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Saeed S, Niehoff JH, Boriesosdick J, Michael A, Schönbeck D, Wöltjen MM, Haag NP, Mönninghoff C, Borggrefe J, Kroeger JR. Gyroscope-Assisted CT-Guided Puncture Improves Accuracy and Hit Rate Compared with Free-Hand Puncture: A Phantom Study. Cardiovasc Intervent Radiol 2024; 47:1786-1794. [PMID: 39237781 DOI: 10.1007/s00270-024-03832-8] [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: 02/12/2024] [Accepted: 07/30/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE To evaluate gyroscope-assisted CT-guided needle puncture (GAP) compared to free hand puncture (FHP) in a phantom. MATERIAL AND METHODS A simple, low-cost gyroscope was equipped with a magnetic rail to attach it to common puncture needles. 18 radiologists with different levels of training and experience in CT-guided punctures first punctured three targets in free hand technique in a special biopsy phantom with different difficulty levels of the puncture path (T1: not angulated, needle path 7.3 cm, size 15 mm in diameter, T2: single angulated 41°, needle path 11.3 cm, size 9 mm in diameter, T3: double angulated 38°/26°, needle path 7 cm, size 8 mm in diameter). Without knowing the result of the puncture, a second puncture was performed directly afterwards with the aid of the gyroscope. Punctures were performed in a continuous procedure without intermediate control. The hit rate and the distance between the needle tip and the center of the lesion were evaluated. Additionally, the time needed for the procedure was measured. RESULTS Thirty-three of 54 insertions (61.1%) hit the target in GAP compared to 20 of 54 (37%) in FHP (p = 0.002). The mean distance of the needle tip to the lesion center was 7.49 ± 5.31 mm in GAP compared to 13.37 ± 10.24 mm in FHP (p < 0.001). Puncture time was not significantly different between GAP (36.72 ± 20.38 s) and FHP (37.83 ± 20.53 s) (p = 0.362). CONCLUSION Needle guidance with a gyroscope enables an improved hit rate and puncture accuracy in CT-guided punctures without prolonging the puncture time. The needle guidance by gyroscope is inexpensive and easy to establish.
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Affiliation(s)
- Saher Saeed
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
- Johannes Wesling Klinikum, Muehlenkreiskliniken, Hans-Nolte-Straße 1, 32429, Minden, Germany.
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Boriesosdick
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Arwed Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Denise Schönbeck
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Matthias Michael Wöltjen
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Nina P Haag
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christoph Mönninghoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
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Gherman B, Hajjar NA, Tucan P, Radu C, Vaida C, Mois E, Burz A, Pisla D. Risk Assessment-Oriented Design of a Needle Insertion Robotic System for Non-Resectable Liver Tumors. Healthcare (Basel) 2022; 10:389. [PMID: 35207006 PMCID: PMC8872014 DOI: 10.3390/healthcare10020389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/19/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
Medical robotics is a highly challenging and rewarding field of research, especially in the development of minimally invasive solutions for the treatment of the worldwide leading cause of death, cancer. The aim of the paper is to provide a design methodology for the development of a safe and efficient medical robotic system for the minimally invasive, percutaneous, targeted treatment of hepatocellular carcinoma, which can be extended with minimal modification for other types of abdominal cancers. Using as input a set of general medical requirements to comply with currently applicable standards, and a set of identified hazards and failure modes, specific methods, such as the Analytical Hierarchy Prioritization, Risk Analysis and fuzzy logic Failure Modes and Effect Analysis have been used within a stepwise approach to help in the development of a medical device targeting the insertion of multiple needles in brachytherapy procedures. The developed medical device, which is visually guided using CT scanning, has been tested for validation in a medical environment using a human-size ballistic gel liver, with promising results. These prove that the robotic system can be used for the proposed medical task, while the modular approach increases the chances of acceptance.
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Affiliation(s)
- Bogdan Gherman
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Nadim Al Hajjar
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania; (N.A.H.); (C.R.); (E.M.)
| | - Paul Tucan
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Corina Radu
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania; (N.A.H.); (C.R.); (E.M.)
| | - Calin Vaida
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Emil Mois
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania; (N.A.H.); (C.R.); (E.M.)
| | - Alin Burz
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Doina Pisla
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
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Feasibility, safety, and efficacy of artificial carbon dioxide pneumothorax for computed tomography fluoroscopy-guided percutaneous radiofrequency ablation of hepatocellular carcinoma. Jpn J Radiol 2021; 39:1119-1126. [PMID: 34089475 DOI: 10.1007/s11604-021-01148-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To retrospectively assess the feasibility, safety, and efficacy of artificial carbon dioxide (CO2) pneumothorax for computed tomography (CT) fluoroscopy-guided percutaneous radiofrequency (RF) ablation of hepatocellular carcinoma (HCC). MATERIALS AND METHODS This study included 26 sessions of 24 patients in whom the creation of artificial CO2 pneumothorax was attempted to avoid the transpulmonary route during CT fluoroscopy-guided percutaneous RF ablation of HCC between April 2011 and December 2017. In these 26 sessions, 29 HCCs (mean tumor diameter: 12 mm, range: 6-22 mm) were treated. RESULTS Adequate lung displacement after induction of artificial CO2 pneumothorax was achieved in 23 of the 26 sessions (88.5%). In the remaining three sessions, transpulmonary RF ablation, transthoracic extrapulmonary RF ablation after switching to an artificial pleural effusion procedure, or RF ablation with electrode insertion in the caudal-cranial oblique direction was performed. No major complications were found. Among the 29 treated tumors, one (3.4%) showed local progression, and the other 28 (96.6%) were completely ablated at the last follow-up (mean follow-up period: 39.3 months, range: 7-78 months). CONCLUSION Artificial CO2 pneumothorax for CT fluoroscopy-guided percutaneous RF ablation appeared to be a feasible, safe, and useful therapeutic option for HCC.
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Cillo U, Finotti M, Di Renzo C, Vitale A, Zanus G, Gringeri E, Bertacco A, Polacco M, D'Amico F. Thoracoscopic Ablation of Critically Located Liver Tumors: A Safety and Efficacy Cohort Study. Front Surg 2021; 8:626297. [PMID: 33816545 PMCID: PMC8010311 DOI: 10.3389/fsurg.2021.626297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Liver resection represents the first curative treatment to treat primary and secondary hepatic tumors. Thoracoscopic liver ablation is a viable and minimally invasive alternative treatment, especially for patients with previous multiple abdominal surgeries. The aim of the study was to evaluate the safety and efficacy of thoracoscopic ablation for liver tumors. Methods: Retrospective analysis of a prospective database of patients with liver tumors, treated with thoracoscopic trans-diagrammatic ablation (MWA or RFA) at our institution from 2012 to 2018. The primary endpoint was post-operative mortality at 30 days, while secondary endpoints were morbidity and efficacy of ablation (i.e., response rate evaluated according to mRECIST criteria, and overall patient survival). Patient demographics, operational characteristics, and complications were recorded. Results: A total of 13 nodules were treated in 10 patients with a median age of 65.5 years. Post-operative mortality was 0%, and overall morbidity was 40% (Clavien-Dindo I complications 30%, II 0%, III 10%, IV 0%). Complete radiological response was obtained in 83.3% of nodules at 3 months. After a median follow-up of 20.95 months, the local tumor progression rate was 30%, with an intra-segmental-recurrence of 30%, and an intra-hepatic-recurrence of 30%. The overall 1-, 2-, and 3-years survival rates were 80%, 58%, and 58%. Conclusion: Thoracoscopic trans-diaphragmatic ablation proved to be a safe and effective way to treat liver tumors when abdominal approach is not feasible. Considering the low morbidity, it is a viable option to treat patients with recurrent disease and/or previous multiple abdominal surgeries.
