• Guideline
• Hepatocellular carcinoma
• Local ablation
• Practical recommendation

• Liver Neoplasms/surgery
• Humans
• Carcinoma, Hepatocellular/surgery
• Republic of Korea
• Consensus
• Ablation Techniques/methods
• Patient Selection
• Catheter Ablation/methods
• Radiofrequency Ablation/methods

• Korea Liver Cancer Association

• Guidance
• Guideline
• Hepatocellular carcinoma
• Hepatoma
• Liver cancer
• Local ablation
• Practical recommendation

• Humans
• Ablation Techniques/methods
• Carcinoma, Hepatocellular/surgery
• Carcinoma, Hepatocellular/diagnostic imaging
• Catheter Ablation/methods
• Consensus
• Liver Neoplasms/surgery
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Patient Selection
• Republic of Korea

• Korea Liver Cancer Association

• Guidance
• Guideline
• Hepatocellular carcinoma
• Hepatoma
• Liver cancer
• Local ablation
• Practical recommendation

• Korea Liver Cancer Association

• body position change
• hepatocellular carcinoma
• local ablation therapies

• Carcinoma, hepatocellular
• Propensity score
• Radiofrequency ablation
• Treatment outcome

• Male
• Humans
• Middle Aged
• Carcinoma, Hepatocellular/pathology
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/surgery
• Retrospective Studies
• Treatment Outcome
• Catheter Ablation/methods
• Radiofrequency Ablation

• Ablation
• Fusion imaging
• Liver malignancies
• Treatment outcome
• Ultrasound

• Humans
• Prospective Studies
• Feasibility Studies
• Catheter Ablation/methods
• Contrast Media
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/surgery
• Liver Neoplasms/pathology
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/surgery
• Carcinoma, Hepatocellular/pathology
• Ultrasonography/methods
• Magnetic Resonance Imaging/methods
• Tomography, X-Ray Computed/methods
• Treatment Outcome

• 0620101950 Canon Medical Systems Corporation
• 0620200760 Siemens Healthineers

• antitumor effect
• combinational therapy
• multimodal therapy
• platinum drugs
• platinum-resistance

• Humans
• Platinum/therapeutic use
• Antineoplastic Agents/pharmacology
• Antineoplastic Agents/therapeutic use
• Neoplasms/drug therapy
• Neoplasms/pathology
• Combined Modality Therapy
• Penicillins/therapeutic use
• Anti-Infective Agents/therapeutic use

• Guideline
• Hepatocellular carcinoma
• No-touch radiofrequency ablation

• RS-2020-KD000303 Korea Medical Device Development Fund
• 1711138983 Korea Medical Device Development Fund

• Combined therapy
• Hepatocellular carcinoma (HCC)
• Immunotherapy
• Radiofrequency ablation (RFA)
• Transarterial chemoembolization (TACE)
• Tyrosine kinase inhibitors (TKIs)

• Benign thyroid nodules
• Case report
• Complication
• Hemorrhage
• Hydrodissection
• Radiofrequency ablation

• Artificial ascites
• hepatocellular carcinoma
• one-step method
• radiofrequency ablation

• Diaphragm
• Hepatocellular carcinoma
• Laparoscopy
• Local tumor progression
• Radiofrequency ablation

• Computed tomography
• Hepatic malignancy
• Liver tumor
• Microwave ablation
• Percutaneous thermal ablation
• Pneumothorax
• Transpulmonary
• Transthoracic

Microwave (MWA) and radiofrequency ablation (RFA) are main ablative techniques for hepatocellular carcinoma (HCC) and colorectal liver metastasis (MT). This randomized phase 2 clinical trial compares the effectiveness of MWA and RFA as well as morphology of corresponding ablation zones. HCC and MT patients with 1.5–4 cm tumors, suitable for ablation, were randomized into MWA or RFA Groups. The primary endpoint was short-to-long diameter ratio of ablation zone (SLR). Primary technical success (TS) and a cumulative local tumor progression (LTP) after a median 2-year follow-up were compared. Between June 2015 and April 2020, 82 patients were randomly assigned (41 patients per group). For the per-protocol analysis, five patients were excluded. MWA created larger ablation zones than RFA (p = 0.036) although without differences in SLR (0.5 for both groups, p = 0.229). The TS was achieved in 98% (46/47) and 90% (45/50) (p = 0.108), and LTP was observed in 21% (10/47) vs. 12% (6/50) (OR 1.9 [95% CI 0.66–5.3], p = 0.238) of tumors in MWA vs. RFA Group, respectively. Major complications were found in 5 cases (11%) vs. 2 cases (4%), without statistical significance. MWA and RFA show similar SLR, effectiveness and safety in liver tumors between 1.5 and 4 cm.

