|
1
|
Vandeputte M, Saveyn T, Lutin B, De Meyere C, Parmentier I, D'Hondt M. Combined Ablation and Resection for Colorectal Liver Metastases in the Minimally Invasive Surgical Era. Surg Laparosc Endosc Percutan Tech 2023; 33:121-128. [PMID: 36821654 DOI: 10.1097/sle.0000000000001153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/12/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND Thermal ablation is an accepted treatment modality for small and central liver tumors. In extensive colorectal liver metastatic disease (CRLM), hepatectomy can be combined with ablation, resulting in a parenchymal-sparing strategy. This may increase salvageability rates in case of recurrence. METHODS All patients with advanced CRLM that underwent combined ablation and resection between April 2012 and April 2021, were retrospectively analyzed from a prospectively maintained database. Primary endpoints include postoperative 30-day morbidity and ablation-site recurrence (ASR). The surgical approaches were compared. Ablated lesions were screened for ASR on postoperative follow-up imaging. RESULTS Of 54 patients that underwent combined ablation and resection, 32 (59.3%) were performed through a minimally invasive approach. Eleven (20.4%) were minor resections, 32 (59.3%) were technically major and 11 (20.4%) were anatomically major resections. Twelve complications occurred (22.2%), among which 2 (3.8%) major complications (Clavien-Dindo ≥IIIa). Ninety-day mortality rate was 1.9%. Out of 82 ablated lesions, 6 ASRs (11.1%) occurred. Median blood loss was significantly lower in the minimally invasive group, compared with open [90 mL (32.5 to 200) vs. 200 mL (100 to 400), P =0.005]. Pringle maneuver was significantly performed less in the minimally invasive group [8 (25.0%) vs. 16 (72.7%), P =0.001], but took more time [36.1 min (±15.6) vs. 21.6 (±9.9); P =0.011]. Short-term (1 y) overall and disease-free survival were respectively 81.4% and 50.0%. CONCLUSION Combining microwave ablation and liver resection is a feasible and safe parenchymal-sparing technique, through both minimally invasive and open approach for treating extended CRLM disease. It has a low ablation-related complication rate and acceptable ablation-site recurrence rate.
Collapse
Affiliation(s)
| | | | | | | | | | - Mathieu D'Hondt
- Departments of Digestive and Hepatobiliary/Pancreatic Surgery
| |
Collapse
|
|
2
|
Musick JR, Philips P, Scoggins CR, Egger ME, McMasters KM, Martin RC. Laparoscopic microwave ablation versus percutaneous microwave ablation of hepatic malignancies: Efficacy and recurrence-free survival outcomes in patients. Surgery 2023; 173:598-602. [PMID: 36270823 DOI: 10.1016/j.surg.2022.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hepatic thermal ablation has been found to be effective and equivalent to resection in certain liver histologies. Of the 16,000 annual liver ablations performed in the United States, only 13% (2,080 ablations) are performed laparoscopically. The laparoscopic technique remains underused even with the benefits of improved staging and better access to tumors. The purpose of this study is to compare laparoscopic microwave ablation versus percutaneous microwave ablation in terms of efficacy and recurrence-free survival outcomes in patients with hepatic malignancies. METHODS A comparative analysis was performed on 275 patients (289 ablation procedures) who underwent laparoscopic microwave ablation or percutaneous microwave ablation between February 2011 and May 2021. Ablation success was confirmed postprocedure and recurrence was monitored at follow-up via contrast-enhanced computed tomography/magnetic resonance imaging and/or computed tomography/positron emission tomography. RESULTS The groups were similar for sex, age, body mass index, location of tumor, size of tumor, and number of tumors. Ablation success was 100% in both groups. Local recurrence was significant (5%: laparoscopic microwave ablation vs 22%: percutaneous microwave ablation, P = .002) and same-lobe recurrence (21%: laparoscopic microwave ablation vs 24%: percutaneous microwave ablation) was lower in the laparoscopic microwave ablation group. Median recurrence-free survival was 15.8 months for the laparoscopic microwave ablation group and 5.6 months for the percutaneous microwave ablation group (P = .0002). Overall, 90-day complications were lower in the laparoscopic microwave ablation group (11%) compared with the percutaneous microwave ablation group (21%) (P = .11). CONCLUSION Laparoscopic surgical ablation is a critical surgical skill that must be taught in fellowship. Laparoscopic microwave ablation leads to better tumor specific outcomes and oncologic outcomes demonstrating clinical efficacy in the treatment of hepatic malignancies compared with percutaneous microwave ablation.
