. [PMID: 35114665 DOI: 10.1159/000522374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/31/2022] [Indexed: 12/24/2022]
Abstract
Background and Aims Radiofrequency ablation (RFA) has replaced percutaneous ethanol injection (PEI) as the treatment of choice for hepatocellular carcinoma (HCC); however, control of local tumor progression (LTP) remains a challenge in perivascular HCC. The aim of this study is to determine whether PEI added to RFA can reduce the LTP rate in perivascular HCC patients. Methods We retrospectively analyzed 167 patients, with 197 newly diagnosed HCC nodules with peritumoral vessels, who underwent either RFA plus PEI or RFA monotherapy as the first-line treatment between June 2001 and April 2015. Ethanol was injected inside the tumor close to the peritumoral vessels in the combination therapy group. Patients were matched 1:1 according to their propensity scores to reduce selection bias; cumulative LTP was then analyzed using log-rank tests and Cox proportional hazard regression analyses. Results The two matched groups comprised 62 tumors each. The overall median follow-up period was 34 months (range, 1-140 months). In the RFA plus PEI group, the cumulative LTP rates were 5.7%, 15.5%, and 20.4% at 1, 3, and 5 years, respectively; in the RFA monotherapy group, the rates were 13.2%, 32.0%, and 40.2%, respectively. The rates were significantly lower in the RFA plus PEI group (P = 0.032). Cox proportional hazard regression analysis showed that PEI combination treatment was significantly associated with a reduced risk of local HCC recurrence (hazard ratio, 0.44; 95% confidence interval, 0.19-0.93; P = 0.031). Discussion/Conclusion The risk of LTP after RFA for perivascular HCC can be significantly reduced by injecting ethanol close to the peritumoral vessels.
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Affiliation(s)
- Kazuhide Takata
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takashi Tanaka
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akira Anan
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Department of Internal Medicine, Shiida Clinic, Fukuoka, Japan
| | - Atsushi Fukunaga
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takahiro Nagata
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiromi Fukuda
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryo Yamauchi
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hideo Kunimoto
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Department of Hepatology, Nagano Municipal Hospital, Nagano, Japan
| | - Keiji Yokoyama
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Daisuke Morihara
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yasuaki Takeyama
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kaoru Iwata
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Department of Internal Medicine, Meotoiwa Hospital, Fukuoka, Japan
| | - Satoshi Shakado
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shotaro Sakisaka
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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18
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Wu TH, Wang YC, Hung HC, Lee JC, Wu CY, Cheng CH, Lee CF, Wu TJ, Chou HS, Chan KM, Lee WC. Preferred Treatment with Curative Intent for Left Lateral Segment Early Hepatocellular Carcinoma under the Era of Minimal Invasive Surgery. J Pers Med 2022; 12:79. [PMID: 35055394 PMCID: PMC8779404 DOI: 10.3390/jpm12010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/25/2021] [Accepted: 01/04/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) occurring at the left lateral segment (LLS) is relatively susceptible to treatment with curative intent in terms of tumor location. However, outcomes might vary depending on the selection of treatment modalities. This study aimed to analyze patients who had undergone curative treatment for early HCC at LLS. METHODS A retrospective analysis of 179 patients who underwent curative treatment for early HCC at LLS was performed. Patients were grouped based on treatment modalities, including radiofrequency ablation (RFA) and liver resection (LR). The long-term outcomes of the two groups were compared. Additionally, the impact of the LR approach on patient outcomes was analyzed. RESULTS Among these patients, 60 received RFA and 119 underwent LR as primary treatment with curative intent. During follow-up, a significantly higher incidence of HCC recurrence was observed in the RFA group (37/60, 61.7%) than in the LR group (45/119, 37.8%) (p = 0.0025). The median time of HCC recurrence was 10.8 (range: 1.1-60.9 months) and 17.6 (range: 2.4-94.8 months) months in the RFA and LR groups, respectively. In addition, multivariate analysis showed that liver cirrhosis, multiple tumors, and RFA treatment were significant risk factors for HCC recurrence. The 1-, 2-, and 5-year overall survival rates in the RFA and LR groups were 96.4%, 92.2%, and 71.5% versus 97.3%, 93.6%, and 87.7%, respectively. (p = 0.047). Moreover, outcomes related to LR were comparable between laparoscopic and conventional open methods. The 1-, 2-, and 5-year recurrence free survival rates in the laparoscopic (n = 37) and conventional open (n = 82) LR groups were 94.1%, 82.0%, and 66.9% versus 86.1%, 74.6%, and 53.1%, respectively. (p = 0.506) Conclusion: Early HCC at LLS had satisfactory outcomes after curative treatment, in which LR seems to have a superior outcome, as compared to RFA treatment. Moreover, laparoscopic LR could be considered a preferential option in the era of minimally invasive surgery.
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Affiliation(s)
- Tsung-Han Wu
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan; (T.-H.W.); (Y.-C.W.); (H.-C.H.); (J.-C.L.); (C.-H.C.); (C.-F.L.); (T.-J.W.); (H.-S.C.); (W.-C.L.)
| | - Yu-Chao Wang
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan; (T.-H.W.); (Y.-C.W.); (H.-C.H.); (J.-C.L.); (C.-H.C.); (C.-F.L.); (T.-J.W.); (H.-S.C.); (W.-C.L.)
| | - Hao-Chien Hung
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan; (T.-H.W.); (Y.-C.W.); (H.-C.H.); (J.-C.L.); (C.-H.C.); (C.-F.L.); (T.-J.W.); (H.-S.C.); (W.-C.L.)
| | - Jin-Chiao Lee
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan; (T.-H.W.); (Y.-C.W.); (H.-C.H.); (J.-C.L.); (C.-H.C.); (C.-F.L.); (T.-J.W.); (H.-S.C.); (W.-C.L.)
| | - Chia-Ying Wu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan;
| | - Chih-Hsien Cheng
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan; (T.-H.W.); (Y.-C.W.); (H.-C.H.); (J.-C.L.); (C.-H.C.); (C.-F.L.); (T.-J.W.); (H.-S.C.); (W.-C.L.)
| | - Chen-Fang Lee
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan; (T.-H.W.); (Y.-C.W.); (H.-C.H.); (J.-C.L.); (C.-H.C.); (C.-F.L.); (T.-J.W.); (H.-S.C.); (W.-C.L.)
| | - Ting-Jung Wu
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan; (T.-H.W.); (Y.-C.W.); (H.-C.H.); (J.-C.L.); (C.-H.C.); (C.-F.L.); (T.-J.W.); (H.-S.C.); (W.-C.L.)
| | - Hong-Shiue Chou
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan; (T.-H.W.); (Y.-C.W.); (H.-C.H.); (J.-C.L.); (C.-H.C.); (C.-F.L.); (T.-J.W.); (H.-S.C.); (W.-C.L.)
| | - Kun-Ming Chan
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan; (T.-H.W.); (Y.-C.W.); (H.-C.H.); (J.-C.L.); (C.-H.C.); (C.-F.L.); (T.-J.W.); (H.-S.C.); (W.-C.L.)
| | - Wei-Chen Lee
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan; (T.-H.W.); (Y.-C.W.); (H.-C.H.); (J.-C.L.); (C.-H.C.); (C.-F.L.); (T.-J.W.); (H.-S.C.); (W.-C.L.)