• Hepatocellular carcinoma
• Radiofrequency ablation
• Subphrenic location
• Transarterial chemoembolization

• Fluoroscopy
• ablative margin
• diaphragm
• local tumor progression
• transpulmonary approach

• Intervention
• Liver
• MWA
• Thermoprotection

• High intensity focused ultrasound
• imaging
• interventional radiology
• liver tumor
• thermal ablation

• Artificial ascites
• liver neoplasms
• local tumor progression
• risk factor
• tumor ablation

As an emerging minimally invasive treatment method, percutaneous ablation is more and more widely used in the treatment of liver tumors. It has been recommended by guidelines for diagnosis and treatment of hepatocellular carcinoma (HCC) as a curative treatment alongside surgical resection and liver transplantation. In recent years, with the continuous advancement and innovation of percutaneous ablation technologies, their clinical efficacy and safety have been significantly improved, which has led to the expanded application of percutaneous ablation in the treatment of HCC—more and more patients who were previously considered unsuitable for ablation therapies are now being treated with percutaneous ablation. Obviously, percutaneous ablation can reduce the risk of treatment changes from curative strategies to palliative strategies. Based on clinical practice experience, this review enumerates the advantages and disadvantages of different ablative modalities and summarizes the existing combinations of ablation techniques, thus will help clinicians choose the most appropriate ablative modality for each patient and will provide scientific guidance for improving prognosis and making evidence-based treatment decisions. In addition, we point out the challenges and future prospects of the ablation therapies, thereby providing direction for future research.

• assistive technology
• hepatocellular carcinoma
• image guidance
• percutaneous ablation

To evaluate the efficacy and safety of percutaneous radiofrequency ablation (RFA) for subcapsular colorectal cancer liver metastases (CLMs).

With the approval of the Institutional Review Board, the clinical data of CLM patients who underwent percutaneous RFA for the first time from August 2010 to August 2020 were continuously collected. All CLMs were divided into subcapsular and non-capsular groups. Baseline characteristic data, technical effectiveness, minimal ablative margin, complications, local tumor progression (LTP), and overall survival (OS) between the two groups were analyzed using the t-test or chi-square test. A Cox regression model was used to evaluate the prognostic factors of LTP.

One hundred and ninety-nine patients (124 males; mean age, 60.2 years) with 402 CLMs (221 subcapsular; mean size, 16.0 mm) were enrolled in the study. Technical effectiveness was achieved in 93.5% (376/402) of CLMs, with a major complication rate of 5.5%. Compared with non-subcapsular tumors, the minimal ablative margin achieved in subcapsular CLM was smaller (χ² = -8.047, P < 0.001). With a median follow-up time of 23 months (range, 3−96 months), 37.1% of the tumors had LTP. The estimated cumulative OS at 1, 3, and 5 years was 96.1%, 66.0%, and 44.2%, respectively. There were no statistically significant differences between the two groups in terms of technical effectiveness (χ² = 0.484, P = 0.487), major complications (χ² = 0.082, P = 0.775), local tumor progression-free survival (LTPFS) (χ² = 0.881, P = 0.348), and OS (χ² = 2.874, P = 0.090). Minimal ablative margin, tumor size (≥20 mm), and technical effectiveness were predictors of LTP (all P < 0.05).

RFA is a safe and effective technique for local tumor control of subcapsular CLMs.

• colorectal cancer liver metastases
• complications
• local tumor progression
• minimal ablative margin
• radiofrequency ablation

• Hepatocellular carcinoma
• Liver
• Position
• Surveillance
• Ultrasound

• Korean Liver Cancer Study Group

Percutaneous ablation is an accepted treatment modality for primary hepatocellular carcinoma (HCC) and liver metastases. The goal of curative ablation is to cause the necrosis of all tumour cells with an adequate margin, akin to surgical resection, while minimising local damage to non-target tissue. Aside from the ablative modality, the proceduralist must decide the most appropriate imaging modality for visualising the tumour and monitoring the ablation zone. The proceduralist may also employ protective measures to minimise injury to non-target organs. This review article discusses the important considerations an interventionalist needs to consider when performing the percutaneous ablation of liver tumours. It covers the different ablative modalities, image guidance, and protective techniques, with an emphasis on new and advanced ablative modalities and adjunctive techniques to optimise results and achieve satisfactory ablation margins.