Collapse
Affiliation(s)
- Joslin R Musick
- Division of Surgical Oncology, Department of Surgery, The Hiram C. Polk, Jr., MD, University of Louisville School of Medicine, KY
| | - Prejesh Philips
- Division of Surgical Oncology, Department of Surgery, The Hiram C. Polk, Jr., MD, University of Louisville School of Medicine, KY
| | - Charles R Scoggins
- Division of Surgical Oncology, Department of Surgery, The Hiram C. Polk, Jr., MD, University of Louisville School of Medicine, KY
| | - Michael E Egger
- Division of Surgical Oncology, Department of Surgery, The Hiram C. Polk, Jr., MD, University of Louisville School of Medicine, KY
| | - Kelly M McMasters
- Division of Surgical Oncology, Department of Surgery, The Hiram C. Polk, Jr., MD, University of Louisville School of Medicine, KY
| | - Robert Cg Martin
- Division of Surgical Oncology, Department of Surgery, The Hiram C. Polk, Jr., MD, University of Louisville School of Medicine, KY.
| |
Collapse
|
|
3
|
Chamani F, Barnett I, Pyle M, Shrestha T, Prakash P. A Review of In Vitro Instrumentation Platforms for Evaluating Thermal Therapies in Experimental Cell Culture Models. Crit Rev Biomed Eng 2022; 50:39-67. [PMID: 36374822 DOI: 10.1615/critrevbiomedeng.2022043455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Thermal therapies, the modulation of tissue temperature for therapeutic benefit, are in clinical use as adjuvant or stand-alone therapeutic modalities for a range of indications, and are under investigation for others. During delivery of thermal therapy in the clinic and in experimental settings, monitoring and control of spatio-temporal thermal profiles contributes to an increased likelihood of inducing desired bioeffects. In vitro thermal dosimetry studies have provided a strong basis for characterizing biological responses of cells to heat. To perform an accurate in vitro thermal analysis, a sample needs to be subjected to uniform heating, ideally raised from, and returned to, baseline immediately, for a known heating duration under ideal isothermal condition. This review presents an applications-based overview of in vitro heating instrumentation platforms. A variety of different approaches are surveyed, including external heating sources (i.e., CO2 incubators, circulating water baths, microheaters and microfluidic devices), microwave dielectric heating, lasers or the use of sound waves. We discuss critical heating parameters including temperature ramp rate (heat-up phase period), heating accuracy, complexity, peak temperature, and technical limitations of each heating modality.
Collapse
Affiliation(s)
- Faraz Chamani
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS, USA
| | - India Barnett
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS, USA
| | - Marla Pyle
- Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
| | - Tej Shrestha
- Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA; Nanotechnology Innovation Center of Kansas State (NICKS), Kansas State University, Manhattan, KS, USA
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, USA
| |
Collapse
|
|
4
|
Sparchez Z, Radu P, Bartos A, Nenu I, Craciun R, Mocan T, Horhat A, Spârchez M, Dufour JF. Combined treatments in hepatocellular carcinoma: Time to put them in the guidelines? World J Gastrointest Oncol 2021; 13:1896-1918. [PMID: 35070032 PMCID: PMC8713312 DOI: 10.4251/wjgo.v13.i12.1896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/03/2021] [Accepted: 11/05/2021] [Indexed: 02/06/2023] Open
Abstract
The time for battling cancer has never been more suitable than nowadays and fortunately against hepatocellular carcinoma (HCC) we do have a far-reaching arsenal. Moreover, because liver cancer comprises a plethora of stages-from very early to advanced disease and with many treatment options-from surgery to immunotherapy trials-it leaves the clinician a wide range of options. The scope of our review is to throw light on combination treatments that seem to be beyond guidelines and to highlight these using evidence-based analysis of the most frequently used combination therapies, discussing their advantages and flaws in comparison to the current standard of care. One particular combination therapy seems to be in the forefront: Transarterial chemoembolization plus ablation for medium-size non-resectable HCC (3-5 cm), which is currently at the frontier between Barcelona Clinic Liver Cancer classification A and B. Not only does it improve the outcome in contrast to each individual therapy, but it also seems to have similar results to surgery. Also, the abundance of immune checkpoint inhibitors that have appeared lately in clinical trials are bringing promising results against HCC. Although the path of combination therapies in HCC is still filled with uncertainty and caveats, in the following years the hepatology and oncology fields could witness an HCC guideline revolution.