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Shin SW, Cho SK, Hyun D, Park KB, Park HS, Do YS. Guidewire-catheter induced hydrodissection to assist radiofrequency ablation for subcapsular hepatocellular carcinoma with iodized oil retention in patients with failed artificial ascites due to perihepatic adhesion. DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY (ANKARA, TURKEY) 2021; 27:746-753. [PMID: 34792029 DOI: 10.5152/dir.2021.21056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate the usefulness of guidewire-catheter induced hydrodissection (GIH) to assist radiofrequency ablation (RFA) for subcapsular hepatocellular carcinoma (HCC) with iodized oil retention in patients with failed artificial ascites due to perihepatic adhesion. METHODS This retrospective study included 17 patients with small subcapsular HCC ineligible for ultrasonography-guided RFA who received RFA under guidance of fluoroscopy and cone-beam computed tomography immediately after iodized oil transarterial chemoembolization (TACE) between April 2011 and January 2016. In the study patients, creation of artificial ascites to protect the perihepatic structures failed due to perihepatic adhesion and GIH was attempted to separate the perihepatic structures from the ablation zone. The technical success rate of GIH, technique efficacy of RFA with GIH, local tumor progression (LTP), peritoneal seeding, and complications were evaluated. RESULTS The technical success rate of GIH was 88.24% (15 of 17 patients). Technique efficacy was achieved in all 15 patients receiving RFA with GIH. During an average follow-up period of 48.1 months, LTP developed in three patients. Cumulative LTP rates at 1, 2, 3, and 5 years were 13.3%, 20.6%, 20.6%, and 20.6%, respectively. No patient had peritoneal seeding. Two of the 15 patients receiving RFA with GIH had a CIRSE grade 3 liver abscess, but none had complications associated with thermal injury to the diaphragm or abdominal wall near the ablation zone. CONCLUSION GIH can be a useful method to assist RFA for subcapsular HCC with iodized oil retention in patients with failed artificial ascites due to perihepatic adhesion.
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Affiliation(s)
- Sung Wook Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-Gu, Korea
| | - Sung Ki Cho
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-Gu, Korea
| | - Dongho Hyun
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-Gu, Korea
| | - Kwang Bo Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-Gu, Korea
| | - Hong Suk Park
- Departments of Radiology and Center for Imaging Science Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Soo Do
- Departments of Radiology and Center for Imaging Science Samsung Medical Center, Sungkyunkwan University School of Medicine
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20
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Hu H, Chi JC, Liu R, Zhai B. Microwave ablation for peribiliary hepatocellular carcinoma: propensity score analyses of long-term outcomes. Int J Hyperthermia 2021; 38:191-201. [PMID: 33682598 DOI: 10.1080/02656736.2019.1706766] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To compare the long-term outcomes of MWA as the first-line treatment for HCC in peribiliary versus non-peribiliary locations using propensity score matching analysis. METHODS The study participants were recruited between April 2012 and October 2016. In total, 236 patients with HCC <5 cm who underwent ultrasonography-guided percutaneous MWA as the first-line treatment were enrolled. The patients were grouped into two according to tumor location: peribiliary (n = 74) and non-peribiliary (n = 162). The progression-free survival (PFS) and overall survival (OS) rates were compared before and after propensity score matching. Subgroup analyses were conducted for the peribiliary group according to the biliary grading. RESULTS Propensity score matching yielded 63 matched pairs of patients. In the two matched groups, cumulative PFS rates were 29.0% and 14.0% in the peribiliary group, and 51.0% and 31.0% in the non-peribiliary group at 3 and 5 years, respectively. Corresponding OS rates were 51.0% and 49.0% in the peribiliary group, and 77.0% and 70.0% in the non-peribiliary group at 3 and 5 years, respectively. In addition, there were significant differences in major complication rates between the two groups (25.7% vs 8.0%; p < .001). In contrast to peribiliary HCCs adjacent to the second-degree branches of intrahepatic bile duct (67.1 ± 5.2 months), subgroup analysis indicated that the mean OS was significantly lower in peribiliary HCCs adjacent to the first-degree branches (51.2 ± 7.5 months) (p = .015). CONCLUSION The application of MWA for peribiliary HCC leads to a higher rate of complications and worse long-term tumor control than for non-peribiliary HCC.KEY POINTSThe application of MWA for peribiliary HCC leads to a higher rate of complications than for non-peribiliary HCC.The application of MWA for peribiliary HCC leads to worse long-term tumor control than for non-peribiliary HCC. Abbreviations: Hepatocellular carcinoma (HCC); microwave ablation (MWA); α-fetoprotein (α-FP); local tumor progression (LTP); intrahepatic distal recurrence (IDR); progression-free survival (PFS); overall survival (OS).
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Affiliation(s)
- Hao Hu
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jia Chang Chi
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Liu
- Department of Interventional Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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21
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Bréhier G, Besnier L, Delagnes A, Oberti F, Lebigot J, Aubé C, Paisant A. Imaging after percutaneous thermal and non-thermal ablation of hepatic tumour: normal appearances, progression and complications. Br J Radiol 2021; 94:20201327. [PMID: 33793305 DOI: 10.1259/bjr.20201327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The increasing number of liver tumours treated by percutaneous ablation leads all radiologists to be confronted with the difficult interpretation of post-ablation imaging. Radiofrequency and microwave techniques are most commonly used. Recently, irreversible electroporation treatments that do not induce coagulation necrosis but cellular apoptose and respect the collagen architecture of bile ducts and vessels have been introduced and lead to specific post-ablation features and evolution. Ablations cause 'normal' changes in ablation and periablation zones. It is necessary to know these post-ablation features to avoid the misinterpretation of recurrence or complication that would lead to unnecessary treatments. Another challenge for the radiologist is to detect as early as possible the residual unablated tumour or the disease progression (local progression and tumour seeding) that will require a new treatment. Finally, the complications, frequent or rarer, should be recognised to be managed adequately. The purpose of this article is therefore to describe the large spectrum of normal and pathological aspects related to the treatment of hepatic tumour by percutaneous thermal ablation and irreversible electroporation ablation.
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Affiliation(s)
- Germain Bréhier
- Department of Radiology, University Hospital, Angers, France
| | - Louis Besnier
- Department of Radiology, University Hospital, Angers, France
| | - Anaïs Delagnes
- Department of Radiology, University Hospital, Angers, France
| | - Frédéric Oberti
- Department of Hepato-gastro-enterology, University Hospital, Angers, France.,Laboratoire HIFIH, EA 3859, UNIV Angers, Angers, France
| | - Jérôme Lebigot
- Department of Radiology, University Hospital, Angers, France
| | - Christophe Aubé
- Department of Radiology, University Hospital, Angers, France.,Laboratoire HIFIH, EA 3859, UNIV Angers, Angers, France
| | - Anita Paisant
- Department of Radiology, University Hospital, Angers, France.,Laboratoire HIFIH, EA 3859, UNIV Angers, Angers, France
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22
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Wang Y, Zhang L, Li Y, Wang W. Computed tomography-guided percutaneous microwave ablation with artificial ascites for problematic hepatocellular tumors. Int J Hyperthermia 2020; 37:256-262. [PMID: 32157926 DOI: 10.1080/02656736.2020.1736649] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: The aim of this study was to assess the feasibility, safety and efficacy of computed tomography (CT)-guided percutaneous microwave ablation with artificial ascites for problematic hepatocellular tumors.Methods: Forty-eight patients with 61 problematic hepatocellular carcinomas who underwent CT-guided percutaneous microwave ablation with artificial ascites were reviewed retrospectively. Lesions less than 5 mm away from the gastrointestinal system, diaphragm, pericardium or kidney were defined as problematic tumors with the potential risk of thermal damage. Microwave ablation was performed after artificial ascites was established between tumors and the adjacent high-risk organs. The technical effectiveness of microwave ablation, local tumor progression and complications was assessed.Results: Microwave ablation with artificial ascites was successfully performed in all 61 tumors. The technical effectiveness rate was 100% with contrast-enhanced CT performed immediately after the ablation procedure. Local tumor progression occurred in three (6%) of the 48 patients during the follow-up period (mean, 15 months; range, 6-24 months). No major complications related to the procedure occurred.Conclusion: CT-guided percutaneous microwave ablation with artificial ascites is a feasible, safe and effective choice for treating problematic hepatocellular tumors, avoiding potential thermal damage to the adjacent high-risk organs.
