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Monsel A, Sitbon A, Roux C, Eyraud D, Scatton O, Vezinet C, Oré MV, Gallet J, Wagner M, Thabut D, Boughdad S, Renaud F, Mazzola A, Goumard C, Allaire M. Current insights into anaesthesia and critical care management of patients with hepatocellular carcinoma: Multifaceted implications for the anaesthesiologist and intensive care physician. Eur J Anaesthesiol 2025; 42:435-448. [PMID: 39945138 DOI: 10.1097/eja.0000000000002141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 01/23/2025] [Indexed: 04/03/2025]
Abstract
BACKGROUND The incidence of hepatocellular carcinoma (HCC) is on the rise worldwide, due to the increasing prevalence of liver diseases associated with metabolic dysfunction and better management of cirrhosis and its complications. The diversification of HCC treatments has recently increased, with the choice of strategy based on HCC characteristics, liver function and comorbidities. The combination of new therapies has transformed the prognosis, with up to 70% survival at 5 years. OBJECTIVE The aim of this review was to analyse the most recent data on preoperative evaluation, peri-operative anaesthetic management of liver resection, liver transplantation and other types of procedures, and to highlight the multidisciplinary aspect of such management. MAIN FINDINGS AND DISCUSSION The importance of preanaesthetic evaluation will depend largely on the procedure proposed, associated co-morbidities and the stage of liver disease. This assessment should verify stabilisation of all comorbidities, and evaluate the degree of portal hypertension, cirrhosis severity and sarcopenia. Liver resection and liver transplantation for HCC present specific surgical challenges, and minimally invasive techniques improve recovery. Nonsurgical procedures considered as therapeutic (ablation) or standby (regional embolisation) are diverse, and all expose patients to specific intra-anaesthetic complications, sometimes requiring intensive care management. Peri-operative anaesthetic strategies deployed in the management of liver resection or nonsurgical procedures involve specific management of fluids, coagulation, narcosis and analgesia, which can impact on patients' overall, and cancer prognosis. Lastly, new down-staging strategies combining several types of procedure and possibly immunotherapy, also call for collegial reflection on posthepatic transplant immunosuppression, which must remain tailored to each individual patient.
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Affiliation(s)
- Antoine Monsel
- From the Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP) Sorbonne University, Paris, France (AM, AS, DE, CV, MVO, JG), Sorbonne Université-INSERM UMRS_959, Immunology-Immunopathology-Immunotherapy (I3), 75013 Paris, France (AM), Sorbonne Université, INSERM, Centre de Recherche de Saint-Antoine (CRSA), UMRS-938, 75012, Paris, France (AM, AS, OS, CG), Department of Advanced Interventional Radiology, APHP, Sorbonne University, Hôpital Pitié-Salpétrière, Paris, France (CR), Hepatology and gastrenterology Unit, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP) Sorbonne University, Paris, France (DT, AM, MA), Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France (OS, CG), Department of Radiology (SISU), APHP, Sorbonne University, Laboratoire d'imagerie biomédicale, Hôpital Pitié-Salpétrière, Paris, France (MW, SB), Nuclear Medicine Department, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France (SB), Pathology Department, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France (FR), Genomic Instability, Metabolism, Immunity and Liver Tumorigenesis laboratory, Equipe Labellisée LIGUE 2023, Paris, France (MA), Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Paris, France (MA), Radiotherapy Department, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
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Chan PS, Chang LK, Malwade S, Chung WY, Yang SM. Cone Beam CT Derived Laser-Guided Percutaneous Lung Ablation: Minimizing Needle-Related Complications Under General Anesthesia with Lung Separation. Acad Radiol 2024; 31:4676-4686. [PMID: 38862349 DOI: 10.1016/j.acra.2024.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 06/13/2024]
Abstract
RATIONALE AND OBJECTIVES Percutaneous lung tumor ablations are mostly performed in computed tomography (CT) rooms under local anesthesia with conscious sedation. However, maintaining the breath-hold phase during this can be challenging, affecting image quality and increasing complications. With the advent of hybrid operating rooms (HORs), this procedure can be performed with endotracheal tube (ETGA) intubation under general anesthesia with lung separation, ensuring precise imaging in a single-stage setting. Lung separation provides surgical exposure of one lung while ensuring ample gas exchange with the other. This study evaluated tumor ablations performed in an HOR equipped with cone beam CT and laser guidance. MATERIALS AND METHODS This retrospective study included patients who underwent lung tumor ablation under general anesthesia with an ETGA in an HOR between July 2020 and May 2023. Anesthesia considerations, perioperative management, and postoperative follow-ups were evaluated. RESULTS 65 patients (78 tumors) underwent ablation using two types of lung ventilation methods including a single-lumen tube with a blocker (SLT/BL) (n = 15) and double-lumen tube (DLT) (n = 50). Most patients experienced desaturation during the apnea phase of dynamic CT and needling. The average SpO2 value was significantly lower in the DLT group than in the SLT/BL group during the procedure (81.1% versus 88.7%, P = 0.033). Five, three, and two patients developed pneumothorax, subcutaneous emphysema, and pleural effusion, respectively. CONCLUSION Percutaneous ablation under general anesthesia with endotracheal intubation and lung separation performed in HORs was feasible and safe. The setup minimized complication risks and maintained a balance between patient safety and successful procedures.
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Affiliation(s)
- Pak-Si Chan
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Anesthesiology, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Ling-Kai Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | | | - Wen-Yuan Chung
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Shun-Mao Yang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.