Collapse
Affiliation(s)
- Zeno Sparchez
- 3rd Medical Department, “Ïuliu Hatieganu” University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Pompilia Radu
- Department of Visceral Surgery and Medicine, Hepatology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Adrian Bartos
- Department of Surgery, “Ïuliu Hatieganu” University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Iuliana Nenu
- 3rd Medical Department, “Ïuliu Hatieganu” University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Rares Craciun
- 3rd Medical Department, “Ïuliu Hatieganu” University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Tudor Mocan
- 3rd Medical Department, “Ïuliu Hatieganu” University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Adelina Horhat
- 3rd Medical Department, “Ïuliu Hatieganu” University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Mihaela Spârchez
- Department of Mother and Child, 2nd Paediatric Clinic, “Ïuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400177, Romania
| | - Jean-François Dufour
- Department for BioMedical Research, Hepatology, University of Bern, Bern 3008, Switzerland
| |
Collapse
|
|
5
|
Recurrence and survival following microwave, radiofrequency ablation, and hepatic resection of colorectal liver metastases: A systematic review and network meta-analysis. Hepatobiliary Pancreat Dis Int 2021; 20:307-314. [PMID: 34127382 DOI: 10.1016/j.hbpd.2021.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/20/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Gold standard for colorectal liver metastases (CRLM) remains hepatic resection (HR). However, patients with severe comorbidities, unresectable or deep-situated resectable CRLM are candidates for ablation. The aim of the study was to compare recurrence rate and survival benefit of the microwave ablation (MWA), radiofrequency ablation (RFA) and HR by conducting the first network meta-analysis. DATA SOURCES Systematic search of the literature was conducted in the electronic databases. Both updated traditional and network meta-analyses were conducted and the results were compared between them. RESULTS HR cohort demonstrated significantly less local recurrence rate and better 3- and 5-year disease-free (DFS) and overall survival (OS) compared to MWA and RFA cohorts. HR cohort included significantly younger patients and with significantly lower preoperative carcinoembryonic antigen (CEA) by 10.28 ng/mL compared to RFA cohort. Subgroup analysis of local recurrence and OS of solitary and ≤ 3 cm CRLMs did not demonstrate any discrepancies when compared with the whole sample. CONCLUSIONS For resectable CRLM the treatment of choice still remains HR. MWA and RFA can be used as a single or adjunct treatment in patients with unresectable CRLM and/or prohibitive comorbidities.
Collapse
|
|
6
|
Elfrink AKE, Nieuwenhuizen S, van den Tol MP, Burgmans MC, Prevoo W, Coolsen MME, van den Boezem PB, van Delden OM, Hagendoorn J, Patijn GA, Leclercq WKG, Liem MSL, Rijken AM, Verhoef C, Kuhlmann KFD, Ruiter SJS, Grünhagen DJ, Klaase JM, Kok NFM, Meijerink MR, Swijnenburg RJ. Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study. HPB (Oxford) 2021; 23:827-839. [PMID: 33218949 DOI: 10.1016/j.hpb.2020.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Combining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation. METHODS In this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery. RESULTS Of 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy. CONCLUSION Significant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy.