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Affiliation(s)
- Yongzheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan, China
| | - Lili Zhang
- Department of Gastroenterology, People's Hospital of Qihe County, Qihe, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan, China
| | - Wujie Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan, China
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23
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Rogger TM, Michielan A, Sferrazza S, Pravadelli C, Moser L, Agugiaro F, Vettori G, Seligmann S, Merola E, Maida M, Ciarleglio FA, Brolese A, de Pretis G. Gastrointestinal tract injuries after thermal ablative therapies for hepatocellular carcinoma: A case report and review of the literature. World J Gastroenterol 2020; 26:5375-5386. [PMID: 32994695 PMCID: PMC7504251 DOI: 10.3748/wjg.v26.i35.5375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) and microwave ablation (MWA) represent the standard of care for patients with early hepatocellular carcinoma (HCC) who are unfit for surgery. The incidence of reported adverse events is low, ranging from 2.4% to 13.1% for RFA and from 2.6% to 7.5% for MWA. Gastrointestinal tract (GIT) injury is even more infrequent (0.11%), but usually requires surgery with an unfavourable prognosis. Due to its low incidence and the retrospective nature of the studies, the literature reporting this feared complication is heterogeneous and in many cases lacks information on tumour characteristics, comorbidities and treatment approaches. CASE SUMMARY A 77-year-old man who had undergone extended right hepatectomy for HCC was diagnosed with early disease recurrence with a small nodule compatible with HCC in the Sg4b segment of the liver with a subcapsular location. He was treated with percutaneous RFA and a few week later he was urgently admitted to the Surgery ward for abdominal pain and fever. A subcutaneous abscess was diagnosed and treated by percutaneous drainage. A fistulous tract was then documented by the passage of contrast material from the gastric antrum to the abdominal wall. The oesophagogastroduodenoscopy confirmed a circular wall defect at the lesser curvature of gastric antrum, leading directly to the purulent abdominal collection. An over-the-scope clip (OTSC) was used to successfully close the defect. CONCLUSION This is the first reported case of RFA-related GIT injury to have been successfully treated with an OTSC, which highlights the role of this endoscopic treatment for the management of this complication.
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Affiliation(s)
- Teresa Marzia Rogger
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Andrea Michielan
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Sandro Sferrazza
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Cecilia Pravadelli
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Luisa Moser
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Flora Agugiaro
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Giovanni Vettori
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Sonia Seligmann
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Elettra Merola
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S.Elia-Raimondi Hospital, Caltanissetta, Caltanissetta 93100, Italy
| | | | - Alberto Brolese
- Department of Surgery, Hepato-biliary Surgery Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Giovanni de Pretis
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
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"Primum Non Nocere" in Interventional Oncology for Liver Cancer: How to Reduce the Risk for Complications? Life (Basel) 2020; 10:life10090180. [PMID: 32899925 PMCID: PMC7555139 DOI: 10.3390/life10090180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022] Open
Abstract
Interventional oncology represents a relatively new clinical discipline based upon minimally invasive therapies applicable to almost every human organ and disease. Over the last several decades, rapidly evolving research developments have introduced a newer generation of treatment devices, reagents, and image-guidance systems to expand the armamentarium of interventional oncology across a wide spectrum of disease sites, offering potential cure, control, or palliative care for many types of cancer patients. Due to the widespread use of locoregional procedures, a comprehensive review of the methodologic and technical considerations to optimize patient selection with the aim of performing a safe procedure is mandatory. This article summarizes the expert discussion and report from the Mediterranean Interventional Oncology Live Congress (MIOLive 2020) held in Rome, Italy, integrating evidence-reported literature and experience-based perceptions as a means for providing guidance on prudent ways to reduce complications. The aim of the paper is to provide an updated guiding tool not only to residents and fellows but also to colleagues approaching locoregional treatments.
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Ho PH, Teng W, Lin CC, Jeng WJ, Chen WT, Lin CY, Lin SM, Sheen IS. Prolonged post-ablation fever may predict one-year tumor recurrence in hepatocellular carcinoma after radiofrequency ablation. Int J Hyperthermia 2020; 37:1008-1015. [PMID: 32814458 DOI: 10.1080/02656736.2020.1806363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Ping-Hung Ho
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
| | - Wei Teng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chen-Chun Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wei-Ting Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chun-Yen Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Shi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - I-Shyan Sheen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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Huang Q, Li J, Zeng Q, Tan L, Zheng R, He X, Li K. Value of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery. BMC Cancer 2020; 20:763. [PMID: 32795279 PMCID: PMC7427902 DOI: 10.1186/s12885-020-07261-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/04/2020] [Indexed: 12/22/2022] Open
Abstract
Background To evaluate the feasibility and effectiveness of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery. Methods Thirty-nine patients with a total of 40 liver malignant tumors were enrolled between January 2016 and June 2019. All had histories of hepatectomy, splenectomy, cholecystectomy, and intestinal surgery. The distance between the tumor and the gastrointestinal tract was < 5 mm. Normal saline was used as artificial ascites to protect the gastrointestinal tract during thermal ablation. The success rate of the procedure, incidence of major complications, and the technical efficacy of ablation were recorded. Patients were followed for local tumor progression (LTP), and overall survival (OS). Results The use of artificial ascites was successful in 38 of the 40 procedures (95%). Major complications occurred in two of the 39 patients (5.1%) following the procedure. One was an intestinal fistula that occurred in a failed case and was associated with an infection. The other was a liver abscess that occurred in a successful case. The technical efficacy of ablation was 100% (40/40 procedures). The median follow-up was 16 months. The 1-, 2-, and 3-year LTP rates were 2.9, 5.7 and 5.7%. The 1-, 2-, and 3-year OS rates were 97.1, 86.8 and 69.5%. Conclusion In patients with previous abdominal surgery, artificial ascites is feasible and effective for assisting thermal ablation of liver cancer adjacent to the gastrointestinal tract.
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Affiliation(s)
- Qiannan Huang
- Department of Medical ultrasonics, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, PR China
| | - Jianguo Li
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, PR China
| | - Qingjing Zeng
- Department of Medical ultrasonics, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, PR China
| | - Lei Tan
- Department of Medical ultrasonics, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, PR China
| | - Rongqin Zheng
- Department of Medical ultrasonics, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, PR China
| | - Xuqi He
- Department of Medical ultrasonics, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, PR China.
| | - Kai Li
- Department of Medical ultrasonics, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, PR China.
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Makary MS, Khandpur U, Cloyd JM, Mumtaz K, Dowell JD. Locoregional Therapy Approaches for Hepatocellular Carcinoma: Recent Advances and Management Strategies. Cancers (Basel) 2020; 12:1914. [PMID: 32679897 PMCID: PMC7409274 DOI: 10.3390/cancers12071914] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and third leading cause of cancer-related mortality worldwide. While surgical resection and transplantation are the standard first-line treatments for early-stage HCC, most patients do not fulfill criteria for surgery. Fortunately, catheter-directed and percutaneous locoregional approaches have evolved as major treatment modalities for unresectable HCC. Improved outcomes have been achieved with novel techniques which can be employed for diverse applications ranging from curative-intent for small localized tumors, to downstaging or bridging to resection and transplantation for early and intermediate disease, and locoregional control and palliation for advanced disease. This review explores recent advances in liver-directed techniques for HCC including bland transarterial embolization, chemoembolization, radioembolization, and ablative therapies, with a focus on patient selection, procedural technique, periprocedural management, and outcomes.