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Knapen RRMM, Homberg MC, Balthasar AJR, Jans K, Van Kuijk SMJ, de Boer SW, Bouman EAC, Van der Leij C. Sex-Differences in Post-Procedural Pain Experiences After Thermal Liver Ablations for Liver Tumors: A Retrospective Study. Cardiovasc Intervent Radiol 2024; 47:1485-1492. [PMID: 39231889 PMCID: PMC11541288 DOI: 10.1007/s00270-024-03851-5] [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: 02/17/2024] [Accepted: 08/23/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION Literature shows differences in pain experiences between sexes. The exact influence of thermal liver ablation on experienced pain is still not well-known. This study aims to investigate the maximum pain intensity at the recovery between men and women after percutaneous thermal liver ablation. METHODS Patients treated with percutaneous thermal liver ablation (radiofrequency or microwave ablation) in Maastricht University Medical Center + between 2018 and 2022 for primary or secondary liver tumors were included retrospectively. Outcomes included maximum numerical rating scale (NRS, scale:0-10) score at the recovery room, prevalence of post-procedural pain (defined as NRS score ≥ 4), duration of anesthesia, length of stay at recovery, and complications. Regression analyses were adjusted for age, ASA-score, BMI, tumor type, maximum diameter of lesion, chronic pain in patients' history, and history of psychological disorder. RESULTS 183 patients were included of which 123 men (67%). Results showed higher average maximum NRS scores in women patients compared to men (mean:3.88 versus 2.73), but not after adjustments (aß:0.75, 95%CI:-0.13-1.64). Women suffered more from acute post-procedural pain (59% versus 35%; aOR:2.50, 95%CI:1.16-5.39), and needed analgesics more often at the recovery room (aOR:2.43, 95%CI:1.07-5.48) compared to men. NRS score at recovery arrival did not significantly differ (aß:0.37, 95%CI:-0.48-1.22). No differences were seen in the length of stay at the recovery, duration of anesthesia, procedure time, and complication rate. Location of the tumor (subcapsular or deep), total tumors per patient, and distinction between primary and secondary tumors had no influence on the NRS. CONCLUSION This retrospective single-center study shows higher post-procedural pain rates after thermal liver ablation in women, resulting in higher analgesics use at the recovery room. The results suggest considering higher dosage of analgesics during thermal liver ablation in women to reduce post-procedural pain. LEVEL OF EVIDENCE 3: Non-controlled retrospective cohort study.
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Affiliation(s)
- R R M M Knapen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands.
| | - M C Homberg
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - A J R Balthasar
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - K Jans
- Department of Cardiology, VieCuri Medical Center, Venlo, The Netherlands
| | - S M J Van Kuijk
- Department of Epidemiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - S W de Boer
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - E A C Bouman
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - C Van der Leij
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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Jung CFM, Liverani E, Binda C, Cristofaro L, Gori A, Alemanni LV, Sartini A, Coluccio C, Gibiino G, Petraroli C, Serra C, Fabbri C. Non-Operating Room Anesthesia (NORA) for Ultrasound-Guided Liver Radiofrequency Ablation. Diagnostics (Basel) 2024; 14:1783. [PMID: 39202272 PMCID: PMC11353362 DOI: 10.3390/diagnostics14161783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 09/03/2024] Open
Abstract
INTRODUCTION Percutaneous ultrasound-guided radiofrequency ablation (RFA) is a well-studied treatment option for locally non-advanced hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLMs). Sedation is of crucial interest as it enables safe and pain-free procedures. Whether the type of sedation has an impact on procedural outcome is still not well investigated. METHODS We retrospectively collected data on patients undergoing liver RFA for various oncological conditions. Procedures were conducted in a non-operating room anesthesia (NORA) setting. Procedural-related complications and short-term oncological outcomes were analyzed. RESULTS Thirty-five patients (mean age 71.5 y, 80% male) were treated for HCC (26), CRLM (6) and gastric cancer metastases (3). Mean lesion size was 21 mm (SD ± 10.1 mm), and the most common tumor localization was the right hepatic lobe. RFA was performed in a step-up sedation approach, with subcutaneous lidocaine injection prior to needle placement and subsequent deep sedation during ablation. No anesthesia-related early or late complications occurred. One patient presented with pleural effusion due to a large ablation zone and was treated conservatively. Local tumor-free survival after 1 and 6 months was 100% in all cases where a curative RFA approach was intended. CONCLUSIONS NORA for liver RFA comes with high patient acceptance and tolerance, and optimal postoperative outcomes and oncologic results.
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Affiliation(s)
- Carlo Felix Maria Jung
- Gastroenterology and Digestive Endoscopy Unit, Forlì–Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy; (E.L.); (C.B.); (L.V.A.); (A.S.); (C.C.); (G.G.); (C.P.); (C.F.)
| | - Elisa Liverani
- Gastroenterology and Digestive Endoscopy Unit, Forlì–Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy; (E.L.); (C.B.); (L.V.A.); (A.S.); (C.C.); (G.G.); (C.P.); (C.F.)
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì–Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy; (E.L.); (C.B.); (L.V.A.); (A.S.); (C.C.); (G.G.); (C.P.); (C.F.)
| | - Ludovica Cristofaro
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum–University of Bologna, 40138 Bologna, Italy;
| | - Alberto Gori
- Anesthesiology and Intensive Care Unit, Morgagni Pierantoni Hospital, AUSL Romagna, 47121 Forlì, Italy;
| | - Luigina Vanessa Alemanni
- Gastroenterology and Digestive Endoscopy Unit, Forlì–Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy; (E.L.); (C.B.); (L.V.A.); (A.S.); (C.C.); (G.G.); (C.P.); (C.F.)
| | - Alessandro Sartini
- Gastroenterology and Digestive Endoscopy Unit, Forlì–Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy; (E.L.); (C.B.); (L.V.A.); (A.S.); (C.C.); (G.G.); (C.P.); (C.F.)
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forlì–Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy; (E.L.); (C.B.); (L.V.A.); (A.S.); (C.C.); (G.G.); (C.P.); (C.F.)
| | - Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Forlì–Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy; (E.L.); (C.B.); (L.V.A.); (A.S.); (C.C.); (G.G.); (C.P.); (C.F.)
| | - Chiara Petraroli
- Gastroenterology and Digestive Endoscopy Unit, Forlì–Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy; (E.L.); (C.B.); (L.V.A.); (A.S.); (C.C.); (G.G.); (C.P.); (C.F.)
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, IRCCS, Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy;
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì–Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy; (E.L.); (C.B.); (L.V.A.); (A.S.); (C.C.); (G.G.); (C.P.); (C.F.)
