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Ishigami A, Inaka S, Ishida Y, Nosaka M, Kuninaka Y, Yamamoto H, Shimada E, Kimura A, Furukawa F, Kondo T. A case of hemoperitoneum after percutaneous radiofrequency ablation in a patient with hepatocellular carcinoma. Forensic Sci Med Pathol 2024; 20:189-193. [PMID: 36943648 DOI: 10.1007/s12024-023-00601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/23/2023]
Abstract
We report a case of hemoperitoneum after percutaneous radiofrequency ablation in a patient with hepatocellular carcinoma. A 60-year-old female was hospitalized for the treatment of thrombasthenia and cirrhosis caused by chronic Hepatitis C, and computed tomography revealed hepatocellular carcinoma, which was treated by percutaneous radiofrequency ablation. After the ablation, hemoperitoneum was suspected because of the low hemoglobin level with abdominal pain. Approximately 6 h after the ablation treatment, the patient suddenly fell into a shock state and died. In this case, medical treatment-related death including malpractice was suspected, and forensic autopsy was performed. The abdominal cavity contained 910 mL of dark red fluid blood and 210 g of soft hemocoagula. Moreover, several puncture marks were observed on the liver surface and diaphragm, and there was no clear damage to the main arteries and veins. Considering the macroscopic and microscopic findings, the cause of death was assumed as hemorrhagic shock due to the hemoperitoneum caused by the damage to the liver by radiofrequency ablation. It is important to consider all the indications and adverse effects of radiofrequency ablation.
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Affiliation(s)
- Akiko Ishigami
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Shogo Inaka
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Yuko Ishida
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Mizuho Nosaka
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Yumi Kuninaka
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Hiroki Yamamoto
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Emi Shimada
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Akihiko Kimura
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Fukumi Furukawa
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Toshikazu Kondo
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan.
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Shyn PB, Seyal AR, Gottumukkala RV, Silverman SG, Bhagavatula SK, Alencar RO, Dabiri BE, Souza DAT, Cosman ER, Kapur T. Feasibility and safety of bipolar radiofrequency track cautery during percutaneous image-guided abdominal biopsy procedures. Abdom Radiol (NY) 2024; 49:586-596. [PMID: 37816800 DOI: 10.1007/s00261-023-04054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE The purpose of this study was to assess the feasibility and safety of using a bipolar radiofrequency track cautery device during percutaneous image-guided abdominal biopsy procedures in at-risk patients. METHODS Forty-two patients (26-79 years old; female 44%) with at least one bleeding risk factor who underwent an abdominal image-guided (CT or US) biopsy and intended bipolar radiofrequency track cautery (BRTC) were retrospectively studied. An 18G radiofrequency electrode was inserted through a 17G biopsy introducer needle immediately following coaxial 18G core biopsy, to cauterize the biopsy track using temperature control. Bleeding risk factors, technical success, and adverse events were recorded. RESULTS BRTC was technically successful in 41/42 (98%) of procedures; in one patient, the introducer needle retracted from the liver due to respiratory motion prior to BRTC. BRTC following percutaneous biopsy was applied during 41 abdominal biopsy procedures (renal mass = 12, renal parenchyma = 10, liver mass = 9, liver parenchyma = 5, splenic mass or parenchyma = 4, gastrohepatic mass = 1). All patients had one or more of the following risk factors: high-risk organ (spleen or renal parenchyma), hypervascular mass, elevated prothrombin time, renal insufficiency, thrombocytopenia, recent anticoagulation or anticoagulation not withheld for recommended interval, cirrhosis, intraprocedural hypertension, brisk back bleeding observed from the introducer needle, or subcapsular tumor location. No severe adverse events (grade 3 or higher) occurred. Two (2/41, 5%) mild (grade 1) bleeding events did not cause symptoms or require intervention. CONCLUSION Bipolar radiofrequency track cautery was feasible and safe during percutaneous image-guided abdominal biopsy procedures. IRB approval: MBG 2022P002277.