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Affiliation(s)
- Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Umang Khandpur
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Jordan M. Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Khalid Mumtaz
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
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McDevitt JL, Collard MD, Murphy RP, Sutphin PD, Yopp AC, Singal AG, Kalva SP. Comparison of radiofrequency and microwave ablation and identification of risk factors for primary treatment failure and local progression. Clin Imaging 2020; 67:146-151. [PMID: 32659600 DOI: 10.1016/j.clinimag.2020.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/19/2020] [Accepted: 06/07/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of Hepatocellular carcinoma (HCC) and to identify risk factors for treatment failure and local progression. METHODS 145 unique HCC [87 (60%) RFA, 58 (40%) MWA] were retrospectively reviewed from a single tertiary medical center. Adverse events were classified as severe, moderate, or mild according to the Society of Interventional Radiology Adverse Event Classification system. Primary and secondary efficacy, as well as local progression, were determined using mRECIST. Predictors of treatment failure and time to local progression were analyzed using generalized estimating equations and Cox regression, respectively. RESULTS Technical success was achieved in 143/145 (99%) HCC. There were 1 (0.7%) severe and 2 (1.4%) moderate adverse events. Of the 143 technically successful initial treatments, 136 (95%) completed at least one follow-up exam. Primary efficacy was achieved in 114/136 (84%). 9/22 (41%) primary failures underwent successful repeat ablation, so secondary efficacy was achieved in 128/136 (90%) HCC. Local progression occurred in 24 (19%) HCC at a median of 25 months (95% CI = 19-32 months). There was no difference in technical success, primary efficacy, or time to local progression between RFA and MWA. In HCC treated with MWA, same-day biopsy was associated with primary failure (RR = 9.0, 95% CI: 1.7-47, P = 0.015), and proximity to the diaphragm or gastrointestinal tract was associated with local progression (HR = 2.40, 95% CI:1.5-80, P = 0.017). CONCLUSION There was no significant difference in primary efficacy or time to local progression between percutaneous RFA and MWA.
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Affiliation(s)
- Joseph L McDevitt
- Department of Radiology, UT Southwestern Medical Center, United States of America.
| | - Michael D Collard
- Department of Radiology, UT Southwestern Medical Center, United States of America
| | - Ryan P Murphy
- Department of Radiology, UT Southwestern Medical Center, United States of America
| | - Patrick D Sutphin
- Department of Radiology, UT Southwestern Medical Center, United States of America
| | - Adam C Yopp
- Department of Surgery, UT Southwestern Medical Center, United States of America
| | - Amit G Singal
- Department of Medicine, UT Southwestern Medical Center, United States of America
| | - Sanjeeva P Kalva
- Department of Radiology, UT Southwestern Medical Center, United States of America; Department of Radiology, Massachusetts General Hospital, United States of America
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Transcatheter arterial chemoembolization alone or combined with ablation for recurrent intermediate-stage hepatocellular carcinoma: a propensity score matching study. J Cancer Res Clin Oncol 2020; 146:2669-2680. [PMID: 32449005 DOI: 10.1007/s00432-020-03254-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The recurrence after curative hepatectomy is common. Limited data have investigated the effect of transcatheter arterial chemoembolization (TACE) combined with ablation in treating recurrent intermediate-stage hepatocellular carcinoma (HCC) after hepatectomy. We aim to compare the efficacy of TACE combined with ablation versus TACE alone in treating recurrent intermediate-stage HCC after hepatectomy. METHODS A total of 183 patients with recurrent intermediate-stage HCC after hepatectomy were enrolled at Sun Yat-sen University Cancer Centre, including 111 patients who underwent TACE alone and 72 patients who underwent TACE combined with ablation (TACE-Ablation). Overall survival (OS) and progression-free survival (PFS) were compared by the log-rank test. Propensity score matching (PSM) was used to reduce the confounding bias. RESULTS Before PSM, the 5-year OS rates were 43.3% vs. 27.9% (P = 0.001), and the 5-year PFS rates were 21.7% vs. 13.0% (P < 0.001) for TACE-Ablation and TACE-alone groups, respectively. After PSM, TACE-Ablation still resulted in better 5-year OS (41.6% vs. 30.2%, P = 0.028) and 5-year PFS rate (21.3% vs. 15.8%, P = 0.024) than that of TACE alone. Patients in TACE-Ablation group exhibited similar major complication rates to TACE-alone group but higher minor complication rates both before and after PSM. Cox regression analysis identified TACE-alone modality as an independently unfavourable predictor for OS and PFS (both P < 0.05). CONCLUSION TACE combined with ablation is safe and superior to TACE alone in tumour control and prolonging overall survival in recurrent intermediate-stage HCC after hepatectomy.
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Yu SCH, Hui JWY, Chong CCN, Chu CM, Cheung S, Wong J, Lee KF. Transarterial Ethanol Ablation for Small Hepatocellular Carcinoma (≤ 3 cm): A Comparative Study Versus Radiofrequency Ablation. Cardiovasc Intervent Radiol 2020; 43:732-739. [PMID: 32152720 DOI: 10.1007/s00270-020-02426-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/28/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The objective was to evaluate the local treatment efficacy of transarterial ethanol ablation (TEA) as compared to radiofrequency ablation (RFA) for small hepatocellular carcinoma (HCC). MATERIALS AND METHODS This was a retrospective study between January 2005 and April 2017, in which the treatment outcomes of all patients who received either percutaneous TEA or RFA for HCC tumors of size ≤ 3 cm, of Child-Pugh grade A or B, received no prior treatment other than surgical resection, were compared. For TEA, a mixture of absolute ethanol and ethiodized oil at a proportion of 1:2 by volume was administered superselectively into the tumor via a microcatheter placed at the feeding arteries. The TEA group and the RFA group consisted of 68 consecutive patients (88 treated target tumors) and 129 consecutive patients (129 tumors), respectively. RESULTS Technical success was achieved in all the target tumors in both groups. Grade 3 complication (CIRSE Classification) of prolonged fever occurred in 3 cases with multi-focal and large tumors in the TEA group. There was no statistically significant difference in complete response rate between the TEA group (84/88 or 95.5%) and the RFA group (188/195 or 96.4%) (p = 0.7). Time to progression in the TEA group [median 11.9 months, interquartile range (IQR) 5.6-18 months] was not statistically different from that in the RFA group (median 9.5 months, IQR 3.5-18.7 months) (p = 0.773). CONCLUSION TEA could be an effective alternative of RFA for the local treatment of small HCC; it is especially valuable for tumors of unfavorable location.
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Affiliation(s)
- Simon Chun Ho Yu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
- Vascular and Interventional Radiology Foundation Clinical Science Center, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Joyce Wai Yi Hui
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
- Vascular and Interventional Radiology Foundation Clinical Science Center, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
| | - Charing Ching Ning Chong
- Department of Surgery, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
| | - Cheuk Man Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
- Vascular and Interventional Radiology Foundation Clinical Science Center, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
| | - Sunny Cheung
- Department of Surgery, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
| | - John Wong
- Department of Surgery, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
| | - Kit Fai Lee
- Department of Surgery, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
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Yang Y, Zhang Y, Wu Y, Chen J, Liang B, Chen Q, Wang Q, Lyu J, Li Y, Mu F, Du D. Efficacy and Safety of Percutaneous Argon-Helium Cryoablation for Hepatocellular Carcinoma Abutting the Diaphragm. J Vasc Interv Radiol 2020; 31:393-400.e1. [PMID: 31987705 DOI: 10.1016/j.jvir.2019.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 10/15/2019] [Accepted: 11/02/2019] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of percutaneous argon-helium cryoablation (CA) for hepatocellular carcinoma (HCC) abutting the diaphragm (<5 mm). MATERIALS AND METHODS A total of 61 consecutive patients (50 men, 11 women; mean age, 56.3 ± 12.1 years old; range, 32-83 years) with 74 HCC tumors (mean size, 3.3 ± 1.7 cm; range, 0.8-7 cm) who were treated with percutaneous argon-helium CA were enrolled in this retrospective study. Adverse events were evaluated according to Common Terminology Criteria for Adverse Events, version 5.0. Local tumor progression (LTP) and overall survival (OS) were analyzed using the Kaplan-Meier method and the log-rank test. The risk factors associated with OS and LTP were evaluated using univariate and multivariate Cox regression analysis. RESULTS No periprocedural (30-day) deaths occurred. A total of 29 intrathoracic adverse events occurred in 24 of the 61 patients. Major adverse events were reported in 5 patients (pleural effusion requiring catheter drainage in 4 patients and pneumothorax requiring catheter placement in 1 patient). Median follow-up was 18.7 months (range, 2.3-60.0 months). Median time to LTP after CA was 20.9 months (interquartile range [IQR], 14.1-30.6 months). Median times of OS after CA and diagnosis were 27.3 months (IQR, 15.1-45.1 months) and 40.9 months (interquartile range, 24.8-68.6 months), respectively. Independent prognostic factors for OS included tumor location (left lobe vs right lobe; hazard ratio [HR], 2.031; 95% confidence interval [CI], 1.062-3.885; P = .032) and number of intrahepatic tumors (solitary vs multifocal; HR, 2.684; 95% CI, 1.322-5.447; P = .006). Independent prognostic factors for LTP included age (HR, 0.931; 95% CI, 0.900-0.963; P < .001), guidance modality (ultrasound vs computed tomography and US; HR, 6.156 95% CI, 1.862-20.348; P = .003) and origin of liver disease. CONCLUSIONS Percutaneous argon-helium CA is safe for the treatment of HCC abutting the diaphragm, with acceptable LTP and OS.