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Affiliation(s)
- Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, Italy
| | - Michele Finotti
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, Italy
| | - Chiara Di Renzo
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, Italy
| | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, Italy
| | - Giacomo Zanus
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, Italy
| | - Enrico Gringeri
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, Italy
| | - Alessandra Bertacco
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, Italy
| | - Marina Polacco
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, Italy
| | - Francesco D'Amico
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padova University, Padova, Italy.,Department of Surgery, Immunology and Transplantation Unit, Yale University, New Haven, CT, United States
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Pickens RC, Sulzer JK, Passeri MJ, Murphy K, Vrochides D, Martinie JB, Baker EH, Ocuin LM, McKillop IH, Iannitti DA. Operative Microwave Ablation for the Multimodal Treatment of Neuroendocrine Liver Metastases. J Laparoendosc Adv Surg Tech A 2020; 31:917-925. [PMID: 33296283 DOI: 10.1089/lap.2020.0558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and Purpose: Operative microwave ablation (MWA) is a safe modality for treating hepatic tumors. The aim of this study is to present our 10-year, single-center experience of operative MWA for neuroendocrine liver metastases (NLM). Methods: A single-institution retrospective review of patients who underwent operative MWA for NLM was performed (2008-2018). Demographics, primary tumor site, operative approach, combined surgical operations, and carcinoid symptoms were recorded. Clinical outcomes for major complications, readmission, and mortality were analyzed 30 days postoperatively. Postablation imaging was evaluated for incomplete ablation/missed lesions, and surveillance imaging reviewed for local, regional, and metastatic recurrence. Results: Of the 50 patients (166 targeted lesions) who received MWA for NLM, 41 (82%) were treated with a minimally invasive approach, and 22 (44%) underwent MWA concomitant with hepatectomy and/or primary tumor resection. Within the study cohort 70% of patients were treated with curative intent with a 77% (27/35) success rate. Carcinoid symptoms were reported in 40% (20/50) of patients preoperatively, and MWA treatment improved symptoms in 19/20 patients. Incomplete ablation occurred in 1/166 treated lesions. Recurrence-free survival at 1 and 5 years was 86% and 28%, respectively. Overall survival at 1 and 5 years was 94% and 70%, respectively (median follow-up 32 months, range 0-116 months). Conclusion: Operative MWA is a versatile modality, which can be safe and effectively performed alone or combined with hepatectomy for NLM, preferably using a minimally invasive approach, to achieve symptom control and possibly improve survival.
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Affiliation(s)
- Ryan C Pickens
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
| | - Jesse K Sulzer
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
| | - Michael J Passeri
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
| | - Keith Murphy
- Carolinas Center for Surgical Outcomes Science, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
| | - Dionisios Vrochides
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
| | - John B Martinie
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
| | - Erin H Baker
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
| | - Lee M Ocuin
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
| | - Iain H McKillop
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
| | - David A Iannitti
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
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Schullian P, Johnston E, Laimer G, Putzer D, Eberle G, Amann A, Effenberger M, Maglione M, Freund MC, Loizides A, Bale R. Frequency and risk factors for major complications after stereotactic radiofrequency ablation of liver tumors in 1235 ablation sessions: a 15-year experience. Eur Radiol 2020; 31:3042-3052. [PMID: 33125554 PMCID: PMC8043912 DOI: 10.1007/s00330-020-07409-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/27/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
Objectives To assess the frequency of major complications after multi-probe stereotactic radiofrequency ablation (SRFA) in a large cohort of patients over 15 years and to elucidate risk factors for adverse events. Materials and methods A retrospective study was carried out between July 2003 and December 2018. Seven hundred ninety-three consecutive patients (median 65.0 years (0.3–88), 241 women and 552 men, were treated in 1235 SRFA sessions for 2475 primary and metastatic liver tumors with a median tumor size of 3.0 cm (0.5–18 cm). The frequency of major complications was evaluated according to SIR guidelines and putative predictors of adverse events analyzed using simple and multivariable logistic regression. Results Thirty-day mortality after SRFA was 0.5% (6/1235) with an overall major complication rate of 7.4% (91/1235). The major complication rate decreased from 11.5% (36/314) (before January 2011) to 6.0% (55/921) (p = 0.001). 50.5% (46/91) of major complications were successfully treated in the same anesthetic session by angiographic coiling for hemorrhage and chest tube insertion for pneumothorax. History of bile duct surgery/intervention, number of coaxial needles, and location of tumors in segment IVa or VIII were independent prognostic factors for major complications following multivariable logistic regression analysis. Simple logistic regression revealed the number of tumors, tumor size, location close to the diaphragm, tumor conglomerate, and segment VII as other significant predictors. Conclusion SRFA of liver tumors is safe and can extend the treatment spectrum of conventional RFA. Adaptations over time combined with increasing experience resulted in a significant decrease in complications. Key Points • In 1235 ablation sessions in 793 patients over 15 years, we found a mortality rate of 0.5% (6/1235) and an overall major complication rate of 7.4%, which fell from 11.5 (36/314) to 6.0% (55/921, p = 0.001) after January 2011, likely due to procedural adaptations. • History of bile duct surgery/intervention (p = 0.013, OR = 3.290), number of coaxial needles (p = 0.026, OR = 1.052), and location of tumors in segment IVa (p = 0.016, OR = 1.989) or VIII (p = 0.038, OR = 1.635) were found to be independent prognostic factors. • Simple logistic regression revealed that number of tumors, tumor size, location close to the diaphragm, tumor conglomerates, and segment VII were other significant predictors of major complications.
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Affiliation(s)
- Peter Schullian
- Section of Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Edward Johnston
- The Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK
| | - Gregor Laimer
- Section of Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Daniel Putzer
- Section of Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gernot Eberle
- Section of Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Arno Amann
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Maria Effenberger
- Department of Internal Medicine I, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Manuel Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Martin C Freund
- Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Alexander Loizides
- Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Reto Bale
- Section of Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Chen J, Lin Z, Lin Q, Lin R, Yan Y, Chen J. Percutaneous radiofrequency ablation for small hepatocellular carcinoma in hepatic dome under MR-guidance: clinical safety and efficacy. Int J Hyperthermia 2020; 37:192-201. [PMID: 32066293 DOI: 10.1080/02656736.2020.1728397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose: To evaluate the clinical safety and efficacy of percutaneous radiofrequency ablation (RFA) using multitined expandable electrodes under magnetic resonance imaging (MRI) guidance in the treatment of small hepatocellular carcinomas (HCCs) in the hepatic dome.Materials and methods: The data of 49 patients with 50 HCC lesions in the hepatic dome who underwent MRI-guided RFA from April 2010 to January 2018 were retrospectively analyzed. Planning, targeting, and controlling were performed under MR-guidance during the procedure. The complications after RFA were observed. Follow-up MRI was performed to evaluate the curative effect. The local progression-free survival, recurrence-free survival, and overall survival rates were calculated using the Kaplan-Meier survival curve.Results: The procedures were successfully accomplished in all patients without major complications. The mean follow-up time was 36.9 ± 25.8 months (range, 3-99 months). Technical success was 100% after one RFA session with MRI assessment after 1 month. Local tumor progression was observed in one patient (2%) with the lesion located in the hepatic dome at 4 months on a subsequent follow-up MRI. The progression-free survival time was 25.0 ± 22.7 months (median, 17.0 months). The 1-,3-, and 5-year local tumor progression-free survival rates were all 98.0%. The 1-,3-, and 5-year recurrence-free survival rates were 68.1%, 39.9%, and 28.5%, respectively, and the estimated overall survival rates were 93.7%, 76.3%, and 54.3%, respectively.Conclusion: Planning, targeting, and controlling of RFA were well supported by MRI with acceptable time. MRI-guided RFA for small HCCs in the hepatic dome is safe and effective with fewer RF sessions.