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Keum H, Cevik E, Kim J, Demirlenk YM, Atar D, Saini G, Sheth RA, Deipolyi AR, Oklu R. Tissue Ablation: Applications and Perspectives. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2310856. [PMID: 38771628 PMCID: PMC11309902 DOI: 10.1002/adma.202310856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/05/2024] [Indexed: 05/22/2024]
Abstract
Tissue ablation techniques have emerged as a critical component of modern medical practice and biomedical research, offering versatile solutions for treating various diseases and disorders. Percutaneous ablation is minimally invasive and offers numerous advantages over traditional surgery, such as shorter recovery times, reduced hospital stays, and decreased healthcare costs. Intra-procedural imaging during ablation also allows precise visualization of the treated tissue while minimizing injury to the surrounding normal tissues, reducing the risk of complications. Here, the mechanisms of tissue ablation and innovative energy delivery systems are explored, highlighting recent advancements that have reshaped the landscape of clinical practice. Current clinical challenges related to tissue ablation are also discussed, underlining unmet clinical needs for more advanced material-based approaches to improve the delivery of energy and pharmacology-based therapeutics.
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Affiliation(s)
- Hyeongseop Keum
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Enes Cevik
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Jinjoo Kim
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Yusuf M Demirlenk
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Dila Atar
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Gia Saini
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Rahul A Sheth
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Amy R Deipolyi
- Interventional Radiology, Department of Surgery, West Virginia University, Charleston Area Medical Center, Charleston, WV 25304, USA
| | - Rahmi Oklu
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
- Division of Vascular & Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, Arizona 85054, USA
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Chang ATC, Ng CSH, Nezami N. Treatment strategies for malignant pulmonary nodule: beyond lobectomy. Point-counterpoint. Curr Opin Pulm Med 2024; 30:35-47. [PMID: 37916619 DOI: 10.1097/mcp.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW Technological advancement in low-dose computed tomography resulted in an increased incidental discovery of early-stage lung cancer and multifocal ground glass opacity. The demand for parenchyma-preserving treatment strategies is greater now than ever. Pulmonary ablative therapy is a groundbreaking technique to offer local ablative treatment in a lung-sparing manner. It has become a promising technique in lung cancer management with its diverse applicability. In this article, we will review the current development of ablative therapy in lung and look into the future of this innovative technique. RECENT FINDINGS Current literature suggests that ablative therapy offers comparable local disease control to other local therapies and stereotactic body radiation therapy (SBRT), with a low risk of complications. In particular, bronchoscopic microwave ablation (BMWA) has considerably fewer pleural-based complications due to the avoidance of pleural puncture. BMWA can be considered in the multidisciplinary treatment pathway as it allows re-ablation and allows SBRT after BMWA. SUMMARY With the benefits which ablative therapy offers and its ability to incorporate into the multidisciplinary management pathway, we foresee ablative therapy, especially BMWA gaining significance in lung cancer treatment. Future directions on developing novel automated navigation platforms and the latest form of ablative energy would further enhance clinical outcomes for our patients.
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Affiliation(s)
- Aliss Tsz Ching Chang
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore
- The Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, University of Maryland, Colleague Park, , Maryland, USA
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Lin Z, Li S, Zhou Y, Lu X, Yang B, Yu Z, Cheng Y, Sun J. A comparative study of esketamine-dexmedetomidine and sufentanil-dexmedetomidine for sedation and analgesia in lung tumor percutaneous radiofrequency ablation (PRFA): a randomized double-blind clinical trial. BMC Anesthesiol 2023; 23:304. [PMID: 37684574 PMCID: PMC10486108 DOI: 10.1186/s12871-023-02266-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE To observe and evaluate the effectiveness and safety of Esketamine or Sufentanil combined with Dexmedetomidine for sedation and analgesia in lung tumor percutaneous radiofrequency ablation (PRFA) to provide a clinical basis for the optimization of sedation and analgesia in lung tumor PRFA protocols outside the operating room. METHODS In this trial, 44 patients aged 37 to 84 undergoing lung tumor PRFA were enrolled and assigned to Group E (n = 22, Esketamine 0.2 mg/kg) or Group S (n = 22,Sufentanil 0.1 μg/kg ). Dexmedetomidine was infused intravenously as a sedative in both groups. The modified observer's assessment of alertness and sedation scale (MOAAS), physical movement pain scale, intraoperative vital signs, anesthesia recovery time, radiologist and patient satisfaction rates, incidence of respiratory depression, and incidence of postoperative nausea and vomiting were recorded. RESULTS Although there was no significant difference in the physical movement pain scale, blood oxygen saturation or incidence of perioperative adverse events between the two groups during ablation, the MOAAS, mean arterial pressure (MAP) and heart rate (HR) were higher in Group E than in Group S. The anesthesia recovery time was shorter in Group E than in Group S, and radiologist satisfaction was better in Group E than in Group S, but there was no significant difference between the two groups in terms of patient satisfaction. CONCLUSION Esketamine or Sufentanil combined with Dexmedetomidine is safe for lung tumor PRFA. However, in elderly patients with multiple underlying diseases, low-dose Esketamine combined with Dexmedetomidine has fewer hemodynamic effects on patients, milder respiratory depression, shorter recovery time, and better radiologist satisfaction because of its better controllability of sedation depth. TRIAL REGISTRATION Chinese Clinical Trial Registry (Registration number#ChiCTR ChiCTR21000500 21); Date of Registration: 16/08/2021.
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Affiliation(s)
- Zhonglan Lin
- The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
- Department of Anesthesiology, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, 310006, China
| | - Shuxin Li
- The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Yun Zhou
- The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Xinlei Lu
- The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Bin Yang
- The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Zhengwei Yu
- The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Yuan Cheng
- The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Jianliang Sun
- The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China.