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Affiliation(s)
- Yumei Yang
- Department of Ultrasound, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Yanfang Zhang
- Department of Interventional Therapy, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, China
| | - Yumin Wu
- Department of Interventional Therapy, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen 518035, China
| | - Jibing Chen
- Biotherapy Center, Fuda Cancer Hospital of Jinan University, Guangzhou, China
| | - Bing Liang
- Department of Oncology, Fuda Cancer Hospital of Jinan University, Guangzhou, China
| | - Quanhong Chen
- Department of Interventional Therapy, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen 518035, China
| | - Qiuyu Wang
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Jialing Lyu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen 518035, China
| | - Yong Li
- Department of Interventional Therapy, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, China
| | - Feng Mu
- Department of Oncology, Fuda Cancer Hospital of Jinan University, Guangzhou, China
| | - Duanming Du
- Department of Interventional Therapy, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen 518035, China.
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Precision Locoregional Therapies for Hepatocellular Carcinoma: Percutaneous Ablation and Radiotherapy. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/978-3-030-21540-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Kwon JH, Won JY, Han K, Han S, Kim D, Kim H, Kim GM, Kim MD, Lee DY. Safety and Efficacy of Percutaneous Cryoablation for Small Hepatocellular Carcinomas Adjacent to the Heart. J Vasc Interv Radiol 2019; 30:1223-1228. [PMID: 30956074 DOI: 10.1016/j.jvir.2018.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 12/21/2018] [Accepted: 12/21/2018] [Indexed: 01/22/2023] Open
Abstract
PURPOSE This study evaluated the safety and efficacy of percutaneous cryoablation for treatment of the left subdiaphragmatic small hepatocellular carcinomas (HCCs) adjacent to the heart. MATERIALS AND METHODS Between September 2013 and March 2018, 189 consecutive patients underwent cryoablation for small HCCs (≤3 cm); 70 patients (mean: 61.3 ± 10.6 years of age; range: 40-82 years) with left hepatic tumors (22 juxtacardiac and 48 nonjuxtacardiac tumors) were retrospectively analyzed. Patients were divided into juxtacardiac and nonjuxtacardiac tumor groups (tumor margins: ≤10 mm and >10 mm, respectively, from the heart border). The rates of technical success, complete ablation, complications, and local tumor recurrence (LTR) were evaluated. RESULTS No significant intergroup differences were observed in the mean diameter of the tumor (17.9 ± 5.5 mm vs. 17.5 mm ± 5.2, respectively; P = 0.781) and of the ablation zone (41.3 ± 4.2 mm vs. 43.5 ± 5.8 mm, respectively; P = 0.115). Technical success was achieved in all patients. No procedure-related major complications occurred in either group. The median follow-up period was 15 months (range: 3.1-49.6 months). No statistically significant intergroup differences were observed in the rates of complete ablation (90.9% vs. 93.8%, respectively; P = 0.646) and LTR (20% vs. 15.6%, respectively; P = 0.725). CONCLUSIONS Cryoablation is a safe treatment modality for patients with juxtacardiac small HCCs, without an increased risk of cardiac complications compared to treatment of HCCs that are nonjuxtacardiac, and with comparable efficacy.
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Affiliation(s)
- Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Jong Yun Won
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea.
| | - Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Seungchul Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Doyoung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Heejoon Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Man-Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
| | - Do Yun Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 120-752, Korea
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Mohkam K, Mabrut JY. Reply to: "Treatment for solitary hepatocellular carcinoma ranging from 2 and 5 cm: Is the curative effect of no-touch multibipolar radiofrequency ablation comparable to that of surgical resection?". J Hepatol 2019; 70:576-577. [PMID: 30591264 DOI: 10.1016/j.jhep.2018.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 11/27/2018] [Indexed: 12/04/2022]
Affiliation(s)
- Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France; INSERM Unit 1052, Clinical Research Center of Lyon, France.
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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Hsieh YC, Limquiaco JL, Lin CC, Chen WT, Lin SM. Radiofrequency ablation following artificial ascites and pleural effusion creation may improve outcomes for hepatocellular carcinoma in high-risk locations. Abdom Radiol (NY) 2019; 44:1141-1151. [PMID: 30460530 DOI: 10.1007/s00261-018-1831-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the outcomes of radiofrequency ablation (RFA) following artificial ascites (AA) and artificial pleural effusion (AP) creation for hepatocellular carcinoma (HCC) in high-risk locations. MATERIALS AND METHODS Eligible patients were divided into 2 study periods (non-AAAP and AAAP groups) with AAAP performed in the latter period. Local tumor progression, primary technique effectiveness and complications were compared between patients with and without AAAP. Cumulative probability of local tumor progression and overall survival were estimated with Kaplan-Meier curves. RESULTS One hundred thirty-eight patients with 195 tumors were evaluated. AAAP was performed in 48 patients with 76 tumors. Local tumor progression rates at 12 and 24 months were 9.3% and 22.2% in the non-AAAP group versus 5.5% and 9% in the AAAP group (p < 0.0001). Primary technique effectiveness was achieved in 76.5% of the non-AAAP group versus 89.5% of the AAAP group (p = 0.046). Night (7.6%) major complications occurred in the non-AAAP group and 2 (2.6%) cases occurred in the AAAP group. Therapy-oriented severity grading system after RFA was lower in the AAAP group (p = 0.02). Overall survival rates at 12 and 24 months were 85.6% and 77.7% in the non-AAAP group versus 97.2% and 89.7% in the AAAP group (p = 0.033). CONCLUSION RFA following AA and AP for high-risk located HCC may improve outcomes.
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Affiliation(s)
- Yi-Chung Hsieh
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
| | - Jenny L Limquiaco
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
- Division of Gastroenterology, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Chen-Chun Lin
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
| | - Wei-Ting Chen
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
| | - Shi-Ming Lin
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan.
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Sato K, Taniki N, Kanazawa R, Shimizu M, Ishii S, Ohama H, Takawa M, Nagamatsu H, Imai Y, Shiina S. Efficacy and Safety of Deep Sedation in Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma. Adv Ther 2019; 36:344-354. [PMID: 30607546 DOI: 10.1007/s12325-018-0865-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) has been accepted as safe and effective for treating early-stage hepatocellular carcinoma (HCC). However, it often causes severe pain. Therefore, in this study, we performed RFA under deep sedation and investigated its efficacy and safety. METHODS We conducted a retrospective study including 511 HCC patients who received approximately 886 RFA treatments between December 2014 and November 2016 at our institution. Respiratory depression was defined as oxygen saturation of below 90%; and severe body movement was defined as movement caused by pain, which was managed by lowering the power of the generator. Factors associated with respiratory depression and severe body movement were examined via univariate and multivariate regression analyses. RESULTS Respiratory depression occurred in 15.3% of the patients and severe body movement in 26.5% of the patients. In the multivariate analysis, BMI (≥ 25 kg/m2, odds ratio [OR] = 1.75, P = 0.035) and longer ablation (≥ 10 min, OR = 2.59, P = 0.002) were significant respiratory depression-related factors. Male sex (OR = 2.02, P = 0.005), Child-Pugh class A (odds ratio = 1.96, P = 0.018), and longer ablation (≥ 10 min, OR = 3.03, P < 0.001) were significant factors related to severe body movement. CONCLUSION Deep sedation for RFA can be performed safely and effectively. Higher BMI and longer ablation were risk factors for respiratory depression and male sex, Child-Pugh class A, and longer ablation were independent predictors of severe body movement during RFA under deep sedation.