Collapse
Affiliation(s)
- Arthur K E Elfrink
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
| | - Sanne Nieuwenhuizen
- Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - M Petrousjka van den Tol
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Mark C Burgmans
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Warner Prevoo
- Department of Interventional Radiology, OLVG, Amsterdam, the Netherlands
| | - Marielle M E Coolsen
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Otto M van Delden
- Department of Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jeroen Hagendoorn
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Gijs A Patijn
- Department of Surgery, Isala, Zwolle, the Netherlands
| | | | - Mike S L Liem
- Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Arjen M Rijken
- Department of Surgery, Amphia Medical Center, Breda, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Koert F D Kuhlmann
- Department of Surgery, Antoni van Leeuwenhoek - Dutch Cancer Institute, Amsterdam, the Netherlands
| | - Simeon J S Ruiter
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Joost M Klaase
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Niels F M Kok
- Department of Surgery, Antoni van Leeuwenhoek - Dutch Cancer Institute, Amsterdam, the Netherlands
| | - Martijn R Meijerink
- Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | | | | |
Collapse
|
|
7
|
CT-Guided Percutaneous Microwave Ablation of Sclerosing Hepatic Carcinoma. Can J Gastroenterol Hepatol 2020; 2020:8881978. [PMID: 32733821 PMCID: PMC7378586 DOI: 10.1155/2020/8881978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 01/10/2023] Open
Abstract
Sclerosing hepatic carcinoma (SHC) is a rare subtype of hepatic carcinoma that can be caused by various pathogeneses. The histological characteristics of SHC demonstrate its high resistance to chemoembolization and thermal ablation; thus, surgical resection represents the primary option for the majority of patients. However, a small proportion of patients who cannot withstand surgery or who have inoperable tumors may not receive adequate treatment, causing the progression of cancer and related high mortality. To overcome the high puncture resistance, high thermal resistance, and poor thermal conductivity of microwave ablation, we developed percutaneous no-touch multiple-site microwave ablation (NTMSWA) to ablate SHC lesions. In this retrospective study, 96 and 41 patients underwent NTMSWA and surgery, respectively. In the NTMSWA group, tumor size and histological classification were determined by medical imaging and tissue biopsy before ablation, and then a personalized ablation regimen was performed. Complete ablation was achieved in a single session in 81 out of 96 (84.4%) patients. The median survival (MS) of the 90 patients who underwent NTMSWA was 51 months, and the overall survival (OS) rate at 5 years was 49.1%. In contrast, the MS in the control group was 57 months, and the OS rate at 5 years was 56.3%. There was no significant difference between the two groups, indicating that SHC <50 mm in size can be effectively ablated with NTMSWA. By adopting no-touch, multiple-site, low-power, intermittent ablation, SHC less than 50 mm in size can be completely ablated.
Collapse
|
|
8
|
Ryu T, Takami Y, Wada Y, Sasaki S, Imamura H, Ureshino H, Saitsu H. Combined hepatectomy and microwave ablation for multifocal hepatocellular carcinoma: Long-term outcomes and prognostic factors. Asian J Surg 2020; 44:186-191. [PMID: 32473893 DOI: 10.1016/j.asjsur.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/07/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND It remains to be clarified whether combined hepatectomy and microwave ablation for multifocal hepatocellular carcinoma (HCC) is feasible. This aim of this study was to examine the perioperative and oncological outcomes after combined hepatectomy and microwave ablation for multifocal HCC. METHODS This retrospective study included 81 patients who underwent combined hepatectomy and microwave ablation for multifocal HCC in our institute between June 1998 and December 2017. We analyzed overall survival (OS) and recurrence-free survival (RFS), and evaluated factors related to prognosis. RESULTS Median follow-up time was 45.6 months for the entire cohort. OS rates were 1-year: 96%, 3-year: 72%, and 5-year: 54%; RFS rates were 1-year: 77%, 3-year: 37%, and 5-year: 22%. The major complication rate (Clavien-Dindo classification IIIa or above) after surgery was 10%, with one patient of in-hospital mortality. Multivariate analysis revealed that des-γ-carboxy prothrombin level >200 mAU/mL and >5 tumors were independent risk factors for OS, and des-γ-carboxy prothrombin level >200 mAU/mL, > 5 tumors, and maximum tumor size >5 cm were independent risk factors for RFS. CONCLUSIONS Our results indicate that combined hepatectomy and microwave ablation is safe and feasible for selected patients with multifocal HCC.