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Parhar D, Baum RA, Spouge R, Yan T, Ho S, Hadjivassiliou A, Machan L, Legiehn G, Klass D, Dhatt R, Boucher LM, Liu DM. Hepatic Hilar Nerve Block for Adjunctive Analgesia during Percutaneous Thermal Ablation of Hepatic Tumors: A Retrospective Analysis. J Vasc Interv Radiol 2023; 34:370-377. [PMID: 36473614 DOI: 10.1016/j.jvir.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/01/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To determine whether hepatic hilar nerve block techniques reduce analgesic and sedation requirements during percutaneous image-guided thermal ablation of hepatic tumors. MATERIALS AND METHODS A single-center retrospective cohort analysis was performed of 177 patients (median age, 67 years; range, 33-86 years) who underwent percutaneous image-guided thermal ablation of liver tumors. All patients were treated utilizing local anesthetic and moderate sedation between November 2018 and November 2021 at a tertiary level hospital, with or without the administration of a hepatic hilar nerve block. Univariable and multivariable linear regression analyses were performed to determine the relationship between the administration of the hilar nerve block and fentanyl and midazolam dosages. RESULTS A total of 114 (64%) patients received a hilar nerve block in addition to procedural sedation, and 63 (36%) patients received procedural sedation alone. There were no significant differences in the baseline demographic and tumor characteristics between the cohorts. The procedure duration was longer in the hilar block cohort than in the unblocked cohort (median, 95 vs 82 minutes; P = .0012). The technical success rate (98% in both the cohorts, P = .93) and adverse event rate (11% vs 3%, P = .14) were not significantly different between the cohorts. After adjusting for patient and tumor characteristics, ablation modality, and procedure and ablation durations, hilar nerve blocks were associated with lower fentanyl (-18.4%, P = .0045) and midazolam (-22.7%, P = .0007) dosages. CONCLUSIONS Hepatic hilar nerve blocks significantly decrease the fentanyl and midazolam requirements during thermal ablation of hepatic tumors, without a significant change in the technical success or adverse event rates.
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Affiliation(s)
- Dennis Parhar
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
| | - Richard A Baum
- Division of Interventional Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rebecca Spouge
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tyler Yan
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Ho
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anastasia Hadjivassiliou
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Machan
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerald Legiehn
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Klass
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ravjot Dhatt
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Louis-Martin Boucher
- Department of Radiology, McGill University Health Centre, Montreal, Québec, Canada
| | - David M Liu
- Division of Interventional Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada; Miller School of Medicine, University of Miami, Coral Gables, Florida
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Radiofrequency Ablation, Cryoablation, and Microwave Ablation for the Treatment of Small Renal Masses: Efficacy and Complications. Diagnostics (Basel) 2023; 13:diagnostics13030388. [PMID: 36766493 PMCID: PMC9914157 DOI: 10.3390/diagnostics13030388] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/22/2023] Open
Abstract
Over the last two decades the detection rate of small renal masses has increased, due to improving diagnostic accuracy, and nephron-sparing treatments have become the first-choice curative option for small renal masses. As a minimally invasive alternative, thermal ablation has increased in popularity, offering a good clinical outcome and low recurrence rate. Radiofrequency ablation, Cryoablation, and Microwave ablation are the main ablative techniques. All of them are mostly overlapping in term of cancer specific free survival and outcomes. These techniques require imaging study to assess lesions features and to plan the procedure: US, CT, and both of them together are the leading guidance alternatives. Imaging findings guide the interventional radiologist in assessing the risk of complication and possible residual disease after procedure. The purpose of this review is to compare different ablative modalities and different imaging guides, underlining the effectiveness, outcomes, and complications related to each of them, in order to assist the interventional radiologist in choosing the best option for the patient.
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Gao S, Zhu Y, Tong M, Wang L, Ren S, Rui L, Yang F, Lian Z, Che Y. Different effects of intravenous and local anesthesia in patients undergoing ultrasound-guided radiofrequency ablation of thyroid nodules: a prospective cohort study. Int J Hyperthermia 2022; 39:1036-1043. [PMID: 35938345 DOI: 10.1080/02656736.2022.2106384] [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: 10/15/2022] Open
Abstract
PURPOSE To compare the efficacy and safety of intravenous anesthesia (IV) with local anesthesia (LA) in patients undergoing ultrasound (US)-guided radiofrequency ablation (RFA) of thyroid nodules. METHODS 50 patients with American Society of Anesthesiologists classification grades I-II undergoing US-guided thyroid RFA were enrolled and randomly (1:1) divided into IV (conscious sedation with Ramsay Sedation Scale [RSS] scores of 2-3 with an anesthesiologist) and LA (subcutaneous anesthesia with lidocaine without an anesthesiologist) groups. Pre-, intra- and post-procedural blood pressure (BP) (SBP0/DBP0, SBP1/DBP1, and SBP2/DBP2), intra- and post-procedural pain (NRS1 and NRS2), ablated area volume, treatment time and adverse events were analyzed and compared. RESULTS Age, sex, weight, number, nature, volume of nodules, and SBP0/DBP0 showed no difference between both groups. 11 and 0 patients' SBP1/DBP1 were elevated in the LA and IV groups. NRS1 differed between both groups. 6 patients in the LA group had moderate or severe pain, but none in the IV group. No between-group difference in SBP2/DBP2, NRS2, ablation completion rate and ablated volume was noted. The median procedure duration differed from 1109 (176) s in IV group and 723 (227) s in LA groups. There was no increased incidence of adverse events in IV group. CONCLUSIONS IV with RSS scores of 2-3 maintained intra-procedural BP and relieved intra-procedural pain better, without affecting the ablation efficacy and increasing complications. Despite increased treatment time, IV is a potential option for patients undergoing US-guided RFA of thyroid nodules.
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Affiliation(s)
- Shuhang Gao
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yalin Zhu
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Mengying Tong
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lina Wang
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuangsong Ren
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liu Rui
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fang Yang
- Department of Ultrasound, Affiliated People's Hospital of Nankai University, Tianjin, China
| | - Zhiqing Lian
- Department of Ultrasound, Central Hospital of Wafangdian, Dalian, China
| | - Ying Che
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
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Perra E, Hayward N, Pritzker KPH, Nieminen HJ. An ultrasonically actuated needle promotes the transport of nanoparticles and fluids. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 152:251. [PMID: 35931509 DOI: 10.1121/10.0012190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
Non-invasive therapeutic ultrasound (US) methods, such as high-intensity focused ultrasound (HIFU), have limited access to tissue targets shadowed by bones or presence of gas. This study demonstrates that an ultrasonically actuated medical needle can be used to translate nanoparticles and fluids under the action of nonlinear phenomena, potentially overcoming some limitations of HIFU. A simulation study was first conducted to study the delivery of a tracer with an ultrasonically actuated needle (33 kHz) inside a porous medium acting as a model for soft tissue. The model was then validated experimentally in different concentrations of agarose gel showing a close match with the experimental results, when diluted soot nanoparticles (diameter < 150 nm) were employed as delivered entity. An additional simulation study demonstrated a threefold increase in the volume covered by the delivered agent in liver under a constant injection rate, when compared to without US. This method, if developed to its full potential, could serve as a cost effective way to improve safety and efficacy of drug therapies by maximizing the concentration of delivered entities within, e.g., a small lesion, while minimizing exposure outside the lesion.