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Affiliation(s)
- Koki Sato
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Nobuhito Taniki
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryo Kanazawa
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Motonori Shimizu
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shigeto Ishii
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hideko Ohama
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Masashi Takawa
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroaki Nagamatsu
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuharu Imai
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
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Filippiadis DK, Spiliopoulos S, Konstantos C, Reppas L, Kelekis A, Brountzos E, Kelekis N. Computed tomography-guided percutaneous microwave ablation of hepatocellular carcinoma in challenging locations: safety and efficacy of high-power microwave platforms. Int J Hyperthermia 2018; 34:863-869. [PMID: 28828899 DOI: 10.1080/02656736.2017.1370728] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 08/19/2017] [Accepted: 08/19/2017] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To evaluate the clinical efficacy/safety of CT-guided percutaneous microwave ablation for HCC in challenging locations using high-power microwave platforms. MATERIALS AND METHODS A retrospective review was conducted in 26 patients with 36 HCC tumours in challenging locations (hepatic dome, subcapsular, close to the heart/diaphragm/hepatic hilum, exophytic) undergoing CT-guided percutaneous microwave ablation in a single centre since January 2011. Two different microwave platforms were used both operating at 2.45 GHz: AMICA and Acculis MWA System. Patient demographics including age, sex, tumour size and location, as well as technical details were recorded. Technical success, treatment response, patients survival and complication rate were evaluated. RESULTS Treated tumours were located in the hepatic dome (n = 14), subcapsularly (n = 16), in proximity to the heart (n = 2) or liver hilum (n = 2), while two were exophytic tumours at segment VI (n = 2). Mean tumour diameter was 3.30 cm (range 1.4-5 cm). In 3/26 patients (diameter >4 cm), an additional session of DEB-TACE was performed due to tumour size. Technical success rate was 100%; complete response rate was recorded in 33/36 tumours (91.6%). According to Kaplan-Meier analysis, survival rate was 92.3% and 72.11% at 24- and 60-month follow-up, respectively. There were no major complications; two cases of minor pneumothorax and two cases of small subcapsular haematoma were resolved only with observation requiring no further treatment. CONCLUSION CT-guided percutaneous microwave ablation for hepatocellular carcinoma tumours in challenging locations and up to 5 cm in diameter can be performed with high efficacy and safety rates.
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Affiliation(s)
- Dimitrios K Filippiadis
- a 2nd Radiology Department , University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Stavros Spiliopoulos
- a 2nd Radiology Department , University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | | | - Lazaros Reppas
- b 2nd Radiology Department , University General Hospital "ATTIKON" , Athens , Greece
| | - Alexis Kelekis
- b 2nd Radiology Department , University General Hospital "ATTIKON" , Athens , Greece
| | - Elias Brountzos
- b 2nd Radiology Department , University General Hospital "ATTIKON" , Athens , Greece
| | - Nikolaos Kelekis
- b 2nd Radiology Department , University General Hospital "ATTIKON" , Athens , Greece
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Murakami N, Shima S, Okuma K, Iijima K, Tselis N, Uematsu M, Takagawa Y, Kashihara T, Masui K, Yoshida K, Takahashi K, Inaba K, Igaki H, Nakayama Y, Itami J. Artificial ascites for organs at risk sparing in intrapelvic brachytherapy: a case report of recurrent uterine cervical carcinoma adjacent to the bowel. BJR Case Rep 2018; 5:20180067. [PMID: 31131133 PMCID: PMC6519505 DOI: 10.1259/bjrcr.20180067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 07/31/2018] [Indexed: 12/23/2022] Open
Abstract
Artificial ascites has been reported as an effective technique to reduce the risk
of thermal injury in radiofrequency ablation of liver tumors by increasing the
distance of collateral organs located next to the ablated sites. In this case
report we share our experience with artificial ascites in an attempt to reduce
the toxicity of collateral adjacent organs in the setting of re-irradiation for
recurrent cervical cancer. A 52-year-old female who developed local recurrence
after definitive radiation therapy was treated with interstitial re-irradiation
by means of image-guided, (single-implant/multi fraction) high-dose-rate
brachytherapy. Because the sigmoid colon was in close proximity to the recurrent
tumor lesion, artificial ascites was generated before each treatment fraction by
percutaneous injection of a defined amount of saline solution through the
abdominal wall to create additional space between the two volumes. Artificial
ascites showed a dosimetric improvement by reducing the sigmoid colon
D0.1cc per fraction from 286 cGy before to 189 cGy after saline
injection. No severe complication was associated with the injection
procedure.
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Affiliation(s)
- Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Shima
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kotaro Iijima
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Nikolaos Tselis
- Department of Radiotherapy and Oncology, Goethe-University, Frankfurt, Germany
| | - Masakazu Uematsu
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiaki Takagawa
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Radiotherapy and Oncology, Goethe-University, Frankfurt, Germany.,Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Tairo Kashihara
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Radiotherapy and Oncology, Goethe-University, Frankfurt, Germany.,Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Koji Masui
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ken Yoshida
- Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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Nault JC, Sutter O, Nahon P, Ganne-Carrié N, Séror O. Percutaneous treatment of hepatocellular carcinoma: State of the art and innovations. J Hepatol 2018; 68:783-797. [PMID: 29031662 DOI: 10.1016/j.jhep.2017.10.004] [Citation(s) in RCA: 275] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/01/2017] [Accepted: 10/06/2017] [Indexed: 02/06/2023]
Abstract
Percutaneous treatment of hepatocellular carcinoma (HCC) encompasses a vast range of techniques, including monopolar radiofrequency ablation (RFA), multibipolar RFA, microwave ablation, cryoablation and irreversible electroporation. RFA is considered one of the main curative treatments for HCC of less than 5 cm developing on cirrhotic liver, together with surgical resection and liver transplantation. However, controversies exist concerning the respective roles of ablation and liver resection for HCC of less than 3 to 5 cm on cirrhotic liver. In line with the therapeutic algorithm of early HCC, percutaneous ablation could also be used as a bridge to liver transplantation or in a sequence of upfront percutaneous treatment, followed by transplantation if the patient relapses. Moreover, several innovations in ablation methods may help to efficiently treat early HCC, initially considered as "non-ablatable", and might, in some cases, extend ablation criteria beyond early HCC, enabling treatment of more patients with a curative approach.
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Affiliation(s)
- Jean-Charles Nault
- Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France.
| | - Olivier Sutter
- Department of Radiology, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
| | - Pierre Nahon
- Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Nathalie Ganne-Carrié
- Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Olivier Séror
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France; Department of Radiology, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France.
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Management consensus guideline for hepatocellular carcinoma: 2016 updated by the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan. J Formos Med Assoc 2017; 117:381-403. [PMID: 29074347 DOI: 10.1016/j.jfma.2017.09.007] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/16/2017] [Accepted: 09/13/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality in Taiwan. To help clinical physicians to manage patients with HCC, the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan produced the management consensus guideline for HCC. METHODS The recommendations focus on nine important issues on management of HCC, including surveillance, diagnosis, staging, surgery, local ablation, transarterial chemoembolization/transarterial radioembolization/hepatic arterial infusion chemotherapy, systemic therapy, radiotherapy, and prevention. RESULTS The consensus statements were discussed, debated and got consensus in each expert team. And then the statements were sent to all of the experts for further discussion and refinement. Finally, all of the experts were invited to vote for the statements, including the level of evidence and recommendation. CONCLUSION With the development of the management consensus guideline, HCC patients could benefit from the optimal therapeutic modality.