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Affiliation(s)
- Paul B Shyn
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
| | - Adeel R Seyal
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Ravi V Gottumukkala
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Stuart G Silverman
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Sharath K Bhagavatula
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Raquel O Alencar
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Borna E Dabiri
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Daniel A T Souza
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Eric R Cosman
- Cambridge Interventional, LLC, 78 Cambridge St., Burlington, MA, 01803, USA
| | - Tina Kapur
- Department of Radiology, Abdominal Imaging and Intervention, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
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Hoskovec D, Hořejš J, Krška Z, Argalácsová S, Klobušický P. Diaphragmatic Liver Herniation after Radiofrequency Ablation of a Secondary Liver Tumor. Diagnostics (Basel) 2023; 14:26. [PMID: 38201334 PMCID: PMC10796074 DOI: 10.3390/diagnostics14010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Radiofrequency thermal ablation (RFA) is widely used and has been accepted for the treatment of unresectable tumors. The leading technique that is used is percutaneous RFA under CT or US guidance. Multicenter surveys report acceptable morbidity and mortality rates for RFA. The mortality rate ranges from 0.1% to 0.5%, the major complication rate ranges from 2% to 3%. Diaphragmatic injury is a rare complication and it is described after RFA of subdiaphragmatic tumors. Most of them are without clinical importance. There are some case reports about diaphragmatic herniation of the intestine into the pleural cavity. We present a case of diaphragmatic perforation resulting in the herniation of the liver into the pleural cavity. A thoracotomy was performed, the liver was lowered back into the peritoneal cavity and the perforation was closed with mesh.
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Affiliation(s)
- David Hoskovec
- 1st Department of Surgery, 1st Faculty of Medicine Charles University and General University Hospital, 121 08 Prague, Czech Republic;
| | - Josef Hořejš
- Department of Radiodiagnostics, 1st Faculty of Medicine Charles University and General University Hospital, 121 08 Prague, Czech Republic;
| | - Zdeněk Krška
- 1st Department of Surgery, 1st Faculty of Medicine Charles University and General University Hospital, 121 08 Prague, Czech Republic;
| | - Soňa Argalácsová
- Department of Oncology, 1st Faculty of Medicine Charles University and General University Hospital, 121 08 Prague, Czech Republic;
| | - Pavol Klobušický
- 1st Medical Faculty, Charles University, 128 00 Prague, Czech Republic;
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Kang M, Cho JY, Han HS, Yoon YS, Lee HW, Lee B, Park Y, Kim J, Yoon CJ. Comparative Study of Long-Term Outcomes of Laparoscopic Liver Resection versus Radiofrequency Ablation for Single Small Hepatocellular Carcinoma Located in Left Lateral Segments of the Liver. Medicina (Kaunas) 2023; 59:1063. [PMID: 37374267 DOI: 10.3390/medicina59061063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Laparoscopic liver resection (LLR) is now widely recognized as the primary surgical option for hepatocellular carcinomas (HCC) smaller than 3 cm located in the left lateral segment of the liver. Nevertheless, there is a scarcity of studies comparing laparoscopic liver resection with radiofrequency ablation (RFA) in these cases. Materials and Methods: We retrospectively compared the short- and long-term outcomes of Child-Pugh class A patients who underwent LLR (n = 36) or RFA (n = 40) for a newly diagnosed single small (≤3 cm) HCC located in the left lateral segment of the liver. Results: Overall survival (OS) was not significantly different between the LLR and RFA groups (94.4% vs. 80.0%, p = 0.075). However, disease-free survival (DFS) was better in the LLR group than in the RFA group (p < 0.001), with 1-, 3-, and 5-year DFS rates of 100%, 84.5%, and 74.4%, respectively, in the LLR group vs. 86.9%, 40.2%, and 33.4%, respectively, in the RFA group. The hospital stay was significantly shorter in the RFA group than in the LLR (2.4 vs. 4.9 days, p < 0.001). The overall complication rate was higher in the RFA group than in the LLR group (15% vs. 5.6%). In patients with an α-fetoprotein level of ≥20 ng/mL, the 5-year OS (93.8% vs. 50.0%, p = 0.031) and DFS (68.8% vs. 20.0%, p = 0.002) rates were greater in the LLR group. Conclusions: LLR showed superior OS and DFS compared to RFA in patients with a single small HCC situated in the left lateral segment of the liver. LLR can be considered for patients with an α-fetoprotein level of ≥20 ng/mL.