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Affiliation(s)
- Emanuele Perra
- Medical Ultrasonics Laboratory (MEDUSA), Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, 02150, Finland
| | - Nick Hayward
- Medical Ultrasonics Laboratory (MEDUSA), Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, 02150, Finland
| | - Kenneth P H Pritzker
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Heikki J Nieminen
- Medical Ultrasonics Laboratory (MEDUSA), Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, 02150, Finland
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Botsa E, Thanou I, Tavernaraki K, Thanos L. Ablation techniques in non-small cell lung cancer patients: experience of a single center. Hippokratia 2022; 26:105-109. [PMID: 37324042 PMCID: PMC10266325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) are well-established treatments for patients with non-small cell lung cancer (NSCLC). This study assessed the efficacy and safety of RFA and MWA performed on NSCLC patients. MATERIAL AND METHODS This retrospective study included one hundred twenty-four patients with NSCLC who underwent percutaneous ablation from November 2014 to November 2020 in the Department of Medical Imaging and Interventional Radiology of Sotiria General Hospital for Chest Diseases in Athens, Greece. Forty (stage IA) were treated with RFA, while 84 were treated with MWA (stages IA, IB, and IIA). All procedures were performed using the AMICA GEN radiofrequency and microwave generator. As a follow-up method, computed tomography was performed immediately after the procedure to evaluate the lesion's response and complications and one, three, six, and twelve months after the ablation. RESULTS All ablations were technically successful. The first-month follow-up revealed stage IIA residual tumors in eight patients. Local recurrence was detected one year after RFA in two of the 40 patients and thirteen of the 84 patients after MWA. Overall survival (OS) rates at one, two, and three years for stage IA NSCLC patients treated with ablation were 94 %, 73 %, 57 % for RFA, and 96 %, 75 %, and 62 % for MWA, respectively. In contrast, the OS for stages IB and IIA patients treated with MWA was 90 %, 66 %, and 51 % for the IB stage and 82 %, 62 %, and 48 % for the IIA stage, respectively. Fifteen percent of patients after RFA and 9.5 % after MWA experienced minor complications. Pneumothorax was documented in three patients after RFA and four after MWA. Post-ablation syndrome occurred in 15 % of RFA patients and 8.3 % of MWA patients. There were no major complications. CONCLUSION RFA and MWA have comparable efficacy and safety for patients in stage IA. MWA is an effective alternative treatment option for non-resectable IB or IIA stages NSCLC patients. HIPPOKRATIA 2022, 26 (3):105-109.
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Affiliation(s)
- E Botsa
- First Pediatric Clinic, National and Kapodistrian University of Athens, Agia Sofia Children's Hospital, Athens, Greece
| | - I Thanou
- Department of Medical Imaging and Interventional Radiology, Sotiria General Hospital for Chest Diseases, Athens, Greece
| | - K Tavernaraki
- Department of Medical Imaging and Interventional Radiology, Sotiria General Hospital for Chest Diseases, Athens, Greece
| | - L Thanos
- Department of Medical Imaging and Interventional Radiology, Sotiria General Hospital for Chest Diseases, Athens, Greece
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13
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Perra E, Hayward N, Pritzker KPH, Nieminen HJ. An ultrasonically actuated fine-needle creates cavitation in bovine liver. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 151:3690. [PMID: 35778205 DOI: 10.1121/10.0010534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
Ultrasonic cavitation is being used in medical applications as a way to influence matter, such as tissue or drug vehicles, on a micro-scale. Oscillating or collapsing cavitation bubbles provide transient mechanical force fields, which can, e.g., fractionate soft tissue or even disintegrate solid objects, such as calculi. Our recent study demonstrates that an ultrasonically actuated medical needle can create cavitation phenomena inside water. However, the presence and behavior of cavitation and related bioeffects in diagnostic and therapeutic applications with ultrasonically actuated needles are not known. Using simulations, we demonstrate numerically and experimentally the cavitation phenomena near ultrasonically actuated needles. We define the cavitation onset within a liver tissue model with different total acoustic power levels. We directly visualize and quantitatively characterize cavitation events generated by the ultrasonic needle in thin fresh bovine liver sections enabled by high-speed imaging. On a qualitative basis, the numerical and experimental results show a close resemblance in threshold and spatial distribution of cavitation. These findings are crucial for developing new methods and technologies employing ultrasonically actuated fine needles, such as ultrasound-enhanced fine-needle biopsy, drug delivery, and histotripsy.
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Affiliation(s)
- Emanuele Perra
- Medical Ultrasonics Laboratory (MEDUSA), Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, 02150, Finland
| | - Nick Hayward
- Medical Ultrasonics Laboratory (MEDUSA), Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, 02150, Finland
| | - Kenneth P H Pritzker
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Heikki J Nieminen
- Medical Ultrasonics Laboratory (MEDUSA), Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, 02150, Finland
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Lin YM, Bale R, Brock KK, Odisio BC. Contemporary evidence on colorectal liver metastases ablation: toward a paradigm shift in locoregional treatment. Int J Hyperthermia 2022; 39:649-663. [PMID: 35465805 PMCID: PMC11770825 DOI: 10.1080/02656736.2021.1970245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/21/2021] [Accepted: 08/14/2021] [Indexed: 10/18/2022] Open
Abstract
Image-guided percutaneous ablation techniques represent an attractive local therapy for the treatment of colorectal liver metastases (CLM) given its low risk of severe complications, which allows for early initiation of adjuvant therapies and spare functional liver parenchyma, allowing repeated treatments at the time of recurrence. However, ablation does not consistently achieve similar oncological outcomes to surgery, with the latter being currently considered the first-line local treatment modality in international guidelines. Recent application of computer-assisted ablation planning, guidance, and intra-procedural response assessment has improved percutaneous ablation outcomes. In addition, the evolving understanding of tumor molecular profiling has brought to light several biological factors associated with oncological outcomes following local therapies. The standardization of ablation procedures, the understanding of previously unknown biological factors affecting ablation outcomes, and the evidence by ongoing prospective clinical trials are poised to change the current perspective and indications on the use of ablation for CLM.
