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Cassanelli G, Paolantonio G, Parapatt GK, Natali GL. Tumor ablation in children. Pediatr Radiol 2025; 55:733-746. [PMID: 39441218 DOI: 10.1007/s00247-024-06059-4] [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: 05/01/2024] [Revised: 09/09/2024] [Accepted: 09/10/2024] [Indexed: 10/25/2024]
Abstract
Tumor ablation represents an increasingly important topic in pediatric interventional radiology. Many ablative techniques are well known and established in the adult population, and the adoption of these techniques in the pediatric field is increasing. Image-guided tumor ablation represents a wide category of interventional radiology procedures that can be applied to both benign and malignant pediatric solid tumors. Tumor ablation, either alone or in combination with locoregional therapy, can have curative, debulking, or palliative effects on a wide variety of histological tumor types.
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Affiliation(s)
- Giulia Cassanelli
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Guglielmo Paolantonio
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - George Koshy Parapatt
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Gian Luigi Natali
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
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Yang Y, Liu F, Yu J, Cheng Z, Han Z, Dou J, Hu J, Wang Z, Gao H, Yang Q, Tian J, Xu Y, Bai X, Lu L, Liang P. Risk Factor Analysis of Acute Kidney Injury After Microwave Ablation of Hepatocellular Carcinoma: A Retrospective Study. Front Oncol 2020; 10:1408. [PMID: 33014779 PMCID: PMC7498714 DOI: 10.3389/fonc.2020.01408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/03/2020] [Indexed: 12/03/2022] Open
Abstract
Objectives: Acute kidney injury (AKI) is a recently observed side effect in patients after microwave ablation (MWA) of hepatocellular carcinoma (HCC) and is associated with negative outcomes. The aim of this study is to explore the risk factors of affecting the occurrence of AKI (stages 1b, 2, and 3), because they have a higher mortality rate than patients with AKI (stage 1a) and without AKI. Materials and methods: In this retrospective study, a total of 1,214 patients with HCC who were treated with MWA under ultrasound (US) guidance in our department between January 2005 and November 2017 were enrolled. We evaluated the influence of 20 risk factors. Univariate and multivariate analysis were used for statistical analysis. The possible risk factors of AKI after MWA for HCC were summarized. Results: AKI, AKI (stage 1a), and AKI (stages 1b, 2, and 3) after MWA were found in 34, 15, and 19 patients (2.80, 1.24, and 1.57%), respectively. Among 34 patients with AKI, 10 cases with AKI (stage 1a) and 6 cases with AKI (stages 1b, 2, and 3) recovered before their discharge without any treatment for AKI and 9 cases with AKI (stages 1b, 2, and 3) with further treatment. Four cases who had chronic renal failure before MWA of liver accepted renal dialysis. By univariate analysis, the number of antenna insertions (P = 0.027, OR = 3.3), MWA time ≥20 min (P = 0.029, OR = 4.3), creatinine (Cr)-pre above the upper limit of the reference value (P < 0.001, OR = 35.5), albumin (Alb)-pre (P = 0.030, OR = 0.9), and red blood cell (RBC)-pre (P < 0.001, OR = 0.3) were significant risk factors. By multivariate analysis, Cr-pre ≥ 110 μmol/L (P < 0.001, OR = 31.4) and MWA time ≥20 min (P = 0.043 OR = 9.9) were the independent risk factors. Conclusion: AKI (stages 1b, 2, and 3) is a relatively serious complication after MWA for HCC, which is related to MWA time and Cr-pre. It requires attention by clinicians. So it is of great necessity to assess the Cr-pre level and reduce the MWA time to <20 min to minimize the risk of AKI after MWA for HCC.