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Affiliation(s)
- Jin Chen
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhengyu Lin
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qingfeng Lin
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ruixiang Lin
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuan Yan
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jian Chen
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Long Y, Zeng Q, He X, Ye H, Su Y, Zheng R, Yu J, Xu E, Li K. One-lung ventilation for percutaneous thermal ablation of liver tumors in the hepatic dome. Int J Hyperthermia 2020; 37:49-54. [PMID: 31918592 DOI: 10.1080/02656736.2019.1708483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose: To investigate the feasibility, efficacy and safety of one-lung ventilation for percutaneous thermal ablation of liver tumors in the hepatic dome.Materials and methods: From 5 January 2017 to 16 April 2019, 64 patients who underwent ultrasound-guided thermal ablation with a total of 75 liver malignant tumors located in the hepatic dome were enrolled in the present study. One-lung ventilation was employed to improve the acoustic window and protect the lung and diaphragm. If the one-lung ventilation was unsuccessful, artificial pleural effusion was added. The technical efficacy was confirmed by contrast-enhanced computed tomography/magnetic resonance imaging (CT/MRI) 1 month later. After that, CT/MRI was performed every 3-6 months.Results: Among the enrolled patients, the technical success rate of one lung ventilation was 92.2% (59/64). The visibility scores of tumors were improved significantly after one-lung ventilation compared to those before one-lung ventilation (p < .001). Finally, 78.6% (55/70) of the tumors achieved clinical success of one-lung ventilation to become clearly visible and underwent thermal ablation. Fourteen of the remaining 15 tumors achieved a satisfactory acoustic window after combination of artificial pleural effusion. One lesion remained inconspicuous and partly affected by pulmonary gas. The follow-up period was 8 months (3-30 months). The technical efficacy rate was confirmed to be 100% (75/75). During the follow-up period, local tumor progression occurred in 2 patients (2/75, 2.7%). Major complications occurred in two patients (2/64, 3.1%) receiving one-lung ventilation.Conclusions: One-lung ventilation is a promising noninvasive method for the thermal ablation of hepatic dome tumors due to its efficacy and safety.
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Affiliation(s)
- Yinglin Long
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qingjing Zeng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuqi He
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huolin Ye
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yating Su
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Erjiao Xu
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Maeda H, Kajiwara K, Yoshimatsu R, Yamanishi T, Minamiguchi H, Karashima T, Inoue K, Awai K, Yamagami T. Artificially induced pneumothorax with a Veress needle for cryoablation of renal cell carcinoma. MINIM INVASIV THER 2020; 31:483-486. [PMID: 32903048 DOI: 10.1080/13645706.2020.1814341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Thermal ablative techniques are used increasingly to treat renal cell carcinoma (RCC). Percutaneous cryoablation of tumors at the upper pole of the kidney may result in pulmonary damage due to the intervening lung parenchyma. We treated two patients with RCC in the upper pole of the kidney by inducing pneumothorax with a pneumoperitoneum needle before proceeding to percutaneous cryoablation. The procedures, performed under computed tomography (CT) fluoroscopy guidance, resulted in complete tumor necrosis. There was no pulmonary damage.
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Affiliation(s)
- Hitomi Maeda
- Radiology, Medical School, Kochi University, Kochi, Japan
| | - Kenji Kajiwara
- Radiology, Medical School, Kochi University, Kochi, Japan
| | | | | | | | | | - Keiji Inoue
- Urology, Medical School, Kochi University, Kochi, Japan
| | - Kazuo Awai
- Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Schullian P, Johnston EW, Putzer D, Eberle G, Laimer G, Bale R. Stereotactic radiofrequency ablation of subcardiac hepatocellular carcinoma: a case-control study. Int J Hyperthermia 2020; 36:876-885. [PMID: 31462110 DOI: 10.1080/02656736.2019.1648886] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate the safety and efficacy of stereotactic radiofrequency ablation (SRFA) for the treatment of subcardiac hepatocellular carcinoma (HCC). Material and methods: From 2003 to 2018, 79 consecutive patients underwent 104 multi-probe SRFA sessions for the treatment of 114 subcardiac HCC with a median size of 2.5 cm (0.5-9.5 cm). The results were compared with a randomly selected control group of 79 patients with 242 HCC with a median size of 2.0 cm (0.5-12 cm) following SRFA in other (non-subcardiac) locations with propensity score matching. Results: The 95.6% of the tumors were successfully treated by the first ablation session (primary technical efficacy rate) and 99.1% after the second session (secondary technical efficacy rate). Local tumor recurrence developed in 8 nodules (7.0%). Major complication and perioperative mortality rates were 7.7% (8/104) and 1% (1/104), respectively. The overall survival (OS) rates from the date of the first SRFA with single subcardiac HCCs were 92%, 77% and 65% at 1, 3 and 5 years, respectively, with a median OS of 90.6 months. The disease-free survival (DFS) after SRFA was 75, 34 and 34%, at 1, 3 and 5 years, respectively, with a median DFS of 19.1 months. There was no statistically significant difference with the control group in terms of local tumor control, safety, OS and DFS. Conclusion: SRFA of subcardiac tumors is as safe and efficacious as when treating tumors remote from the heart.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
| | | | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
| | - Gernot Eberle
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
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Duan F, Bai YH, Cui L, Li XH, Yan JY, Wang MQ. Simultaneous transarterial chemoembolization and radiofrequency ablation for large hepatocellular carcinoma. World J Gastrointest Oncol 2020; 12:92-100. [PMID: 31966917 PMCID: PMC6960077 DOI: 10.4251/wjgo.v12.i1.92] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a common cancer and a leading cause of tumor-related death. Patients with large HCC (≥ 8 cm) are at an advanced stage and have poor prognosis, and hepatic resection may not be suitable, and the incidence of postoperative recurrence is high.
AIM To evaluate recurrence and mid-term survival of patients with large HCC treated by transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA).
METHODS This was a retrospective study. From 2010 to 2013, 46 consecutive patients with large HCC were treated with simultaneous TACE and RFA. Thirty-five of 46 patients had a single tumor. Progression-free survival (PFS) and overall survival (OS) were analyzed at 2 years and 3 years, respectively.
RESULTS Forty-six patients treated by simultaneous TACE and RFA had no significant complications and treatment was successful. After 3 years, median PFS and OS were 10.21 ± 1.58 mo and 26.44 ± 2.26 mo, retrospectively. The survival rate was 67.5% after 2 years and 55.67% after 3 years.
CONCLUSION These preliminary data show that simultaneous TACE and RFA are safe and effective for large HCC.