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Affiliation(s)
- MeeYoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Hae Won Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Boram Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Yeshong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Jinju Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
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Ma J, Zhu J, Ding T, Cai L, Zhou C, Zhang Y. Thrombus formation in the suprahepatic inferior vena cava after microwave ablation in patients with hepatic metastasis: a case report. Thromb J 2023; 21:36. [PMID: 37016383 PMCID: PMC10071747 DOI: 10.1186/s12959-023-00481-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/29/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Microwave ablation (MWA) via ultrasound guidance is an important tool in the treatment of liver metastases. The most common postoperative complications are abdominal hemorrhage and bile leakage, whereas thrombosis in the suprahepatic inferior vena cava (IVC) is very rare, and clinical management is very difficult when the head end of the thrombus reaches the right atrium. CASE PRESENTATION This is a case report of a 52-year-old man with hepatic metastasis 21 months after radical resection of rectal cancer. After chemotherapy combined with targeted therapy, metastasis in segment IV (S4) of the liver was treated with microwave ablation. Two months after treatment, the hepatic metastasis in S4 showed a microwave ablation zone on MRI.Enhanced MRI showed venous thrombosis located in the left hepatic vein and IVC, and the head of the thrombus reached the right atrium. After two weeks of anticoagulation and thrombolytic treatment, the follow-up MRI showed that the venous thrombus had nearly disappeared. CONCLUSION When liver metastases are close to the hepatic vein, clinicians should pay attention to the occurrence of hepatic vein and IVC thrombosis following MWA; through early diagnosis and anticoagulation, pulmonary thromboembolism (PTE) can be minimized.
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Affiliation(s)
- Jun Ma
- Department of General Surgery, Anqing Municipal Hospital, No. 352, Ren-Ming Road, Anqing, Anhui Province, 24600, P.R. China
| | - Juan Zhu
- Department of Imaging, Anqing Municipal Hospital, Anqing, 246000, P.R. China
| | - Tengyun Ding
- Department of Ultrasound, Anqing Municipal Hospital, Anqing, 246000, P.R. China
| | - Libin Cai
- Department of Imaging, Anqing Municipal Hospital, Anqing, 246000, P.R. China
| | - Chaoping Zhou
- Department of General Surgery, Anqing Municipal Hospital, No. 352, Ren-Ming Road, Anqing, Anhui Province, 24600, P.R. China
| | - Yaming Zhang
- Department of General Surgery, Anqing Municipal Hospital, No. 352, Ren-Ming Road, Anqing, Anhui Province, 24600, P.R. China.
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Domini J, Makary MS. Single-center analysis of percutaneous ablation in the treatment of hepatocellular carcinoma: long-term outcomes of a 7-year experience. Abdom Radiol (NY) 2023; 48:1173-1180. [PMID: 36717404 DOI: 10.1007/s00261-023-03819-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE The objective of this study is to examine the safety and efficacy of ablative therapy for hepatocellular carcinoma (HCC). METHODS A retrospective review of 419 consecutive patients diagnosed with HCC, treated with percutaneous ablation at a tertiary academic medical center from June 2015 to June 2022, was conducted. Data evaluated included demographics, disease and tumor burden scores, and functional status. Procedural outcomes included procedural course, complication rates, biochemical and radiologic response, survival, and functional status. RESULTS A total of 419 patients, including 313 males (74.7%) and 106 females (25.3%) with a mean age of 63.8 ± 6.64 years, made up the study cohort. 120 patients (28.6%) presented with solitary lesions and 299 patients (71.4%) had multifocal involvement, with a mean tumor size of 2.3 ± 0.92 cm. A majority of the interventions performed were microwave ablations (n = 413, 98.3%), with 6 radiofrequency ablations (1.4%). Treatment response was radiographically assessed up to 6 months post-ablation and graded as complete response (96.2%), partial response (2.6%), stable disease (0%), and progressive disease (1.2%). 97 (23.2%) of the treated patients went on to receive liver transplant. The average progression-free survival in the study population was 24 months with a survival of 85.9% (n = 360), 67.8% (n = 284), and 63.2% (n = 265) at 1 year, 3 years, and 5 years respectively. Functional outcomes, as defined by ECOG scores, were maintained or improved in 383 patients (91.4%) and 349 patients (83.3%) at 6 months and 12 months respectively. CONCLUSIONS This large institutional experience demonstrated safety and efficacy of ablation therapies for treatment of HCC with promising tumor response rates and enduring clinical outcomes including prolonged survival and preserved functional status.