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Affiliation(s)
- Yongfeng Yang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jianping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Hu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ze Wang
- Special Clinic Department, The 985th Hospital of Chinese People's Liberation Army Joint Logistic Support Force, Taiyuan, China
| | - Haigang Gao
- Ultrasonic Diagnosis Department, The 991st Hospital of Chinese People's Liberation Army Joint Logistic Support Force, Xiangyang, China
| | - Qiao Yang
- Ultrasound Department, Zunhua People's Hospital, Zunhua, China
| | - Jing Tian
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yongjie Xu
- Department of Diagnostic Ultrasound, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Xiaoli Bai
- Ultrasound Department, Hohhot Mongolian Hospital of Traditional Chinese Medicine, Hohhot, China
| | - Liping Lu
- Department of Ultrasonography, Nanhai Hospital of Southern Medical University, Foshan, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Ding M, Ma S, Tang X, Wang T, Qi X, Chi J, Wang Z, Cui D, Shi Y, Zhang Y, Li P, Zhai B. Oliguric acute kidney injury after microwave ablation of large liver tumors: incidence and preventive measures. Int J Hyperthermia 2019; 35:141-149. [PMID: 30204038 DOI: 10.1080/02656736.2018.1487589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Acute kidney injury (AKI), especially oliguric AKI, is a recognized complication following microwave ablation (MWA) of large liver tumors. This study evaluated the clinical features, mechanisms, risk factors and prevention strategies for oliguric AKI after MWA of large liver tumors. METHODS From March 2011 to May 2015, 441 patients with liver tumors ≧5 cm received MWA in our hospital. The clinical features, prevention strategies, further mechanisms and possible risk factors for oliguric AKI after MWA were analyzed. RESULTS One hundred four (23.6%) patients had AKI after MWA; 11 (10.6%) patients had oliguric AKI, and 93 (89.4%) patients had nonoliguric AKI. All patients with nonoliguric AKI recovered without any special treatments. The eleven patients with oliguric AKI received appropriate treatments and had completely normal renal function three months later. Using double needles for ablation was a risk factor for nonoliguric AKI, while high preoperative levels of red blood cells (RBC), hemoglobin (HGB) and albumin (Alb) were risk factors for oliguric AKI. The decrease levels of hemoglobin were significantly high in oliguric AKI patients (p < .05). Patients with oliguric AKI had abnormally high postoperative transaminase and renal function indicators. Compared to postoperative prevention, intraoperative prevention significantly lowered the occurrence of oliguric AKI (0% vs. 3.7%, p = .018) and shortened the hospital stay. CONCLUSIONS Patients who underwent MWA for large liver tumors are prone to develop oliguric AKI. Implementation of intraoperative strategies during MWA can effectively prevent the occurrence of this severe complication.
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Affiliation(s)
- Min Ding
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Sicong Ma
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Xiaoyin Tang
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Tao Wang
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Xingxing Qi
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Jiachang Chi
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Zhi Wang
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Dan Cui
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Yaoping Shi
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Yuan Zhang
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Ping Li
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Bo Zhai
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
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Martins GLP, Bernardes JPG, Rovella MS, Andrade RG, Viana PCC, Herman P, Cerri GG, Menezes MR. Radiofrequency ablation for treatment of hypersplenism: A feasible therapeutic option. World J Gastroenterol 2015; 21:6391-6397. [PMID: 26034376 PMCID: PMC4445118 DOI: 10.3748/wjg.v21.i20.6391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/06/2014] [Accepted: 02/05/2015] [Indexed: 02/06/2023] Open
Abstract
We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation and measured the total spleen and ablated volumes with contrast-enhanced computed tomography and volumetry. No major complications occurred, thrombocytopenia was resolved, and platelet levels remained stable, which allowed for early treatment of the patient’s underlying disease. Previous work has shown that splenic radiofrequency ablation is an attractive alternative treatment for hypersplenism induced by liver cirrhosis. We aimed to contribute to the currently sparse literature evaluating the role of radiofrequency ablation (RFA) in the management of hypersplenism. We conclude that splenic RFA appears to be a viable and promising option for the treatment of hypersplenism.
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Birsen O, Aliyev S, Aksoy E, Taskin HE, Akyuz M, Karabulut K, Siperstein A, Berber E. A Critical Analysis of Postoperative Morbidity and Mortality After Laparoscopic Radiofrequency Ablation of Liver Tumors. Ann Surg Oncol 2014; 21:1834-40. [DOI: 10.1245/s10434-014-3526-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Indexed: 12/21/2022]
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Abstract
Hepatocellular carcinoma (HCC) is the third leading cause of death in the malignant neoplastic diseases in the world. Surgical operation is sometimes not indicated because of complicated liver cirrhosis and extrahepatic disorders. Radiofrequency ablation has been developed as a less invasive treatment for HCC since 1999, and long-term outcome has been shown. There are several complications which should be paid attention, and to improve the prognosis, combination treatment with transarterial chemoembolization should be discussed. Overall survival after between RFA and surgical resection should be compared prospectively. Establishment of staging system for treatment allocation of HCC and prevention of HCC recurrence is important issue to be examined.
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Affiliation(s)
- Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red-Cross Hospital, Tokyo, Japan.
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