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Affiliation(s)
- Feng Duan
- Department of Interventional Radiology, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China
| | - Yan-Hua Bai
- Department of Interventional Radiology, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China
| | - Li Cui
- Department of Interventional Radiology, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China
| | - Xiao-Hui Li
- Department of Interventional Radiology, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China
| | - Jie-Yu Yan
- Department of Interventional Radiology, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China
| | - Mao-Qiang Wang
- Department of Interventional Radiology, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China
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Robotic CT-guided out-of-plane needle insertion: comparison of angle accuracy with manual insertion in phantom and measurement of distance accuracy in animals. Eur Radiol 2019; 30:1342-1349. [PMID: 31773299 PMCID: PMC7033049 DOI: 10.1007/s00330-019-06477-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/30/2019] [Accepted: 09/27/2019] [Indexed: 01/21/2023]
Abstract
Objectives To evaluate the accuracy of robotic CT-guided out-of-plane needle insertion in phantom and animal experiments. Methods A robotic system (Zerobot), developed at our institution, was used for needle insertion. In the phantom experiment, 12 robotic needle insertions into a phantom at various angles in the XY and YZ planes were performed, and the same insertions were manually performed freehand, as well as guided by a smartphone application (SmartPuncture). Angle errors were compared between the robotic and smartphone-guided manual insertions using Student’s t test. In the animal experiment, 6 robotic out-of-plane needle insertions toward targets of 1.0 mm in diameter placed in the kidneys and hip muscles of swine were performed, each with and without adjustment of needle orientation based on reconstructed CT images during insertion. Distance accuracy was calculated as the distance between the needle tip and the target center. Results In the phantom experiment, the mean angle errors of the robotic, freehand manual, and smartphone-guided manual insertions were 0.4°, 7.0°, and 3.7° in the XY plane and 0.6°, 6.3°, and 0.6° in the YZ plane, respectively. Robotic insertions in the XY plane were significantly (p < 0.001) more accurate than smartphone-guided insertions. In the animal experiment, the overall mean distance accuracy of robotic insertions with and without adjustment of needle orientation was 2.5 mm and 5.0 mm, respectively. Conclusion Robotic CT-guided out-of-plane needle insertions were more accurate than smartphone-guided manual insertions in the phantom and were also accurate in the in vivo procedure, particularly with adjustment during insertion. Key Points • Out-of-plane needle insertions performed using our robot were more accurate than smartphone-guided manual insertions in the phantom experiment and were also accurate in the in vivo procedure. • In the phantom experiment, the mean angle errors of the robotic and smartphone-guided manual out-of-plane needle insertions were 0.4° and 3.7° in the XY plane (p < 0.001) and 0.6° and 0.6° in the YZ plane (p = 0.65), respectively. • In the animal experiment, the overall mean distance accuracies of the robotic out-of-plane needle insertions with and without adjustments of needle orientation during insertion were 2.5 mm and 5.0 mm, respectively. Electronic supplementary material The online version of this article (10.1007/s00330-019-06477-1) contains supplementary material, which is available to authorized users.
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Schullian P, Putzer D, Laimer G, Levy E, Bale R. Feasibility, safety, and long-term efficacy of stereotactic radiofrequency ablation for tumors adjacent to the diaphragm in the hepatic dome: a case-control study. Eur Radiol 2019; 30:950-960. [PMID: 31489472 PMCID: PMC6957558 DOI: 10.1007/s00330-019-06399-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 12/13/2022]
Abstract
Objectives Achievement of adequate treatment margins may be challenging when the target is either difficult to visualize, awkward to access, or situated adjacent to vulnerable structures. Treatment of tumors located close to the diaphragm in the hepatic dome is challenging for percutaneous radiofrequency (RF) ablation for these reasons. The purpose was to assess the feasibility, safety, and clinical outcome of multi-probe stereotactic RF ablation (SRFA) of liver tumors in the subdiaphragmatic area. Methods Between 2006 and 2018, 177 patients (82 HCCs, 6 ICCs, and 89 metastatic tumors) underwent SRFA of 238 tumors abutting the diaphragm in the hepatic dome. For comparison, 177 patients were randomly selected from our database by the R package “MatchIt” for propensity score matching to compare treatment safety and efficacy in this retrospective, single-center study. Results Median treated tumor size was 2.2 cm (range 0.5 to 10 cm). SRFA was primarily successful for 232/238 (97.5%) tumors. Five tumors were successfully retreated, resulting in a secondary technical efficacy rate of 99.6%. Local tumor recurrence developed in 21 of 238 tumors (8.8%). The major ablation complication rate was 10.7% (22 of 204). Twelve (55%) of 22 major complications could be successfully treated by the interventional radiologist in the same anesthesia session. There was no significant difference in adverse events or disease control rates between the subdiaphragmatic tumors and matched controls. Conclusions SRFA is a safe and feasible option in the management of difficult-to-treat tumors abutting the diaphragm in the hepatic dome, with similar safety profile compared with matched controls. Key Points • RFA was primarily successful for 232/238 (97.5%) subdiaphragmatic dome tumors. Local tumor recurrence developed in 21 of 238 tumors (8.8%). • The major complication rate directly related to ablation of the hepatic dome tumors was 10.7% (22 of 204). 12/22 (55%) of major complications could be successfully treated in the same anesthesia session. • There was no significant difference in adverse events or disease control rates between the subdiaphragmatic tumors and matched controls.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Elliot Levy
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Kan X, Wang Y, Han P, Yao Q, Qian K, Xiong B, Zheng C. Combined ultrasound/computed tomography guidance in percutaneous radiofrequency ablation after transarterial chemoembolization for hepatocellular carcinoma in the hepatic dome. Cancer Manag Res 2019; 11:7751-7757. [PMID: 31616188 PMCID: PMC6699493 DOI: 10.2147/cmar.s212127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/28/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose To assess the value of the combined ultrasound (US)/computed tomography (CT) guidance (US guidance was firstly used for puncture with the electrode needle to the site close to the tumor, and subsequently, CT guidance was used for precise positioning of the electrode tips) in percutaneous radiofrequency ablation (RFA) after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) in the hepatic dome. Methods From January 1, 2013 to June 30, 2017, medical records of 65 patients with HCCs in the hepatic dome who received TACE treatment before RFA procedure were retrospectively analyzed. Among them, 34 patients with 35 liver tumors underwent percutaneous RFA under combined US/CT guidance, and 31 patients with 35 liver tumors received percutaneous RFA under CT guidance alone. The efficacy of combined US/CT-guided RFA was analyzed, and the procedure time and safety between the two groups were compared. Results In the combined US/CT-guided RFA group, the 1-, 3-, and 5-year local recurrence rates were 3%, 6%, 9%, respectively, and the 1-, 3-, and 5-year overall survival rates were 100%, 97%, 94%, respectively. The mean procedure time in the CT-guided RFA group was significantly longer than that of the combined US/CT-guided RFA group (P<0.001). Although the overall complication rates between the two groups were not statistically significant, there were no occurrences of RFA-related complications in the combined US/CT-guided RFA group. The incidence of postoperative adverse reaction of right upper quadrant pain in the CT-guided RFA group was greater than that of the combined US/CT-guided RFA group (P=0.01). Conclusion Percutaneous RFA under the combined US/CT guidance was helpful for HCC in the hepatic dome.
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Affiliation(s)
- Xuefeng Kan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yong Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.,Department of Vascular and Interventional Radiology, The Second Affiliated Hospital of Hainan Medical University, Haikou 570311, China
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Qi Yao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Kun Qian
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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Wang Y, Ma K, Zhong A, Xiong Q, Chen J. Hepatopulmonary syndrome after radiofrequency ablation of recurrent intrahepatic cholangiocarcinoma: a case report. Onco Targets Ther 2019; 12:2431-2438. [PMID: 31040688 PMCID: PMC6452817 DOI: 10.2147/ott.s86702] [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] [Indexed: 11/23/2022] Open
Abstract
Background Radiofrequency ablation (RFA) is one of the definitive treatment modalities for liver cancer and has been increasingly used in the scenario of small-sized liver cancer. It is generally believed that RFA is minimally invasive and associated with a favorable safety profile in liver cancer patients. However, this interventional technique is subject to some morbidity in high-risk patients, such as those with complicating cirrhosis or a liver cancer located at a refractory segment. Methods Herein, we report the case of a middle-aged woman who developed acute liver failure with a complicating respiratory failure after RFA of recurrent intrahepatic cholangiocarcinoma. Results A diagnosis of hepatopulmonary syndrome was established. The patient was hospitalized in the intensive care unit for mechanical ventilation. Finally, the patient recovered from an eventful clinical course and survived free of recurrence until the last follow-up visit at 1 year after the discharge. Conclusion Our case report warns that hepatopulmonary syndrome, a less common morbidity secondary to liver cancer RFA, should require timely identification and appropriate management due to its life-threatening outcome.