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Zhang W, Luo E, Gan J, Song X, Bao Z, Zhang H, Chen M. Long-term survival of hepatocellular carcinoma after percutaneous radiofrequency ablation guided by ultrasound. World J Surg Oncol 2017; 15:122. [PMID: 28679433 PMCID: PMC5499042 DOI: 10.1186/s12957-017-1189-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 06/22/2017] [Indexed: 02/06/2023] Open
Abstract
Background The risk factors for recurrence and death after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) remain poorly known. This study was aimed to study the 10-year overall survival (OS) of HCC treated by ultrasound (US)-guided RFA and the risk factors for recurrence and death. Methods Between June 2005 and June 2016, 1000 patients with HCC treated by US-guided RFA at 4 hospitals in China; among them, 525 patients met the criteria for radical ablation and 410 had high AFP levels before RFA treatment. Clinical and biochemical factors were tested for association with recurrence and survival. Patients were divided into the recurrence (n = 348) and no recurrence groups (n = 62). Results The 5- and 10-year survival rates were 66 and 35%, respectively. Tumor size (HR = 1.36, 95% CI 1.12–1.65), albumin levels (HR = 0.76, 95% CI 0.65–0.91), prothrombin time (HR = 2.18, 95% CI 1.54–3.10), and α-fetoprotein levels (HR = 1.13, 95% CI 1.00–1.26) were independently associated with mortality after RFA for HCC. Tumor size (HR = 1.27, 95% CI: 1.15–1.40), HBV-DNA (HR = 7.70, 95% CI 3.57–16.63), AFP levels before treatment (HR = 2.172, 95% CI 1.256–3.756, P = 0.006), and AFP response (HR = 4.722, 95% CI 1.053–21.184, P = 0.0427) were independently associated with the risk of recurrence of HCC after RFA. The median survival of the patients with and without recurrence after RFA was 54 (95% CI 45–58) and 62 (95% CI 48–80) months, respectively (log-rank, P = 0.04). Conclusions Tumor size, albumin, prothrombin time, and α-fetoprotein levels were independently associated with mortality after US-guided RFA for HCC, while tumor size and HBV-DNA were independently associated with recurrence. Patients with recurrence had a poorer survival compared with those without.
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Affiliation(s)
- Weimin Zhang
- Department of Infectious, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Erping Luo
- Department of Infectious, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Jianhe Gan
- Department of Infectious, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
| | - Xiaomin Song
- Department of Ultrasound, Xuhui Centre Hospital, Fudan University, 200031, Shanghai, China
| | - Zuowei Bao
- Department of Ultrasound, The Third People's Hospital of Changzhou, Changzhou, 213001, Jiangsu Province, China
| | - Huiping Zhang
- Department of Ultrasound, The People's Hospital of Maanshan, Maanshan, 243000, Anhui Province, China
| | - Minhua Chen
- Cancer Hospital of Beijing, 100142, Beijing, China
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Fu JJ, Wang S, Yang W, Gong W, Jiang AN, Yan K, Chen MH. Protective and Heat Retention Effects of Thermo-sensitive Basement Membrane Extract (Matrigel) in Hepatic Radiofrequency Ablation in an Experimental Animal Study. Cardiovasc Intervent Radiol 2017; 40:1077-1085. [PMID: 28271330 DOI: 10.1007/s00270-017-1617-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 03/02/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the protective effect of using thermo-sensitive basement membrane extract (Matrigel) for hydrodissection to minimize thermal injury to nearby structures and to evaluate its heat sink effect on the ablation zone in radiofrequency ablation (RFA) of the liver. MATERIALS AND METHODS First, the viscosity profile and heat sink effect of Matrigel were assessed during RFA in vitro and ex vivo. Fresh pig liver tissue was used, and the temperature changes in Matrigel and in 5% dextrose in water (D5W) during RFA were recorded. Then, the size of the ablation zone in the peripheral liver after RFA was measured. Second, in an in vivo study, 45 Sprague-Dawley rats were divided into three groups of 15 rats each (Matrigel, D5W and control). In the experimental groups, artificial ascites with 10 ml of Matrigel or D5W were injected using ultrasound guidance prior to RFA. The frequency of thermal injury to the nearby organs was compared among the three groups, with assessments of several locations: near the diaphragm, the abdominal wall and the gastrointestinal (GI) tract. Finally, the biological degradation of Matrigel by ultrasound was evaluated over 60 days. RESULTS First, Matrigel produced a greater heat retention (less heat sink) effect than D5W during ex vivo ablation (63 ± 9 vs. 26 ± 6 °C at 1 min on the surface of the liver, P < 0.001). Hepatic ablation zone volume did not differ between the two groups. Second, thermal injury to the nearby structures was found in 14 of 15 cases (93.3%) in the control group, 8 of 15 cases (53.3%) in the D5W group, and 1 of 15 cases (6.7%) in the Matrigel group. Significant differences in the thermal injury rates for nearby structures were detected among the three groups (P < 0.001). The most significant difference in the thermal injury rate was found in locations near the GI tract (P = 0.003). Finally, Matrigel that was injected in vivo was gradually degraded during the following 60 days. CONCLUSIONS Using thermo-sensitive Matrigel as a hydrodissection material might help reduce the frequency of collateral thermal injury to nearby structures, especially in locations close to the GI tract, compared to conventional D5W. Additionally, Matrigel did not increase the heat sink effect on the ablation zone during ablation and was degraded over time in vivo.
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Affiliation(s)
- Jing-Jing Fu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital, Beijing, 100142, China
| | - Song Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital, Beijing, 100142, China
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital, Beijing, 100142, China.
| | - Wei Gong
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, 100850, China
| | - An-Na Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital, Beijing, 100142, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital, Beijing, 100142, China
| | - Min-Hua Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound, Peking University Cancer Hospital, Beijing, 100142, China
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CT-guided microwave ablation through the lungs for treating liver tumors near the diaphragm. Oncotarget 2017; 8:79270-79278. [PMID: 29108305 PMCID: PMC5668038 DOI: 10.18632/oncotarget.17422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/20/2017] [Indexed: 01/29/2023] Open
Abstract
Purpose To explore the short-term efficacy and safety of CT-guided microwave ablation (MWA) for treating liver tumors near the diaphragm. Results The complete response (CR) rate for CT-guided MWA through the lung was 94.7% (124/131). The incomplete response (ICR) rate was 5.3% (7/131), of which 6 patients with ICRs achieved CRs after MWA. The CR rate for Group I was higher than Group II (99.0% vs. 80.0%, P=0.001). The mean follow-up time was 11.2 ±7.50 months. The total local recurrence (LR) rate was 15.3% (20/131). The complication rate was 26.5%, and no severe complications were recorded. All complications were controllable and treatable. The incidence of diaphragmatic thickening during the MWA was 18.8% (P>0.05); the incidence of exudative changes inside the lungs was 6.8% (P>0.05). Conclusions CT-guided MWA can detect changes in liver tissue, in the diaphragm and nearby lung tissues during the ablation process. It's safe and effective to treat tumors close to the diaphragm by CT-guided MWA through the lung. Methods CT-guided MWA was used on 131 tumors that were close to the diaphragm (distance between tumor and diaphragm ≤ 5 mm) in 117 patients with liver cancer. The tumors were divided into a < 3.0 cm group (Group I, n= 101) and a ≥ 3.0 cm group (Group II, n= 30) based on tumor diameters. The complications within 2 weeks following treatment were counted, and the safety and short-term efficacy of MWA were analyzed.