Collapse
Affiliation(s)
- Tomoki Ryu
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
| | - Yuko Takami
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yoshiyuki Wada
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Shin Sasaki
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hajime Imamura
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hiroki Ureshino
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hideki Saitsu
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| |
Collapse
|
|
9
|
Winkelmann MT, Archid R, Gohla G, Hefferman G, Kübler J, Weiss J, Clasen S, Nikolaou K, Nadalin S, Hoffmann R. MRI-guided percutaneous thermoablation in combination with hepatic resection as parenchyma-sparing approach in patients with primary and secondary hepatic malignancies: single center long-term experience. Cancer Imaging 2020; 20:37. [PMID: 32460898 PMCID: PMC7251813 DOI: 10.1186/s40644-020-00316-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/18/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Combination therapy using hepatic resection (HR) and intra-operative thermal ablation is a treatment approach for patients with technically unresectable liver malignancies. The aim of this study was to investigate safety, survival and local recurrence rates for patients with technically unresectable liver tumors undergoing HR and separate percutaneous MR-guided thermoablation procedure as an alternative approach. METHODS Data from all patients with primary or secondary hepatic malignancies treated at a single institution between 2004 and 2018 with combined HR and MR-guided percutaneous thermoablation was collected and retrospectively analyzed. Complications, procedure related information and patient characteristics were collected from institutional records. Overall survival and disease-free survival were estimated using the Kaplan-Meier method. RESULTS A total of 31 patients (age: 62.8 ± 9.1 years; 10 female) with hepatocellular carcinoma (HCC; n = 7) or hepatic metastases (n = 24) were treated for 98 hepatic tumors. Fifty-six tumors (mean diameter 28.7 ± 23.0 mm) were resected. Forty-two tumors (15.1 ± 7.6 mm) were treated with MR-guided percutaneous ablation with a technical success rate of 100%. Local recurrence at the ablation site occurred in 7 cases (22.6%); none of these was an isolated local recurrence. Six of 17 patients (35.3%) treated for colorectal liver metastases developed local recurrence. Five patients developed recurrence at the resection site (16.1%). Non-local hepatic recurrence was observed in 18 cases (58.1%) and extrahepatic recurrence in 11 cases (35.5%) during follow-up (43.1 ± 26.4 months). Ten patients (32.3%) developed complications after HR requiring pharmacological or interventional treatment. No complication requiring therapy was observed after ablation. Median survival time was 44.0 ± 7.5 months with 1-,3-, 5-year overall survival rates of 93.5, 68.7 and 31.9%, respectively. The 1-, 3- and 5-year disease-free survival rates were 38.7, 19.4 and 9.7%, respectively. CONCLUSION The combination of HR and MR-guided thermoablation is a safe and effective approach in the treatment of technically unresectable hepatic tumors and can achieve long-term survival.
Collapse
Affiliation(s)
- Moritz T Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Rami Archid
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tübingen, Germany
| | - Georg Gohla
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Gerald Hefferman
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Jens Kübler
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Jakob Weiss
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Stephan Clasen
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tübingen, Germany
| | - Rüdiger Hoffmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| |
Collapse
|
|
10
|
Yang G, Xiong Y, Sun J, Wang G, Li W, Tang T, Li J. The efficacy of microwave ablation versus liver resection in the treatment of hepatocellular carcinoma and liver metastases: A systematic review and meta-analysis. Int J Surg 2020; 77:85-93. [PMID: 32173611 DOI: 10.1016/j.ijsu.2020.03.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/22/2020] [Accepted: 03/05/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Microwave ablation (MWA) is an important method in the treatment of liver cancer. This systematic review compared MWA with liver resection (LR) for liver cancer treatment. In recent years, the MWA has been also reported to play an important role. Studies comparing MWA and LR are lacking. This study aims to compare the efficacy of MWA and LR in the treatment of hepatocellular carcinoma (HCC). METHODS A systematic search of PubMed, Embase, Cochrane Library and Web of Science up to April 1, 2019 was conducted for relevant studies that compared the efficacy of MWA and LR in the treatment of HCC. The primary outcomes were local tumor recurrence (LTR) and overall survival (OS) of patients. The secondary outcomes included disease free survival (DFS), extrahepatic metastasis, intrahepatic de novo lesions, length of stay, complications, intraoperative blood loss and operative time. RESULTS A total of 16 studies including 2622 patients were identified. Incidence of LTR was significantly higher in patients with MWA than LR, with a pooled OR of 2.69 (95% CI 1.33-5.41; P = 0.006). No significant difference in 1-year OS was found. However, patients with MWA experienced higher 3- and 5-year OS, with pooled ORs of 1.40 (95% CI 1.07-1.84; P = 0.01) and 1.41 (95% CI 1.10-1.80; P = 0.007) respectively. In secondary measures, the 1- and 3-year DFS were significantly higher in patients with MWA. However, no significant difference of 5-year DFS was observed. In addition, lower incidence of complications, less intraoperative blood loss and shorter operative time and shorter length of stay were observed in MWA. CONCLUSIONS Though MWA may lead to higher incidence of recurrence, it may be an effective and safe alternative in patients with HCC or liver metastases. MWA may have benefits in patients' survival and safety. Randomized studies should be performed to determine the target population that benefits most from MWA in the future.