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Affiliation(s)
- John Domini
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12Th Ave, 4Th Floor Faculty Office Tower, Columbus, OH, 43210, USA
| | - Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12Th Ave, 4Th Floor Faculty Office Tower, Columbus, OH, 43210, USA.
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Jo MG, Lee MW, Ahn S, Kang TW, Song KD, Cha DI, Min JH, Rhim H. Percutaneous radiofrequency ablation of hepatocellular carcinoma in a recent cohort at a tertiary cancer center: incidence and factors associated with major complications and unexpected hospitalization events. Ultrasonography 2023; 42:41-53. [PMID: 36353791 PMCID: PMC9816693 DOI: 10.14366/usg.22041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/23/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE This study aimed to assess the incidence of and factors associated with major complications, delayed discharge, and emergency room (ER) visits or readmission after percutaneous radiofrequency ablation (RFA) for single hepatocellular carcinoma (HCC) <3 cm in a recent cohort at a tertiary cancer center. METHODS A total of 188 patients with treatment-naïve single HCCs <3 cm who underwent RFA between January 2018 and April 2021 were included in the analysis. Univariable and multivariable logistic regression analyses were performed to identify the factors associated with major complications, delayed discharge, and ER visits or readmission. Local tumor progression (LTP) and overall survival were estimated using the Kaplan-Meier method and Cox proportional-hazards regression analysis. RESULTS Major complications occurred in 3.2% (6/188) of the patients. The longest diameter of the ablation zone was significantly larger in patients with major complications (P=0.023). Delayed discharge occurred in 5.8% (9/188) of the patients, for which albumin-bilirubin grade 3 was identified as an important determinant. No variables other than major complications were significantly associated with ER visits or readmission, which occurred in 7.0% (13/188) of the patients. Major complications, delayed discharge, and ER visits or readmission were not substantially related to the post-treatment outcomes of LTP and overall survival. CONCLUSION This study confirmed RFA as a highly safe procedure for single HCCs <3 cm, despite the rapidly changing RFA techniques in the most recent cohort. A large ablation zone and poor liver function were predictors of major complications and delayed discharge, respectively.
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Affiliation(s)
- Min Geun Jo
- Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea,Correspondence to: Min Woo Lee, MD, PhD, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel. +82-2-3410-2518 Fax. +82-2-3410-2559 E-mail:
| | - Soohyun Ahn
- Department of Mathematics, Ajou University, Suwon, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
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Wu T, Gong X, Wang X, Li L, Chen Z, Yuan P, Xie J, Gong L, Wang X, Zhao Y, Wei Y. Perinatal and neurodevelopmental outcome in complicated monochorionic pregnancy after selective fetal reduction: radiofrequency ablation vs microwave ablation. Ultrasound Obstet Gynecol 2022; 60:506-513. [PMID: 35468234 DOI: 10.1002/uog.24919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To summarize our experience in the application of radiofrequency ablation (RFA) and microwave ablation (MWA) for selective fetal reduction in complicated monochorionic pregnancies and compare the perinatal outcome of the two techniques. METHODS This was a retrospective study of data from a consecutive cohort of all monochorionic twin pregnancies that underwent selective fetal reduction with RFA or MWA at Peking University Third Hospital, Beijing, China from January 2012 to December 2018. All surviving cotwins were followed up to assess their neurodevelopment using the Age & Stage Questionnaire, Chinese version. Perinatal and neurodevelopmental outcomes were compared between the RFA and MWA groups. We also fitted multivariable models to test the association between procedure-related factors and the main perinatal outcomes, including preterm birth (PTB) < 37 weeks' gestation, intrauterine fetal death (IUFD) of the cotwin, adverse outcome (defined as occurrence of IUFD of the cotwin, termination of pregnancy or PTB < 28 weeks) and overall survival. RESULTS In total, 45 cases (42 twin and three triplet pregnancies) underwent RFA and 126 cases (105 twin and 21 triplet pregnancies) underwent MWA. The overall survival rates in monochorionic diamniotic twin pregnancies were similar