• hepatocellular carcinoma
• liver metastases
• percutaneous ablation

• diaphragmatic hernia
• endoscopic procedure
• radiofrequency ablation

• Hepatocellular carcinoma
• Laparoscopy
• Liver
• Local
• Neoplasm recurrence
• Radiofrequency ablation

This is a first paper to report on artificial ascites infusion via vaginal wall for pelvic interstitial brachytherapy. Artificial ascites is commonly used for treating liver tumors, with radiofrequency ablation and percutaneous artificial ascites infusion through the abdominal wall for pelvic brachytherapy has been previously reported by our group. However, the trans-abdominal needle approach under ultrasound guidance is unreliable due to poor visualization resulting in fluid injection into the abdominal wall or mesenterium and the rate of successful artificial ascites infusion was low. Target tumor of the vaginal cuff brachytherapy is usually adjacent to the intestine, and transvaginal artificial ascites infusion under trans-rectal ultrasonography is considered as a rational and simpler method to create a space between target volume and organs at risk, such as intestines or sigmoid colon, by increased visualization of the needle compared to trans-abdominal approach. Here, we report a practical experience of transvaginal artificial ascites infusion.

• artificial ascites
• gynecological brachytherapy
• spacer
• transvaginal infusion

• Directional ablation
• Multi-tine electrode
• Multipolar mode RFA
• Radiofrequency ablation
• Temperature-controlled RFA

• Comparative study
• Hepatocellular carcinoma
• Local regional therapy
• Radiofrequency ablation
• Transarterial ethanol ablation
• Treatment response

• Ablation Techniques/methods
• Aged
• Carcinoma, Hepatocellular/surgery
• Catheter Ablation/methods
• Ethanol/administration & dosage
• Female
• Humans
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Retrospective Studies
• Solvents/administration & dosage
• Treatment Outcome

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.

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.

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.

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.

• 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.

• Liver
• Neoplasms
• Radiofrequency ablation

It is usually difficult to adequately conduct percutaneous ultrasound-guided radiofrequency (RF) ablation for hepatocellular carcinomas (HCCs) abutting the diaphragm. Our hypothesis was that the subphrenic location of HCC could have an effect on the long-term therapeutic outcomes after hepatic resection and RF ablation.

To compare the long-term therapeutic outcomes of hepatic resection and percutaneous RF ablation for HCCs abutting the diaphragm.

A total of 143 Child-Pugh class A patients who had undergone hepatic resection (n = 80) or percutaneous ultrasound-guided RF ablation (n = 63) for an HCC (≤ 3 cm) abutting the right diaphragm were included. Cumulative local tumor progression (LTP), cumulative intrahepatic distant recurrence (IDR), disease-free survival (DFS), and overall survival (OS) rates were estimated. Prognostic factors for DFS and OS were analyzed. Complications were evaluated.

The cumulative IDR rate, DFS rate, and OS rate for the hepatic resection group and RF ablation group at 5 years were “35.9% vs 65.8%”, “64.1% vs 18.3%”, and “88.4% vs 68.7%”, respectively. Hepatic resection was an independent prognostic factor for DFS (P ≤ 0.001; hazard ratio, 0.352; 95%CI: 0.205, 0.605; with RF ablation as the reference category); however, treatment modality was not an independent prognostic factor for OS. The LTP rate was 46.6% at 5 years for the RF ablation group. The major complication rate was not significantly different between the groups (P = 0.630). The rate of occurrence of peritoneal seeding was higher in the RF ablation group (1.3% vs 9.5%, P = 0.044).

Although OS was not significantly different between patients who had gone hepatic resection or percutaneous RF ablation for HCCs abutting the diaphragm, DFS was better in the hepatic resection group.