Collapse
Affiliation(s)
- Gang Yang
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China
| | - Yongfu Xiong
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China; Institute of Hepato-biliary-intestinal Disease, North Sichuan Medical College, Nanchong, 637000, China
| | - Ji Sun
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China
| | - Guan Wang
- Physical Examination Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China
| | - Weinan Li
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China
| | - Tao Tang
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China
| | - Jingdong Li
- Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China; Institute of Hepato-biliary-intestinal Disease, North Sichuan Medical College, Nanchong, 637000, China.
| |
Collapse
|
|
11
|
Glassberg MB, Ghosh S, Clymer JW, Wright GWJ, Ferko N, Amaral JF. Microwave ablation compared with hepatic resection for the treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis. World J Surg Oncol 2019; 17:98. [PMID: 31182102 PMCID: PMC6558848 DOI: 10.1186/s12957-019-1632-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/20/2019] [Indexed: 12/22/2022] Open
Abstract
Background Hepatic resection (HR) is the gold standard liver cancer treatment, but few patients are eligible due to comorbidities or tumor location. Microwave ablation (MWA) is an important complementary liver cancer treatment to HR. This systematic review compared MWA with HR for liver cancer treatment. Methods A systematic search of MEDLINE, EMBASE, and CENTRAL was conducted for randomized and observational studies published from 2006 onwards. The primary outcome was local tumor recurrence (LTR), and a random effects model was used for meta-analyses. Results Of the 1845 studies identified, 1 randomized and 15 observational studies met the inclusion criteria. LTR was significantly increased with MWA versus HR (risk ratio (RR) = 2.49; P = 0.016). In secondary measures, HR provided significantly higher 3- and 5-year overall survival (RR = 0.94; P = 0.03 and RR = 0.88; P = 0.01, respectively) and 3-year disease-free survival (RR = 0.78; P = 0.009). MWA exhibited significantly shorter length of stay (weighted mean difference (WMD) = − 6.16 days; P < 0.001) and operative time (WMD = − 58.69 min; P < 0.001), less intraoperative blood loss (WMD = − 189.09 mL; P = 0.006), and fewer complications than HR (RR = 0.31; P < 0.001). When MWA was combined with HR and compared with either modality alone, complications and blood loss were significantly lower with the combination treatment; however, there were no differences in other outcomes. Subgroup and sensitivity analyses were generally aligned with the main results. Conclusions MWA can be an effective and safe alternative to HR in patients/tumors that are not amenable to resection. More randomized and economic studies should be performed that compare the two treatments, especially to determine the target population that benefits most from MWA. Electronic supplementary material The online version of this article (10.1186/s12957-019-1632-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - Sudip Ghosh
- Ethicon Inc., 4545 Creek Rd, Cincinnati, OH, 45242, USA
| | | | - George W J Wright
- Cornerstone Research Group Inc., 204-3228 South Service Road, Burlington, ON, L7N 3H8, Canada.
| | - Nicole Ferko
- Cornerstone Research Group Inc., 204-3228 South Service Road, Burlington, ON, L7N 3H8, Canada
| | | |
Collapse
|
|
12
|
Personalizing Locoregional Therapy for Patients with Metastatic Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0356-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|