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Affiliation(s)
- Yu Wang
- Institute of Hepatobiliary Surgery, Southwestern Hospital, People's Liberation Army Third Military Medical University, Chongqing, People's Republic of China,
| | - Kuansheng Ma
- Institute of Hepatobiliary Surgery, Southwestern Hospital, People's Liberation Army Third Military Medical University, Chongqing, People's Republic of China,
| | - Ai Zhong
- Institute of Hepatobiliary Surgery, Southwestern Hospital, People's Liberation Army Third Military Medical University, Chongqing, People's Republic of China,
| | - Qing Xiong
- Institute of Hepatobiliary Surgery, Southwestern Hospital, People's Liberation Army Third Military Medical University, Chongqing, People's Republic of China,
| | - Jian Chen
- Institute of Hepatobiliary Surgery, Southwestern Hospital, People's Liberation Army Third Military Medical University, Chongqing, People's Republic of China,
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Hyun D, Cho SK, Shin SW, Park KB, Lee SY, Park HS, Choo SW, Do YS. Combined transarterial chemoembolization of the right inferior phrenic artery and radiofrequency ablation for small hepatocellular carcinoma near the diaphragm: its efficacy and safety. Abdom Radiol (NY) 2018; 43:2851-2858. [PMID: 29492603 DOI: 10.1007/s00261-018-1515-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of the study is to report the efficacy and safety of combined transarterial chemoembolization (TACE) of the right inferior phrenic artery (IPA) and radiofrequency ablation (RFA) for small hepatocellular carcinoma (HCC) near the diaphragm supplied by the right IPA. METHODS From July 2009 through April 2015, 11 patients with small (≤ 3 cm) HCC near the diaphragm, which was infeasible for ultrasound-guided RFA and supplied by the right IPA, received TACE of the right IPA and subsequent RFA in one session. The safety and therapeutic efficacy, including technique effectiveness and local tumor progression (LTP), were evaluated. RESULTS Technique effectiveness was achieved in all the 11 patients (100%). During average follow-up period of 39.2 months (range 13-89 months), LTP occurred in none of the 11 patients. There were twelve minor complications in eight patients, including right shoulder pain (n = 4), right pleural effusion (n = 2), diaphragmatic thickening (n = 2), transient lung change (n = 2), subsegmental intrahepatic bile duct stricture (n = 1), and subsegmental hepatic infarction (n = 1). No major complications were encountered CONCLUSION: Combined TACE of the right IPA and RFA can be a safe and effective treatment for small HCC near the diaphragm that is supplied by the right IPA.
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Affiliation(s)
- Dongho Hyun
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Sung Ki Cho
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
| | - Sung Wook Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Kwang Bo Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Sang Yub Lee
- Department of Radiology, Kyungpook National University Hospital, Daegu, 41944, Korea
| | - Hong Suk Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Sung Wook Choo
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Young Soo Do
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
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Vo Chieu VD, Werncke T, Hensen B, Wacker F, Ringe KI. CT-Guided Microwave Ablation of Liver Tumors in Anatomically Challenging Locations. Cardiovasc Intervent Radiol 2018; 41:1520-1529. [DOI: 10.1007/s00270-018-2007-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 06/04/2018] [Indexed: 12/17/2022]
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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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Wells SA, Hinshaw JL, Lubner MG, Ziemlewicz TJ, Brace CL, Lee FT. Liver Ablation: Best Practice. Radiol Clin North Am 2015; 53:933-71. [PMID: 26321447 DOI: 10.1016/j.rcl.2015.05.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Tumor ablation in the liver has evolved to become a well-accepted tool in the management of increasing complex oncologic patients. At present, percutaneous ablation is considered first-line therapy for very early and early hepatocellular carcinoma and second-line therapy for colorectal carcinoma liver metastasis. Because thermal ablation is a treatment option for other primary and secondary liver tumors, an understanding of the underlying tumor biology is important when weighing the potential benefits of ablation. This article reviews ablation modalities, indications, patient selection, and imaging surveillance, and emphasizes technique-specific considerations for the performance of percutaneous ablation.
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Affiliation(s)
- Shane A Wells
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA.
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Christopher L Brace
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA; Department of Biomedical Engineering, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA; Department of Biomedical Engineering, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
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Kim J, Yoon C, Seong N, Jeong SH, Kim J. Fluoroscopy-guided radiofrequency ablation for small hepatocellular carcinoma: a retrospective comparison with ultrasound-guided ablation. Clin Radiol 2015; 70:1009-15. [DOI: 10.1016/j.crad.2015.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 05/13/2015] [Accepted: 05/28/2015] [Indexed: 01/20/2023]
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Early Stage Hepatocellular Carcinomas Not Feasible for Ultrasound-Guided Radiofrequency Ablation: Comparison of Transarterial Chemoembolization Alone and Combined Therapy with Transarterial Chemoembolization and Radiofrequency Ablation. Cardiovasc Intervent Radiol 2015; 39:417-25. [DOI: 10.1007/s00270-015-1194-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/21/2015] [Indexed: 12/16/2022]
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Min JH, Lee MW, Cha DI, Jeon YH, Shin SW, Cho SK, Rhim H, Lim HK. Radiofrequency ablation combined with chemoembolization for intermediate-sized (3-5 cm) hepatocellular carcinomas under dual guidance of biplane fluoroscopy and ultrasonography. Korean J Radiol 2013; 14:248-58. [PMID: 23483753 PMCID: PMC3590337 DOI: 10.3348/kjr.2013.14.2.248] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 08/07/2012] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To assess the technical feasibility and local efficacy of percutaneous radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) for an intermediate-sized (3-5 cm in diameter) hepatocellular carcinoma (HCC) under the dual guidance of biplane fluoroscopy and ultrasonography (US). MATERIALS AND METHODS Patients with intermediate-sized HCCs were treated with percutaneous RFA combined with TACE. RFA was performed under the dual guidance of biplane fluoroscopy and US within 14 days after TACE. We evaluated the rate of major complications on immediate post-RFA CT images. Primary technique effectiveness rate was determined on one month follow-up CT images. The cumulative rate of local tumor progression was estimated with the use of Kaplan-Meier method. RESULTS Twenty-one consecutive patients with 21 HCCs (mean size: 3.6 cm; range: 3-4.5 cm) were included. After TACE (mean: 6.7 d; range: 1-14 d), 20 (95.2%) of 21 HCCs were visible on fluoroscopy and were ablated under dual guidance of biplane fluoroscopy and US. The other HCC that was poorly visible by fluoroscopy was ablated under US guidance alone. Major complications were observed in only one patient (pneumothorax). Primary technique effectiveness was achieved for all 21 HCCs in a single RFA session. Cumulative rates of local tumor progression were estimated as 9.5% and 19.0% at one and three years, respectively. CONCLUSION RFA combined with TACE under dual guidance of biplane fluoroscopy and US is technically feasible and effective for intermediate-sized HCC treatment.