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Affiliation(s)
- Yuan-Mao Lin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Kristy K. Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruno C. Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Chen PY, Tsai TJ, Yang HY, Chou CK, Chang LJ, Chen TH, Hsu MT, Fang CC, Su CC, Lin YL, Feng YM, Chen CY. The Incidence of Bacteremia and Risk Factors of Post-Radiofrequency Ablation Fever for Patients with Hepato-Cellular Carcinoma. Cancers (Basel) 2021; 13:cancers13215303. [PMID: 34771466 PMCID: PMC8582517 DOI: 10.3390/cancers13215303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
Post-radiofrequency ablation (RFA) fever is a self-limited complication of RFA. The correlation between post-RFA fever and bacteremia and the risk factors associated with post-RFA fever have not been evaluated. Patients with newly diagnosed or recurrent hepatocellular carcinoma who underwent ultrasonography-guided RFA between April 2014 and February 2019 were retrospectively enrolled. Post-RFA fever was defined as any episode of body temperature >38.0 °C after RFA during hospitalization. A total of 272 patients were enrolled, and there were 452 applications of RFA. The frequency of post-RFA fever was 18.4% (83/452), and 65.1% (54/83) of post-RFA fevers occurred on the first day after ablation. Patients with post-RFA fever had a longer hospital stay than those without (9.06 days vs. 5.50 days, p < 0.001). Only four (4.8%) patients with post-RFA fever had bacteremia. The independent factors associated with post-RFA fever were younger age (adjusted odds ratio (OR) = 0.96, 95% CI, 0.94-0.99, p = 0.019), low serum albumin level (adjusted OR = 0.49, 95% CI, 0.25-0.95, p = 0.036), general anesthesia (adjusted OR = 2.06, 95% CI, 1.15-3.69, p = 0.015), tumor size (adjusted OR = 1.52, 95% CI, 1.04-2.02, p = 0.032), and tumor number (adjusted OR = 1.71, 95% CI, 1.20-2.45, p = 0.003).
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Affiliation(s)
- Po-Yueh Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Tsung-Jung Tsai
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Hsin-Yi Yang
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan;
| | - Chu-Kuang Chou
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Li-Jen Chang
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
- Min-Hwei Junior College of Health Care Management, Tainan 73658, Taiwan
| | - Tsung-Hsien Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Ming-Tse Hsu
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Chien-Chung Fang
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Chang-Chao Su
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Yu-Ling Lin
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Yu-Min Feng
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Chi-Yi Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
- Correspondence: ; Tel.: +886-5-2765041 (ext. 62535)
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Ultrasound-Guided Moving Shot Radiofrequency Ablation of Benign Soft Tissue Neoplasm. ACTA ACUST UNITED AC 2021; 57:medicina57080830. [PMID: 34441036 PMCID: PMC8402204 DOI: 10.3390/medicina57080830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 12/16/2022]
Abstract
Background and Objective: To evaluate the effectiveness of radiofrequency ablation (RFA) using the moving-shot technique for benign soft tissue neoplasm. Materials and Methods: This retrospective study reviewed eight patients with benign soft tissue neoplasm presenting with cosmetic concerns and/or symptomatic issues who refused surgery. Six patients had vascular malformation, including four with venous malformation and two with congenital hemangioma. The other two patients had neurofibroma. All patients underwent RFA using the moving-shot technique. Imaging and clinical follow-up were performed in all patients. Follow-up image modalities included ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging. The volume reduction ratio (VRR), cosmetic scale (CS), and complications were evaluated. Results: Among the seven patients having received single-stage RFA, there were significant volume reductions between baseline (33.3 ± 21.2 cm3), midterm follow-up (5.1 ± 3.8 cm3, p = 0.020), and final follow-up (3.6 ± 1.4 cm3, p = 0.022) volumes. The VRR was 84.5 ± 9.2% at final follow-up. There were also significant improvements in the CS (from 3.71 to 1.57, p = 0.017). The remaining patient, in the process of a scheduled two-stage RFA, had a 33.8% VRR after the first RFA. The overall VRR among the eight patients was 77.5%. No complications or re-growth of the targeted lesions were noted during the follow-up period. Of the eight patients, two received RFA under local anesthesia, while the other six patients were under general anesthesia. Conclusions: RFA using the moving-shot technique is an effective, safe, and minimally invasive treatment for benign soft tissue neoplasms, achieving mass volume reduction within 6 months and significant esthetic improvement, either with local anesthesia or with general anesthesia under certain conditions.
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Lin YM, Paolucci I, Brock KK, Odisio BC. Image-Guided Ablation for Colorectal Liver Metastasis: Principles, Current Evidence, and the Path Forward. Cancers (Basel) 2021; 13:3926. [PMID: 34439081 PMCID: PMC8394430 DOI: 10.3390/cancers13163926] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
Image-guided ablation can provide effective local tumor control in selected patients with CLM. A randomized controlled trial suggested that radiofrequency ablation combined with systemic chemotherapy resulted in a survival benefit for patients with unresectable CLM, compared to systemic chemotherapy alone. For small tumors, ablation with adequate margins can be considered as an alternative to resection. The improvement of ablation technologies can allow the treatment of tumors close to major vascular structures or bile ducts, on which the applicability of thermal ablation modalities is challenging. Several factors affect the outcomes of ablation, including but not limited to tumor size, number, location, minimal ablation margin, RAS mutation status, prior hepatectomy, and extrahepatic disease. Further understanding of the impact of tumor biology and advanced imaging guidance on overall patient outcomes might help to tailor its application, and improve outcomes of image-guided ablation.