• Hepatic resection
• Radiofrequency ablation
• Hepatocellular carcinoma
• Diaphragm
• Treatment outcome

• Artificial ascites
• Artificial pleural effusion
• Hepatocellular carcinoma
• High-risk location
• Radiofrequency ablation

• Aged
• Ascites
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/surgery
• Catheter Ablation/methods
• Disease Progression
• Humans
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/mortality
• Liver Neoplasms/surgery
• Magnetic Resonance Imaging
• Pleural Effusion
• Postoperative Complications
• Retrospective Studies
• Survival Rate
• Tomography, X-Ray Computed

Thermotherapy has demonstrated a potential to be an effective non-surgical technique to treat breast cancer.

• Hepatocellular carcinoma
• Radiofrequency ablation
• Right inferior phrenic artery
• Transarterial chemoembolization

• Adult
• Aged
• Arteries/diagnostic imaging
• Carcinoma, Hepatocellular/therapy
• Catheter Ablation/methods
• Chemoembolization, Therapeutic/methods
• Combined Modality Therapy/methods
• Diaphragm/diagnostic imaging
• Female
• Humans
• Liver/blood supply
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Retrospective Studies
• Treatment Outcome
• Ultrasonography, Interventional/methods

Artificial ascites has been reported as an effective technique to reduce the risk of thermal injury in radiofrequency ablation of liver tumors by increasing the distance of collateral organs located next to the ablated sites. In this case report we share our experience with artificial ascites in an attempt to reduce the toxicity of collateral adjacent organs in the setting of re-irradiation for recurrent cervical cancer. A 52-year-old female who developed local recurrence after definitive radiation therapy was treated with interstitial re-irradiation by means of image-guided, (single-implant/multi fraction) high-dose-rate brachytherapy. Because the sigmoid colon was in close proximity to the recurrent tumor lesion, artificial ascites was generated before each treatment fraction by percutaneous injection of a defined amount of saline solution through the abdominal wall to create additional space between the two volumes. Artificial ascites showed a dosimetric improvement by reducing the sigmoid colon D_0.1cc per fraction from 286 cGy before to 189 cGy after saline injection. No severe complication was associated with the injection procedure.

• Diagnosis
• Hepatocellular carcinoma
• Staging
• Surveillance
• Treatment

To prospectively evaluate the safety and therapeutic effectiveness of dual-switching monopolar (DSM) radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC), and to retrospectively compare the results with those of single-switching monopolar (SSM) RFA in a historical control group.

This study was approved by the Institutional Review Board, with informed consent obtained from all patients. Fifty-two HCC patients who underwent DSM-RFA using a separable clustered electrode and dual-generators were prospectively enrolled. Technical parameters, complications, technical success, technical effectiveness, and local tumor progression (LTP) rates were evaluated by means of post-procedural and follow-up imaging. Thereafter, the outcome of DSM-RFA was compared with those of 249 retrospectively included HCC patients treated with SSM-RFA.

There were two major complications (3.8%, 2/52) including pleural and pericardial effusion in the DSM-RFA group. The DSM-RFA yielded a 100% technical success rate, a 98.1% technical effectiveness rate, and a 4.3% 2-year LTP rate. In a retrospective comparison between the two groups, DSM-RFA created significantly larger ablation volume (4.20 ± 2.07 cm³/min vs. 3.03 ± 1.99 cm³/min, p < 0.01), and delivered higher energy (1.43 ± 0.37 kcal/min vs. 1.25 ± 0.50 kcal/min, p < 0.01) per given time, than SSM-RFA. There was no significant difference in major procedure-related complications (3.8% vs. 4.4%) and technical effectiveness rate (98.1% vs. 96.4%) between the two groups (p = 1.00). In addition, the 2-year LTP rate of DSM-RFA and SSM-RFA were 4.3% and 10.1%, respectively (p = 0.15).

DSM-RFA using a separable clustered electrode is safe and provides high local tumor control and good preliminary clinical outcome for small HCCs, which are at least comparable to those of SSM-RFA.

• Hepatocellular carcinoma
• Liver
• Local ablation therapy
• Radiofrequency ablation
• Therapeutic efficacy

• Hepatic dome
• Hepatocellular carcinoma
• Percutaneous intervention
• Radiofrequency ablation

The risk factors for recurrence and death after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) remain poorly known. This study was aimed to study the 10-year overall survival (OS) of HCC treated by ultrasound (US)-guided RFA and the risk factors for recurrence and death.