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Affiliation(s)
- Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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Min JH, Lee MW, Rhim H, Choi D, Kim YS, Kim YJ, Cha DI, Lim HK. Radiofrequency ablation for viable hepatocellular carcinoma around retained iodized oil after transcatheter arterial chemoembolization: usefulness of biplane fluoroscopy plus ultrasound guidance. Korean J Radiol 2012; 13:784-94. [PMID: 23118578 PMCID: PMC3484300 DOI: 10.3348/kjr.2012.13.6.784] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 03/19/2012] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To assess the technical feasibility and local efficacy of biplane fluoroscopy plus US-guided percutaneous radiofrequency ablation (RFA) for viable hepatocellular carcinoma (HCC) around retained iodized oil after transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS Our prospective study was approved by our institutional review board and informed consent was obtained from all participating patients. For patients with viable HCC around retained iodized oil after TACE, biplane fluoroscopy plus US-guided RFA was performed. We evaluated the rate of technical success and major complications on a post-RFA CT examination and local tumor progression with a follow-up CT. RESULTS Among 40 consecutive patients, 19 were excluded due to one of the following reasons: poorly visible HCC on fluoroscopy (n = 13), high risk location (n = 2), RFA performed under monoplane fluoroscopy and US guidance (n = 2), and poorly identifiable new HCCs on US (n = 2). The remaining 21 patients with 21 viable HCCs were included. The size of total tumors ranged from 1.4 to 5.0 cm (mean: 3.2 cm) in the longest diameter. Technical success was achieved for all 21 HCCs, and major complications were observed in none of the patients. During the follow-up period (mean, 20.3 months; range, 6.5-29.9 months), local tumor progression was found in two patients (2/21, 9.5%). Distant intrahepatic metastasis developed in 76.2% (16/21) of patients. CONCLUSION When retained iodized oil around the tumor after TACE hampers the targeting of the viable tumor for RFA, biplane fluoroscopy plus US-guided RFA may be performed owing to its technical feasibility and effective treatment for viable HCCs.
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Affiliation(s)
- Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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Howenstein MJ, Sato KT. Complications of radiofrequency ablation of hepatic, pulmonary, and renal neoplasms. Semin Intervent Radiol 2012; 27:285-95. [PMID: 22550368 DOI: 10.1055/s-0030-1261787] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Percutaneous thermal ablation has emerged as a viable technique for treatment of numerous solid organ malignancies. As the number of these procedures increases, so do the complications that are seen. Most common complications are generally related to bleeding from the target organ during or after the procedure and from thermal injury to adjacent structures. The nature of these injuries depends on the particular organ being treated, therefore it it best to categorize them this way. We will review the more common complications seen following the ablation of tumors in the liver, kidney, and lung, discuss the clinical presentation associated with each, and suggest precautions to help avoid them in the future. Understanding the potential risks associated with this procedure is critical for treatment planning and fundamental for performing these procedures safely.
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Kamei S, Matsuda J, Hagihara M, Kitagawa A, Izumi Y, Katsuda E, Oshima Y, Ikeda S, Kimura J, Ota T, Kawamura T, Ishiguchi T. Oblique approach for CT-guided liver radiofrequency ablation using multiplanar reformation images in hepatocellular carcinoma. Jpn J Radiol 2012; 30:533-9. [PMID: 22528338 DOI: 10.1007/s11604-012-0074-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 03/13/2012] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of CT-guided radiofrequency (RF) ablation by caudal-cranial oblique insertion using multiplanar reformation (MPR) images for hepatocellular carcinomas (HCCs). MATERIALS AND METHODS Twenty-two HCCs in 19 patients that were difficult to demonstrate on ultrasound (mean tumor diameter was 17.5 mm) were treated with CT-guided RF ablation by caudal-cranial oblique insertion to avoid pneumothorax, using MPR images after transcatheter arterial chemoembolization. The insertion point and direction of insertion, avoiding aerated lung parenchyma, bones, large vessels, and intestine, were sought on the MPR images. Technical success was defined as complete eradication of tumor enhancement in the contrast-enhanced CT. Local tumor progression was defined by the appearance of enhanced tumor adjacent to the zone of ablation. The technical success rate, local tumor progression, and complications were investigated. RESULTS The coronal plane was used for insertion in 18 tumors, the sagittal plane in 3 tumors, and the oblique plane in 1 tumor. RF electrode placement was successful and complete necrosis was obtained in all cases. During the mean follow-up period of 38.0 months, local tumor progression was not detected in any of the patients. There were no major complications, including pneumothorax. CONCLUSION CT-guided RF ablation by caudal-cranial oblique insertion using MPR images is a feasible and safe therapeutic option.
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Affiliation(s)
- Seiji Kamei
- Department of Radiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan.
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Iguchi T, Inoue D, Yabushita K, Sakaguchi K, Tatsukawa M, Sasaki H, Kanazawa S. Effect of CT fluoroscopy-guided transpulmonary radiofrequency ablation of liver tumours on the lung. Br J Radiol 2012; 85:e373-7. [PMID: 22374277 DOI: 10.1259/bjr/34646739] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE We retrospectively evaluated the effect of transpulmonary radiofrequency ablation (RFA) of liver tumours on the lung. METHODS 16 patients (10 males and 6 females; mean age, 65.2 years) with 16 liver tumours (mean diameter 1.5 cm) underwent transpulmonary RFA under CT fluoroscopic guidance. The tumours were either hepatocellular carcinoma (n=14) or liver metastasis (n=12). All 16 liver tumours were undetectable with ultrasonography. The pulmonary function values at 3 months after transpulmonary RFA were compared with baseline (i.e. values before RFA). RESULTS In 8 of 16 sessions, minor pulmonary complications occurred, including small pneumothorax (n=8) and small pleural effusion (n=1). In two sessions, major pulmonary complications occurred, including pneumothorax requiring a chest tube (n=2). These chest tubes were removed at 4 and 6 days, and these patients were discharged 7 and 10 days after RFA, respectively, without any sequelae. The pulmonary function values we evaluated were forced expiratory volume in 1 s (FEV1.0) and vital capacity (VC). The mean values of FEV1.0 before and 3 months after RFA were 2.55 l and 2.59 l, respectively; the mean values of VC before and 3 months after RFA were 3.20 l and 3.27 l, respectively. These pulmonary values did not show any significant worsening (p=0.393 and 0.255 for FEV1.0 and VC, respectively). CONCLUSION There was no significant lung injury causing a fatal or intractable complication after transpulmonary RFA of liver tumours.
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Affiliation(s)
- T Iguchi
- Department of Diagnostic and Interventional Radiology, Fukuyama City Hospital, Fukuyama, Japan.
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Takaki H, Yamakado K, Nakatsuka A, Yamada T, Uraki J, Kashima M, Yamanaka T, Shiraki K, Takei Y, Takeda K. Computed tomography fluoroscopy-guided radiofrequency ablation following intra-arterial iodized-oil injection for hepatocellular carcinomas invisible on ultrasonographic images. Int J Clin Oncol 2011; 18:46-53. [DOI: 10.1007/s10147-011-0340-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 10/05/2011] [Indexed: 01/29/2023]
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Lee MW, Kim YJ, Park SW, Yu NC, Choe WH, Kwon SY, Lee CH. Biplane fluoroscopy-guided radiofrequency ablation combined with chemoembolisation for hepatocellular carcinoma: initial experience. Br J Radiol 2011; 84:691-7. [PMID: 21750136 DOI: 10.1259/bjr/27559204] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the technical feasibility and local efficacy of biplane fluoroscopy-guided percutaneous radiofrequency (RF) ablation combined with transcatheter arterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC). METHOD Our retrospective study was approved by the institutional review board and informed consent was waived. 18 patients with 19 HCCs (mean 2.5 cm diameter; range 2-4.2 cm) were treated with percutaneous RF ablation combined with TACE. After segmental TACE, 18 (95%) of 19 HCCs were visible on fluoroscopy. Shortly (median 2 days; range 1-4 days) after TACE, percutaneous RF ablation was performed under real-time biplane fluoroscopic guidance. We evaluated major complications, rate of technical success at immediate post-RF ablation CT images and local tumour progression at follow-up CT images. RESULTS Major complication was not observed in any patients. Technical success was achieved for all 18 visible HCCs. During the follow-up period (median 20 months; range 5-30 months), no local tumour progression was found. CONCLUSION Biplane fluoroscopy-guided RF ablation combined with TACE is technically feasible and effective for treatment of HCC.