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Hai N, Zhang J, Xu R, Han ZY, Liu FY. Percutaneous microwave ablation with artificial ascites for symptomatic uterine adenomyosis: initial experience. Int J Hyperthermia 2017; 33:646-652. [PMID: 28118773 DOI: 10.1080/02656736.2017.1285444] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Ning Hai
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
- Department of Obstetric & Gynecology, Chinese PLA Rocket Force General Hospital, Beijing, China
| | - Jing Zhang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ruifang Xu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fang Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Artificial ascites and pneumoperitoneum to facilitate thermal ablation of liver tumors: a pictorial essay. Abdom Radiol (NY) 2017; 42:620-630. [PMID: 27665483 DOI: 10.1007/s00261-016-0910-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Image-guided percutaneous thermal ablation is increasingly utilized in the treatment of hepatic malignancies. Peripherally located hepatic tumors can be difficult to access or located adjacent to critical structures that can be injured. As a result, ablation of peripheral tumors may be avoided or may be performed too cautiously, leading to inadequate ablation coverage. In these cases, separating the tumor from adjacent critical structures can increase the efficacy and safety of procedures. Artificial ascites and artificial pneumoperitoneum are techniques that utilize fluid and gas, respectively, to insulate critical structures from the thermal ablation zone. Induction of artificial ascites and artificial pneumoperitoneum can enable complete ablation of otherwise inaccessible hepatic tumors, improve tumor visualization, minimize unintended thermal injury to surrounding organs, and reduce post-procedural pain. This pictorial essay illustrates and discusses the proper technique and clinical considerations for successful artificial ascites and pneumoperitoneum creation to facilitate safe peripheral hepatic tumor ablation.
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Yan K, Yang W, Chen MH, Zhang ZY, Lee JC, Liao HX, Wu W, Goldberg SN. Clinical application of hepatic wedge ablation for treating liver malignancies of the inferior margin: a new ablation technique. Int J Hyperthermia 2016; 33:203-211. [PMID: 27590572 DOI: 10.1080/02656736.2016.1232441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Min-Hua Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhong-Yi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jung-Chieh Lee
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hai-Xing Liao
- Department of Ultrasound, First Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - S. Nahum Goldberg
- Division of Image-Guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
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Ishii T, Igarashi T, Naya Y, Aoe T, Isono S. Physiological and Biochemical Responses to Continuous Saline Irrigation Inside the Abdominal Cavity in Anesthetized Pigs. J Laparoendosc Adv Surg Tech A 2016; 26:600-5. [PMID: 27195464 DOI: 10.1089/lap.2015.0463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Water-filled laparoendoscopic surgery (WaFLES) has been proposed as a novel surgical system achieving a wide surgical field in the intra- and extraperitoneal space with continuous irrigation of isotonic fluid into the field. Despite its technical feasibility and advantages, the safety of the technique, particularly with respect to physiological functions, has not been evaluated. METHODS Various types of minor abdominal surgeries were performed under general anesthesia in nine adult pigs either by conventional laparoscopy (n = 3) or WaFLES (n = 6). In addition to esophageal temperature and body weight, cardiorespiratory variables such as blood pressure, heart rate, and arterial blood gas parameters were compared before and after the surgeries. Blood samples were obtained for assessing changes in biochemical parameters before and after the surgeries. RESULTS Three to seven hours of various surgeries were completed without critical cardiorespiratory events in all animals. Oxygenation and ventilation were maintained regardless of the techniques used for the surgeries. A minor increase of body weight (2.5% of initial body weight), metabolic acidosis, hyperkalemia, and impaired hepatic function were observed after WaFLES surgeries. CONCLUSIONS The preliminary study indicated no serious immediate adverse effects of the WaFLES technique.
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Affiliation(s)
- Takuro Ishii
- 1 Center for Frontier Medical Engineering, Chiba University , Chiba, Japan
| | - Tatsuo Igarashi
- 1 Center for Frontier Medical Engineering, Chiba University , Chiba, Japan
| | - Yukio Naya
- 2 Department of Urology, Teikyo University Chiba Medical Center , Ichihara, Japan
| | - Tomohiko Aoe
- 3 Department of Anesthesiology, Teikyo University Chiba Medical Center , Ichihara, Japan
| | - Shiroh Isono
- 4 Department of Anesthesiology, Graduate School of Medicine, Chiba University , Chiba, Japan
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Igarashi T, Ishii T, Aoe T, Yu WW, Ebihara Y, Kawahira H, Isono S, Naya Y. Small-Incision Laparoscopy-Assisted Surgery Under Abdominal Cavity Irrigation in a Porcine Model. J Laparoendosc Adv Surg Tech A 2016; 26:122-8. [PMID: 26745012 PMCID: PMC4754511 DOI: 10.1089/lap.2015.0461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Laparoscopic and robot-assisted surgeries are performed under carbon dioxide insufflation. Switching from gas to an isotonic irrigant introduces several benefits and avoids some adverse effects of gas insufflation. We developed an irrigating device and apparatus designed for single-incision laparoscopic surgery and tested its advantages and drawbacks during surgery in a porcine model. Materials and Methods: Six pigs underwent surgical procedures under general anesthesia. A 30-cm extracorporeal cistern was placed over a 5–6-cm abdominal incision. The abdomen was irrigated with warm saline that was drained via a suction tube placed near the surgical field and continuously recirculated through a closed circuit equipped with a hemodialyzer as a filter. Irrigant samples from two pigs were cultured to check for bacterial and fungal contamination. Body weight was measured before and after surgery in four pigs that had not received treatments affecting hemodynamics or causing diuresis. Results: One-way flow of irrigant ensured laparoscopic vision by rinsing blood from the surgical field. Through a retroperitoneal approach, cystoprostatectomy was successfully performed in three pigs, nephrectomy in two, renal excision in two, and partial nephrectomy in one, under simultaneous ultrasonographic monitoring. Through a transperitoneal approach, liver excision and hemostasis with a bipolar sealing device were performed in three pigs, and bladder pedicle excision was performed in one pig. Bacterial and fungal contamination of the irrigant was observed on the draining side of the circuit, but the filter captured the contaminants. Body weight increased by a median of 2.1% (range, 1.2–4.4%) of initial weight after 3–5 hours of irrigation. Conclusions: Surgery under irrigation is feasible and practical when performed via a cistern through a small abdominal incision. This method is advantageous, especially in the enabling of continuous and free-angle ultrasound observation of parenchymal organs. Adverse effects of abdominal irrigation need further assessment before use in humans.
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Affiliation(s)
- Tatsuo Igarashi
- 1 Center for Frontier Medical Engineering, Chiba University , Chiba, Japan
| | - Takuro Ishii
- 1 Center for Frontier Medical Engineering, Chiba University , Chiba, Japan
| | - Tomohiko Aoe
- 2 Department of Anesthesiology, Asahi General Hospital , Asahi, Japan
| | - Wen-Wei Yu
- 1 Center for Frontier Medical Engineering, Chiba University , Chiba, Japan
| | - Yuma Ebihara
- 3 Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine , Sapporo, Japan
| | - Hiroshi Kawahira
- 1 Center for Frontier Medical Engineering, Chiba University , Chiba, Japan
| | - Shiro Isono
- 4 Department of Anesthesiology, Graduate School of Medicine, Chiba University , Chiba, Japan
| | - Yukio Naya
- 5 Department of Urology, Teikyo University Medical Center , Ichihara City, Japan
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Pua U. Guide Needle-Assisted Ablation of Subcapsular Hepatoma with Colonic Interposition (Chilaiditi's Sign). Cardiovasc Intervent Radiol 2015; 39:632-4. [PMID: 26486154 DOI: 10.1007/s00270-015-1223-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 09/12/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,Yong Loo-Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Lee CH, Chen WT, Lin CC, Teng W, Lin SM, Chiu CT. Radiofrequency ablation assisted by real-time virtual sonography for hepatocellular carcinoma inconspicuous under sonography and high-risk locations. Kaohsiung J Med Sci 2015; 31:413-9. [PMID: 26228280 DOI: 10.1016/j.kjms.2015.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/26/2015] [Accepted: 06/02/2015] [Indexed: 01/06/2023] Open
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