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Affiliation(s)
- Yuan-Mao Lin
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
| | - Iwan Paolucci
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
| | - Kristy K. Brock
- Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Bruno C. Odisio
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
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Percutaneous ablation versus surgical ablation and resection of liver tumors: medicare volume and physician reimbursement trends from 2010 to 2018. Abdom Radiol (NY) 2021; 46:4056-4061. [PMID: 33772616 DOI: 10.1007/s00261-021-03054-3] [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: 02/01/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study is to analyze trends in Medicare volume and physician reimbursement for percutaneous ablation, surgical ablation, and resection of liver tumors from 2010 to 2018. METHODS Claims from the Medicare Part B PSPSMF for the years 2010 to 2018 were extracted using the CPT codes for percutaneous and surgical ablation of liver tumors and surgical liver resection. Total procedural volume and physician payment were analyzed by procedure and physician specialty. RESULTS From 2010 to 2018, the volume of percutaneous ablation of liver tumors increased 94.3% from 1630 to 3168 procedures, and the volume of surgical ablations increased 86.2% from 593 to 1104 procedures. In contrast, there was a 16.8% decrease in liver resections from 10,807 to 8994 procedures. Physician reimbursement for percutaneous ablation decreased from $702.41 to $610.11 (- 13.1%). Conversely, reimbursement for resection increased from $849.18 to $1015.06 (19.5%). Reimbursement for surgical ablation also increased from $722.36 to $744.25 (3.0%). In 2018, physician reimbursement for resection and surgical ablation were 66% and 22% more than that for percutaneous ablation. CONCLUSION An increasing number of patients with liver tumors were treated with percutaneous ablation from 2010 to 2018. Despite higher morbidity, a dwindling set of theoretical advantages over percutaneous ablation, and higher overall costs, the volume of surgical ablation also increased over this time period. The findings of this study suggest that a reevaluation of practice and referral patterns for surgical ablation of liver tumors is warranted in many institutions.
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Loh PS, Yeong CH, Masohood NS, Sulaiman N, Zaki RA, Fabell K, Abdullah BJJ. Comparison of deep and moderate neuromuscular blockade in microwave ablation of liver tumours: a randomized-controlled clinical trial. Sci Rep 2021; 11:2299. [PMID: 33504909 PMCID: PMC7840903 DOI: 10.1038/s41598-021-81913-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/07/2021] [Indexed: 01/18/2023] Open
Abstract
Microwave ablation (MWA) is gaining popularity for the treatment of small primary hepatocellular carcinoma and metastatic lesions especially if patients are not candidates for surgical resection. Deep neuromuscular blockade (DMB) is perceived to improve surgical working conditions compared to moderate neuromuscular blockade (MMB) but no studies have examined the same benefits in MWA of liver tumours. This study aimed to compare the clinical outcomes of DMB and MMB in MWA of liver tumours in terms of liver excursion, performance scores by the interventional radiologists and patients, requirements of additional muscle relaxants and complications. 50 patients were recruited and 45 patients (22 in MMB group, 23 in DMB group) completed the study. The mean liver excursion for the MMB group (1.42 ± 1.83 mm) was significantly higher than the DMB group (0.26 ± 0.38 mm) (p = 0.001). The mean Leiden-Surgical Rating Scale (L-SRS) rated by the two interventional radiologists were 4.5 ± 0.59 and 3.6 ± 0.85 for the DMB and MMB groups, respectively (p = 0.01). There was also statistically significant difference on patient satisfaction scores (0–10: Extremely Dissatisfied–Extremely Satisfied) between DMB (8.74 ± 1.1) and MMB (7.86 ± 1.25) groups (p = 0.01). 5 patients from MMB group and none from DMB group required bolus relaxant during the MWA procedure. Adverse events were also noted to be more severe in the MMB group. In conclusion, DMB significantly reduced liver excursion and movement leading to improved accuracy, safety and success in ablating liver tumour.
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Affiliation(s)
- Pui San Loh
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chai Hong Yeong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, 47500, Subang Jaya, Selangor, Malaysia.
| | - Naeema S Masohood
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Norshazriman Sulaiman
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Rafdzah Ahmad Zaki
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Kamil Fabell
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Basri Johan Jeet Abdullah
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Is there a place for regional anesthesia in nonoperating room anesthesia? Curr Opin Anaesthesiol 2020; 33:561-565. [DOI: 10.1097/aco.0000000000000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang J, Yuan X, Guo W, Xiang X, Wu Q, Fang M, Zhang W, Ding Z, Xie K, Fang J, Zhou H, Fu S. Sedation and Analgesia for Liver Cancer Percutaneous Radiofrequency Ablation: Fentanyl and Oxycodone Comparison. Int J Med Sci 2020; 17:2194-2199. [PMID: 32922181 PMCID: PMC7484665 DOI: 10.7150/ijms.47067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Sedation and analgesia use in percutaneous radiofrequency ablation (RFPA) for liver cancer is a necessary part of the procedure; however, the optimal medicine for sedation and analgesia for PRFA remains controversial. The aim of this study was to compare the perioperative pain management, haemodynamic stability and side effects between oxycodone (OXY) and fentanyl (FEN) use in patients under dexmedetomidine sedation. Methods: Two hundred and five adults with an American Society of Anaesthesiologists physical status score of I to II were included in this study. Patients were assigned to the OXY (n=101) or FEN (n=104) group. Radiofrequency ablation was performed under spontaneous breathing and with painless anaesthesia administered intravenously. The outcomes included fluctuations in mean arterial pressure, heart rate, side effects and the perioperative numerical rating scale (NRS). Results: Radiofrequency ablation was successfully performed in 205 patients. No significant differences were observed in mean blood pressure fluctuations between the two groups despite the longer durations of ablation and total sedation time in the OXY group. The highest NRS score during the surgery and 1 hour and 2 hours after the surgery were significantly lower in the OXY group than in the FEN group. Heart rate fluctuations were significantly lower in the OXY group than in FEN group throughout the surgery. More patients in the FEN group displayed unwanted body movement and respiratory depression. Conclusions: Both oxycodone and fentanyl can be applied for liver cancer percutaneous radiofrequency ablation; however, oxycodone provides a better patient experience, lower postoperative pain, less respiratory depression and stable haemodynamic fluctuations.