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Affiliation(s)
- M W Lee
- Department of Radiology and Research Institute of Biomedical Science, Konkuk University School of Medicine, Seoul, South Korea
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Adán Merino L, Olveira Martín A, Pérez Robledo JP, Prieto I, Gea Rodriguez F, Castillo Grau P, Martín Arranz E, Alonso Gamarra E, Mora Sanz P. [Percutaneous radiofrequency ablation with artificial ascites for hepatocellular carcinoma adjacent to the diaphragm]. GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:709-15. [PMID: 21059478 DOI: 10.1016/j.gastrohep.2010.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 08/14/2010] [Accepted: 09/07/2010] [Indexed: 01/05/2023]
Abstract
Surgical resection is the first-line curative treatment of hepatocellular carcinoma (HCC). However most patients are unable to undergo surgical resection because of advanced tumoral stage, severe liver dysfunction or poor clinical status. Therefore, image-guided tumor ablation techniques have been introduced for the treatment of unresectable HCC. Among them, radiofrequency ablation (RFA) has been demonstrated to be an effective alternative curative therapy. However, local ablative therapy for tumors located close to structures such as the diaphragm or gastrointestinal tract is technically challenging because of the risk of collateral thermal damage to nearby structures or incomplete treatment of the HCC resulting from poor visibility on sonography. The introduction of artificial ascites can separate adjacent organs from the tumor and improve the sonic window. The aim of this study was to evaluate the feasibility, safety and efficacy of RFA with artificial ascites for HCC adjacent to the diaphragm.
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Affiliation(s)
- Luisa Adán Merino
- Servicio de Aparato Digestivo, Hospital Infanta Leonor, Madrid, España.
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Yamakado K, Nakatsuka A, Takaki H, Sakurai H, Isaji S, Yamamoto N, Shiraki K, Takeda K. Subphrenic versus nonsubphrenic hepatocellular carcinoma: combined therapy with chemoembolization and radiofrequency ablation. AJR Am J Roentgenol 2010; 194:530-535. [PMID: 20093620 DOI: 10.2214/ajr.09.2917] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This retrospective study was conducted to evaluate the clinical utility of the combination of chemoembolization and real-time CT fluoroscopically guided radiofrequency ablation in the treatment of patients with subphrenic hepatocellular carcinoma (HCC). MATERIALS AND METHODS Patients who had a single HCC with a maximum diameter of 5 cm or less were included in the study. None of the patients was a candidate for surgery, and all underwent combination therapy as initial treatment. The patients were divided into two groups based on tumor location. In all, the 93 men and 38 women (mean age, 67.9 +/- 9.4 years; range, 43-83 years) had 46 subphrenic HCCs and 85 nonsubphrenic HCCs. No differences were found in the pretreatment baseline characteristics of the two patient groups. Safety profiles, local tumor progression rates, and prognoses were compared. RESULTS Tumor enhancement disappeared after 58 radiofrequency sessions (1.3 sessions/tumor) in patients with subphrenic HCC and after 104 radiofrequency sessions (1.2 sessions/tumor) in patients with nonsubphrenic HCC. The 5-year local tumor progression rates (subphrenic, 3% [95% CI, 0.2-12%]; nonsubphrenic, 9% [95% CI, 3-20%]; p = 0.31) and survival rates (subphrenic, 63% [95% CI, 36-81%]; nonsubphrenic, 69% [95% CI, 53-81%]; p = 0.55) were similar for the two patient groups. Although the incidence of self-limited pneumothorax was significantly higher among the patients with subphrenic HCC (13.8% vs 3.85%; p < 0.03), other complication rates were similar for the two patient groups. CONCLUSION Combination therapy with chemoembolization and real-time CT-guided radiofrequency ablation is safe and useful even when HCC is in the subphrenic region.
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CT-guided radiofrequency ablation for hepatocellular carcinomas that were undetectable at US: therapeutic effectiveness and safety. J Vasc Interv Radiol 2009; 20:490-9. [PMID: 19328427 DOI: 10.1016/j.jvir.2009.01.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 12/20/2008] [Accepted: 01/05/2009] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine the therapeutic effectiveness and safety of computed tomography (CT)-guided radiofrequency (RF) ablation for hepatocelluar carcinomas (HCCs) that were undetectable at ultrasonography (US). MATERIALS AND METHODS CT-guided RF ablation with use of internally cooled electrodes was performed in 66 patients with 97 HCCs (diameter range, 3-39 mm) in 78 sessions. Two radiologists retrospectively evaluated in consensus the presence or absence of local tumor progression as well as the complications at CT performed immediately after RF ablation and at 1-, 3-, 6-, and 12-month follow-up. The relationship between the occurrence of pneumothorax and the electrode length in the lung in patients treated with the transpulmonary approach was statistically evaluated with use of the Mann-Whitney test. RESULTS The technical success rate of CT-guided RF ablation immediately after RF ablation was 97% (94 of 97 HCCs). The primary technique effectiveness rates of complete ablation 1, 3, 6, and 12 months after RF ablation were 97% (94 of 97 HCCs), 94% (91 of 97 HCCs), 84% (81 of 96 HCCs), and 74% (66 of 89 HCCs), respectively. Major complications were observed in six of the 78 treatment sessions (7.7%). In five of these six sessions, pneumothorax developed immediately after RF ablation; the remaining complication was tumor seeding along the electrode tract. Self-limiting pneumothorax was observed in 12 of 38 sessions (32%) in which the transpulmonary approach was used. The electrode length in the lung was not statistically related to the occurrence of pneumothorax (P = .26). CONCLUSIONS For HCCs that are undetectable at US, CT-guided RF ablation is effective and relatively safe.
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Kondo Y, Yoshida H, Tateishi R, Shiina S, Kawabe T, Omata M. Percutaneous radiofrequency ablation of liver cancer in the hepatic dome using the intrapleural fluid infusion technique. Br J Surg 2008; 95:996-1004. [PMID: 18581421 DOI: 10.1002/bjs.6058] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Intrapleural fluid infusion improves ultrasonographic visualization of tumours in the hepatic dome. The aim of this study was to assess the safety and long-term efficacy of ultrasonographically guided percutaneous radiofrequency ablation for tumours in the hepatic dome with intrapleural infusion. METHODS Of 2575 patients with hepatocellular carcinoma or hepatic metastases treated with radiofrequency ablation, intrapleural fluid infusion was performed in 587 patients for tumours in the hepatic dome. After the tip of a 14-G metallic needle was positioned in the pleural cavity under ultrasonographic guidance, 500-1000 ml of 5 per cent glucose solution was infused in 5-15 min. Radiofrequency ablation was performed using an internally cooled electrode. Long-term results were evaluated in 347 patients with a single hepatocellular carcinoma who were naive to any treatment. RESULTS Intrapleural fluid infusion was successfully performed in all 587 patients. The major complication rate on a per tumour basis was similar for patients treated with and without intrapleural infusion (1.6 versus 1.6 per cent; P = 0.924). The overall and recurrence-free survival were both similar for naive patients with a single hepatocellular carcinoma treated with and without intrapleural infusion (P = 0.429 and P = 0.109 respectively). Intrapleural infusion was not associated with lower overall survival in multivariable analysis. CONCLUSION With intrapleural fluid infusion, radiofrequency ablation for tumours in the hepatic dome was safe and effective, resulting in satisfactory overall and recurrence-free survival.