Between June 2005 and June 2016, 1000 patients with HCC treated by US-guided RFA at 4 hospitals in China; among them, 525 patients met the criteria for radical ablation and 410 had high AFP levels before RFA treatment. Clinical and biochemical factors were tested for association with recurrence and survival. Patients were divided into the recurrence (n = 348) and no recurrence groups (n = 62).

The 5- and 10-year survival rates were 66 and 35%, respectively. Tumor size (HR = 1.36, 95% CI 1.12–1.65), albumin levels (HR = 0.76, 95% CI 0.65–0.91), prothrombin time (HR = 2.18, 95% CI 1.54–3.10), and α-fetoprotein levels (HR = 1.13, 95% CI 1.00–1.26) were independently associated with mortality after RFA for HCC. Tumor size (HR = 1.27, 95% CI: 1.15–1.40), HBV-DNA (HR = 7.70, 95% CI 3.57–16.63), AFP levels before treatment (HR = 2.172, 95% CI 1.256–3.756, P = 0.006), and AFP response (HR = 4.722, 95% CI 1.053–21.184, P = 0.0427) were independently associated with the risk of recurrence of HCC after RFA. The median survival of the patients with and without recurrence after RFA was 54 (95% CI 45–58) and 62 (95% CI 48–80) months, respectively (log-rank, P = 0.04).

Tumor size, albumin, prothrombin time, and α-fetoprotein levels were independently associated with mortality after US-guided RFA for HCC, while tumor size and HBV-DNA were independently associated with recurrence. Patients with recurrence had a poorer survival compared with those without.

• Hepatocellular carcinoma
• Radiofrequency ablation
• Recurrence
• Risk factors
• Survival

• Heat sink effect
• Hydrodissection
• Liver
• Radiofrequency ablation
• Thermal injury

• Animals
• Ascites/surgery
• Basement Membrane
• Burns/prevention & control
• Catheter Ablation/adverse effects
• Collagen
• Dissection/methods
• Drug Combinations
• Hot Temperature
• In Vitro Techniques
• Laminin
• Liver/surgery
• Liver Neoplasms/surgery
• Male
• Prospective Studies
• Proteoglycans
• Rats
• Rats, Sprague-Dawley
• Surgery, Computer-Assisted
• Swine

• Artificial ascites
• Artificial pneumoperitoneum
• Tumor ablation

• Ablation
• Incidence
• Liver Abscess
• Liver Neoplasm
• Risk Factors

• Abdomen
• Biopsy
• Percutaneous

Background: Laparoscopic and robot-assisted surgeries are performed under carbon dioxide insufflation. Switching from gas to an isotonic irrigant introduces several benefits and avoids some adverse effects of gas insufflation. We developed an irrigating device and apparatus designed for single-incision laparoscopic surgery and tested its advantages and drawbacks during surgery in a porcine model.

Materials and Methods: Six pigs underwent surgical procedures under general anesthesia. A 30-cm extracorporeal cistern was placed over a 5–6-cm abdominal incision. The abdomen was irrigated with warm saline that was drained via a suction tube placed near the surgical field and continuously recirculated through a closed circuit equipped with a hemodialyzer as a filter. Irrigant samples from two pigs were cultured to check for bacterial and fungal contamination. Body weight was measured before and after surgery in four pigs that had not received treatments affecting hemodynamics or causing diuresis.

Results: One-way flow of irrigant ensured laparoscopic vision by rinsing blood from the surgical field. Through a retroperitoneal approach, cystoprostatectomy was successfully performed in three pigs, nephrectomy in two, renal excision in two, and partial nephrectomy in one, under simultaneous ultrasonographic monitoring. Through a transperitoneal approach, liver excision and hemostasis with a bipolar sealing device were performed in three pigs, and bladder pedicle excision was performed in one pig. Bacterial and fungal contamination of the irrigant was observed on the draining side of the circuit, but the filter captured the contaminants. Body weight increased by a median of 2.1% (range, 1.2–4.4%) of initial weight after 3–5 hours of irrigation.

Conclusions: Surgery under irrigation is feasible and practical when performed via a cistern through a small abdominal incision. This method is advantageous, especially in the enabling of continuous and free-angle ultrasound observation of parenchymal organs. Adverse effects of abdominal irrigation need further assessment before use in humans.