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Affiliation(s)
- Jiangling Wang
- Department of Anaesthesiology, Cancer Hospital of the University of Chinese Academy and Sciences. Zhejiang, Hangzhou, 310022, China
| | - Xiaohong Yuan
- Department of Anaesthesiology, Cancer Hospital of the University of Chinese Academy and Sciences. Zhejiang, Hangzhou, 310022, China
| | - Wenjing Guo
- Department of Anaesthesiology, Cancer Hospital of the University of Chinese Academy and Sciences. Zhejiang, Hangzhou, 310022, China
| | - Xiaobin Xiang
- Department of Anaesthesiology, Cancer Hospital of the University of Chinese Academy and Sciences. Zhejiang, Hangzhou, 310022, China
| | - Qicheng Wu
- Department of Anaesthesiology, Cancer Hospital of the University of Chinese Academy and Sciences. Zhejiang, Hangzhou, 310022, China
| | - Man Fang
- Department of Anaesthesiology, Cancer Hospital of the University of Chinese Academy and Sciences. Zhejiang, Hangzhou, 310022, China
| | - Wen Zhang
- Department of Anaesthesiology, Cancer Hospital of the University of Chinese Academy and Sciences. Zhejiang, Hangzhou, 310022, China
| | - Zewu Ding
- Department of Anaesthesiology, Cancer Hospital of the University of Chinese Academy and Sciences. Zhejiang, Hangzhou, 310022, China
| | - Kangjie Xie
- Department of Anaesthesiology, Cancer Hospital of the University of Chinese Academy and Sciences. Zhejiang, Hangzhou, 310022, China
| | - Jun Fang
- Department of Anaesthesiology, Cancer Hospital of the University of Chinese Academy and Sciences. Zhejiang, Hangzhou, 310022, China
| | - Huidan Zhou
- Department of Anaesthesiology, Cancer Hospital of the University of Chinese Academy and Sciences. Zhejiang, Hangzhou, 310022, China
| | - Shuang Fu
- Department of Anaesthesiology, Cancer Hospital of the University of Chinese Academy and Sciences. Zhejiang, Hangzhou, 310022, China
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Offi C, Garberoglio S, Antonelli G, Esposito MG, Brancaccio U, Misso C, D’Ambrosio E, Pace D, Spiezia S. The Ablation of Thyroid Nodule's Afferent Arteries Before Radiofrequency Ablation: Preliminary Data. Front Endocrinol (Lausanne) 2020; 11:565000. [PMID: 33643218 PMCID: PMC7906008 DOI: 10.3389/fendo.2020.565000] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 12/18/2020] [Indexed: 12/18/2022] Open
Abstract
Induced radiofrequency thermal ablation is the cytoreductive treatment of symptomatic benign thyroid nodules, metastatic and recurrent thyroid tumors and papillary thyroid microcarcinomas. It is a safe and effective alternative to surgery and it allows to obtain satisfactory results in terms of volumetric reduction of the nodule with significant improvement in the quality of life. The trans-isthmic approach and the moving shot technique are the two basic techniques; however, an advanced technique, artery-first feeding radiofrequency ablation, has been developed and validated. We have prospectively included 29 consecutive patients who have undergone radiofrequency ablation (Group A) or artery- first vRFA (Group B). All included patients had a diagnosis of benign nodular goiter and they underwent a single session of radiofrequency ablation. All patients followed a follow-up program at 1 month, 3 months, and 6 months. Continuous variables (age, TSH value, basal volume of nodule, used Joule, time in second of the procedure, nodules' volume at 1-, 3-, and 6- months of follow-up and percentage of volume reduction at 1-, 3-, and 6- months of follow-up) were described as mean, standard deviation and range, while categorical variables (gender, nodule structure and nodule vascularization) were described as number of cases and percentage. Independent samples t-test were performed to compare the continuous variables. A Test of Proportions was applied to the categorical variables. The Fisher's exact test was used to analyze the gender. Statistical significance was considered in case of p-value <0.05. Solid structure and spongiform structure showed statistic differences with p-values of 0.022 and 0.023 respectively between two groups. The percentage of reduction at 1 month did not show a significant difference between two groups; instead, the percentage of volume reduction was decreased mostly in the Group B at 3 months and 6 months of follow-up with a p-value of 0.003 and 0.013, respectively. The Joules/energy used showed a statistically significant difference (p-value=0.05), more energy must be used in vascular radiofrequency ablation. These data allow us to hypothesize that vRFA may improve the effectiveness of the procedure, allowing for a reduction in volume more quickly. They were preliminary but promising results, clearly a larger series of cases and prolonged follow-up are needed to clarify and confirm our observations.
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Affiliation(s)
- Chiara Offi
- Department of Endocrine and Ultrasound-guided Surgery, “Ospedale del Mare”, Naples, Italy
| | - Sara Garberoglio
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanni Antonelli
- Department of Endocrine and Ultrasound-guided Surgery, “Ospedale del Mare”, Naples, Italy
| | - Maria Grazia Esposito
- Department of Endocrine and Ultrasound-guided Surgery, “Ospedale del Mare”, Naples, Italy
| | - Umberto Brancaccio
- Department of Endocrine and Ultrasound-guided Surgery, “Ospedale del Mare”, Naples, Italy
| | - Claudia Misso
- Department of Endocrine and Ultrasound-guided Surgery, “Ospedale del Mare”, Naples, Italy
| | - Edoardo D’Ambrosio
- Department of Endocrine and Ultrasound-guided Surgery, “Ospedale del Mare”, Naples, Italy
| | - Daniela Pace
- Department of Endocrinology, Valmontone Hospital, Valmontone, Italy
| | - Stefano Spiezia
- Department of Endocrine and Ultrasound-guided Surgery, “Ospedale del Mare”, Naples, Italy
- *Correspondence: Stefano Spiezia,
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