The frequency and risk factors of major complications after thermal ablation of liver tumours in 2,084 ablation sessions

Multi-Organ Denervation: The Past, Present and Future

The sympathetic division of the autonomic nervous system plays a crucial role in maintaining homeostasis, but its overactivity is implicated in various pathological conditions, including hypertension, hyperglycaemia, heart failure, and rheumatoid arthritis. Traditional pharmacotherapies often face limitations such as side effects and poor patient adherence, thus prompting the exploration of device-based multi-organ denervation as a therapeutic strategy. Crucially, this procedure can potentially offer therapeutic benefits throughout the 24 h circadian cycle, described as an "always-on" effect independent of medication compliance and pharmacokinetics. In this comprehensive review, we evaluate the evidence behind targeted multi-organ sympathetic denervation by considering the anatomy and function of the autonomic nervous system, examining the evidence linking sympathetic nervous system overactivity to various cardiometabolic and inflammatory conditions and exploring denervation studies within the literature. So far, renal denervation, developed in 2010, has shown promise in reducing blood pressure and may have broader applications for conditions including arrhythmias, glucose metabolism disorders, heart failure, chronic kidney disease and obstructive sleep apnoea. We review the existing literature surrounding the denervation of other organ systems including the hepatic and splenic arteries, as well as the pulmonary artery and carotid body, which may provide additional physiological benefits and enhance therapeutic effects if carried out simultaneously. Furthermore, we highlight the challenges and future directions for implementing multi-organ sympathetic ablation, emphasising the need for further clinical trials to establish optimal procedural technique, efficacy and safety.

Cryoablation versus microwave ablation in the treatment of hepatocellular carcinoma: A Systematic Review and meta-analysis

To evaluate the efficacy and safety of cryoablation (CRA) versus microwave ablation (MWA) for hepatocellular carcinoma (HCC). The PubMed, Embase, Cochrane Library, CNKI, Wan Fang and VIP databases were searched to obtain all related studies on CRA and MWA from the inception dates to July 2022. The Meta-analysis was performed by the RevMan5.3 software. Five studies comparing CRA with MWA were eligible and 470 HCC patients were included in the analysis. No statistically significant differences in complete ablation rate (OR = 1.17, 95 % CI: 0.36-3.79, P > 0.05), local recurrence rate (OR = 0.25, 95 % CI: 0.05-1.29, P = 0.10), 1-year survival rate (OR = 2.07, 95 % CI: 0.89-4.79, P > 0.05) and postoperative decreased value of AFP (MD = -1.63, 95 % CI: -83.13-79.87, P > 0.05) were observed; however, CRA was associated with a significantly lower major complication rate (OR = 0.06, 95 % CI: 0.01-0.31, P < 0.05) compared with MWA. CRA had comparable outcomes to MWA in terms of complete ablation, local recurrence, 1-year survival and postoperative reduced AFP, meanwhile, CRA demonstrated favorable safety, and CRA may be a recommended ablation treatment for HCC.

Risk factors of complications after thermal ablation for hepatocellular carcinoma: the role of assessment of liver background

OBJECTIVE

To use an elastography technology and other clinical and radiological data for assessment of liver background and analyze risk factors of complications after thermal ablation in patients with hepatocellular carcinoma.

METHODS

Demographics, laboratory analyses, and radiological characteristics were collected from all patients. Main elastography-related indicators included F index (fibrosis index), A index (inflammation index), ATT (attenuation coefficient), E (kPa), AREA (area of blue parts), and CORR (correlation). All complications after thermal ablation were collected. Univariate analysis was performed to detect significant variables, which subsequently entered a stepwise logistic regression analysis (conditional forward selection) to identify independent variables.

RESULTS

A total of 218 patients from October 2020 to June 2023 with 291 thermal ablation sessions were enrolled. 115 patients (52.8%) developed complications. Fifteen patients (6.9%) developed major complications. Minor complications included postoperative pain (20.6%), fever (19.3%), effusion (22.5%), and hyperammonemia (1.8%). AREA (P = 0.034), tumor size (P = 0.005), and abnormal aspartate aminotransferase (AST) (P = 0.018) were independent predictors for complications. F index (P = 0.021), tumor size (P < 0.001), and abnormal AST (P = 0.047) were independent predictors for effusion. The results of univariate analysis of infection showed that tumor size, CORR, ATT, diabetes, Child-Turcotte-Pugh grade, abnormal AST, total protein, and albumin were significant (all P < 0.05).

CONCLUSION

Several radiological and combinational elastography indicators related to liver fibrosis, steatosis, or inflammation were significantly correlated with the occurrence of complications. Clinical assessment of the liver background should not be neglected in the management of postablation complications.

Postoperative SIRS after thermal ablation of HCC: Risk factors and short-term prognosis

Background

We aimed to explore the potential risk factors and short-term prognosis for SIRS after thermal ablation of hepatocellular carcinoma (HCC).

Methods

Data from patients with HCC who underwent thermal ablation in the Third Affiliated Hospital of Sun Yat-sen University between January 2015 and August 2021 were retrieved from the perioperative database. Pre-, intra- and postoperative data between SIRS group and non-SIRS group were compared and multivariate logistic regression analysis was performed to identify the risk factors for SIRS after thermal ablation.

Results

A total of 1491 patients were enrolled and 234 (15.7 %) patients developed SIRS after thermal ablation. Compared with those without SIRS, patients with SIRS had a longer hospital stay, higher hospitalization costs and higher risk of more severe postoperative complications. In the multivariate logistic regression analysis, current smoking (OR 1.58, 95 %CI 1.09-2.29), decreased HCT (OR 1.51,95 %CI 1.11-2.04), NEUT < 1.5 × 109/L(OR 1.74, 95 %CI 1.14-2.65), NEUT% < 0.5 or > 0.7 (OR 1.36, 95 %CI 1.01-1.83) and PT > 16.3s (OR 2.42, 95 %CI 1.57-3.74) were significantly associated with postoperative SIRS.

Conclusions

Current smoking, decreased HCT, neutropenia, abnormal percentage of neutrophils and prolonged PT are the independent risk factors for SIRS after thermal ablation of HCC, which worsens outcomes of patients. This study can help identify high-risk population and guide appropriate care so as to reduce the incidence of postoperative SIRS.