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Affiliation(s)
- Y Kondo
- Department of Gastroenterology, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
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Planning Sonography to Assess the Feasibility of Percutaneous Radiofrequency Ablation of Hepatocellular Carcinomas. AJR Am J Roentgenol 2008; 190:1324-30. [DOI: 10.2214/ajr.07.2970] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Percutaneous Radiofrequency Ablation with Artificial Ascites for Hepatocellular Carcinoma in the Hepatic Dome: Initial Experience. AJR Am J Roentgenol 2008; 190:91-8. [DOI: 10.2214/ajr.07.2384] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Head HW, Dodd GD, Dalrymple NC, Prasad SR, El-Merhi FM, Freckleton MW, Hubbard LG. Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm: frequency of diaphragmatic injury. Radiology 2007; 243:877-84. [PMID: 17517940 DOI: 10.1148/radiol.2433060157] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To retrospectively determine the frequency of diaphragmatic injury when percutaneous hepatic radiofrequency (RF) ablation is performed adjacent to the diaphragm. MATERIALS AND METHODS Institutional Review Board approval was obtained for our HIPAA-compliant study. Informed consent for the ablation procedure and for use of related data for future research was obtained from each patient. A retrospective review was conducted of 215 patients undergoing percutaneous RF ablation of hepatic tumors. Twenty-nine patients (21 men and eight women; age, 41-89 years) were identified with tumors abutting the diaphragm. Episodes of right shoulder pain were recorded. A panel of radiologists blinded to the patients' clinical histories reviewed their imaging for evidence of diaphragmatic injury and ablation success. A generalized estimating equation model and the Fisher exact test were used for statistical analysis. RESULTS The 29 patients had a total of 33 tumors abutting the diaphragm. Tumor size was 1.3-5.5 cm (mean, 3.2 cm +/- 1.1). After ablation, five (17%) patients reported right shoulder pain. In four, pain was mild or moderate, with symptoms lasting 2-14 days (median, 5.5 days). Three of these showed diaphragmatic thickening on postablation computed tomographic (CT) scans. One patient had severe pain lasting 2 weeks, followed by milder pain for 2 months. This patient's postablation CT images showed focal nodular diaphragmatic thickening. This patient was treated with a multitined device; the other four, with straight-needle devices. Local tumor progression was seen in 14 tumors (42.4%). Tumors 3 cm or smaller had a much lower local progression rate than tumors larger than 3 cm (12.5% vs 70.6%). CONCLUSION Of 29 patients who had ablation of hepatic tumors adjacent to the diaphragm, five (17%) had diaphragmatic injury, which was clinically apparent with right shoulder pain.
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Affiliation(s)
- Hayden W Head
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, Mail Code 7800, San Antonio, TX 78229, USA.
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Yamaura H, Inaba Y, Sato Y, Najima M, Shimamoto H, Nishiofuku H. Bilateral Pneumothorax after Unilateral Transthoracic Puncture. J Vasc Interv Radiol 2007; 18:793-5. [PMID: 17538145 DOI: 10.1016/j.jvir.2007.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pneumothorax is a common complication following transthoracic interventional procedures. Most often, this occurs unilaterally on the side of the intervention. Bilateral pneumothorax following unilateral puncture is rare, but may mandate emergent chest tube insertion. We describe two cases in which bilateral pneumothorax occurred after unilateral thoracic puncture. One patient had a history of esophageal resection, while the other had no history of thoracic surgery.
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Affiliation(s)
- Hidekazu Yamaura
- Department of Interventional and Diagnostic Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
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Yamagami T, Kato T, Hirota T, Yoshimatsu R, Matsumoto T, Nishimura T. Usefulness and Limitation of Manual Aspiration Immediately After Pneumothorax Complicating Interventional Radiological Procedures with the Transthoracic Approach. Cardiovasc Intervent Radiol 2006; 29:1027-33. [PMID: 16897262 DOI: 10.1007/s00270-005-0368-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The goal of this study was to evaluate the efficacy of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax following interventional radiological procedures performed under computed tomography fluoroscopic guidance with the transthoracic percutaneous approach. While still on the scanner table, 102 cases underwent percutaneous manual aspiration of a moderate or large pneumothorax that had developed during mediastinal, lung, and transthoracic liver biopsies and ablations of lung and hepatic tumors (independent of symptoms). Air was aspirated from the pleural space by an 18- or 20-gauge intravenous catheter attached to a three-way stopcock and 20- or 50-mL syringe. We evaluated the management of each such case during and after manual aspiration. In 87 of the 102 patients (85.3%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement, but chest tube placement was required in 15 patients. Requirement of chest tube insertion significantly increased in parallel with the increased volume of aspirated air. When receiver-operating characteristic curves were applied retrospectively, the optimal cutoff level of aspirated air on which to base a decision to abandon manual aspiration alone and resort to chest tube placement was 670 mL. Percutaneous manual aspiration of the pneumothorax performed immediately after the procedure might prevent progressive pneumothorax and eliminate the need for chest tube placement. However, when the amount of aspirated air is large (such as more than 670 mL), chest tube placement should be considered.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
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Toyoda M, Kakizaki S, Horiuchi K, Katakai K, Sohara N, Sato K, Takagi H, Mori M, Nakajima T. Computed tomography-guided transpulmonary radiofrequency ablation for hepatocellular carcinoma located in hepatic dome. World J Gastroenterol 2006; 12:608-611. [PMID: 16489676 PMCID: PMC4066095 DOI: 10.3748/wjg.v12.i4.608] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Revised: 07/28/2005] [Accepted: 08/26/2005] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the feasibility of performing computed tomography (CT)-guided transpulmonary radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) located in the hepatic dome. METHODS A total of seven patients with HCC comprising seven nodules located in the hepatic dome were treated from April 2004 to December 2004. CT-guided transpulmonary RFA was performed using a cool-tip type electrode (Radionics Company) based on a standardized energy protocol. All tumors located in the hepatic dome were not detectable by the usual ultrasound (US) methods. The lesion diameters ranged from 15 to 27 mm. RESULTS RFA was technically feasible in all the patients. The puncture procedure was performed twice or less and the total average performance time was 40.6 min. Local tumor control was achieved in all the patients. The necrosis diameter ranged from 25 to 35 mm. The mean follow-up period was 9.6 (7-14 mo) mo. There was no local recurrence at the follow-up points. Pneumothorax requiring pleural drainage was the main complication, which was observed in two of the seven patients (28.6%). However, it improved with chest drainage tube, and the tube could be removed within 2-3 d. No other major complications were observed. CONCLUSION CT-guided puncture is useful for the treatment of tumors located in the hepatic dome which are hardly detectable by US, even though pneumothorax sometimes may occur as a complication. In the cases with adhesion in the pleura for which artificial pleural effusion methods are not appropriate, CT-guided RFA is thus considered to be an alternative treatment for HCC located in the hepatic dome.
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Affiliation(s)
- Mitsuo Toyoda
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan
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