between the RFA and MWA groups (61.0% vs 67.0%; P = 0.494). However, pregnancies whose indication for fetal reduction was selective intrauterine growth restriction or twin reversed arterial perfusion had higher overall survival rates (75.5% and 82.6%, respectively) compared with those in other indication groups. A total of 104 children were followed up (20 in the RFA group and 84 in the MWA group); four (20.0%) and eight (9.5%) children were assessed as having overall developmental delay in the RFA and MWA groups, respectively, with no significant difference between the two groups. Multivariable analyses showed that procedure indication, number of ablation cycles and gestational age at procedure were associated significantly with the main perinatal outcomes. CONCLUSIONS RFA and MWA for selective fetal reduction in complicated monochorionic pregnancies can achieve similar overall survival rate and neurodevelopmental outcome, but MWA is associated with a lower risk of preterm birth. Moreover, procedure-related factors are associated significantly with perinatal outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Wu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - X Gong
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - X Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - L Li
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Z Chen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - P Yuan
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - J Xie
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - L Gong
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - X Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Y Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Y Wei
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
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Huang Q, Pang M, Zeng Q, He X, Zheng R, Ge M, Li K. The frequency and risk factors of major complications after thermal ablation of liver tumours in 2,084 ablation sessions. Front Surg 2022; 9:1010043. [PMID: 36189384 PMCID: PMC9520062 DOI: 10.3389/fsurg.2022.1010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/29/2022] [Indexed: 12/24/2022] Open
Abstract
Background To assess the frequency of major complications after thermal ablation of liver tumours and to determine risk factors for adverse events. Methods A retrospective study was conducted between January 2015 and January 2021. A total of 2,084 thermal ablation sessions in 1,592 patients with primary and metastatic liver tumours were evaluated. The frequency of major complications was evaluated according to the Society of Interventional Radiology Standards, and putative predictors of adverse events were analysed using simple and multivariate logistic regression. Results Thermal ablation-related mortality was 0.1% (2/2,084), with an overall major complication rate of 5.6% (117/2,084). The most frequent major complication was symptomatic pleural effusion (2.9%, 60/2,084). Multivariate logistic regression analysis revealed that a total maximum diameter of lesions >3 cm, microwave ablation (MWA) and MWA combined with radiofrequency ablation, intrahepatic cholangiocarcinoma and postoperative systemic inflammatory response syndrome were independent prognostic factors for major complications. Conclusions Thermal ablation of liver tumours is a safe procedure with an acceptable incidence of major complications. The risk factors identified in this study will help to stratify high-risk patients.
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Affiliation(s)
- Qiannan Huang
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mengya Pang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qingjing Zeng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuqi He
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mian Ge
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Correspondence: Kai Li Mian Ge
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Correspondence: Kai Li Mian Ge
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Nakano M, Torisu Y, Nakagawa C, Ueda K, Kanai T, Saeki C, Oikawa T, Saruta M. Safety and efficacy of pentazocine–midazolam combination for pain and anxiety relief in radiofrequency ablation therapy for hepatocellular carcinoma. JGH Open 2022; 6:569-576. [PMID: 35928702 PMCID: PMC9344584 DOI: 10.1002/jgh3.12788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 12/24/2022]
Abstract
Background and Aim Radiofrequency ablation (RFA) therapy is frequently used as first‐line treatment for small hepatocellular carcinoma (HCC). RFA is often associated with pain; however, no definitive solution has been established for its relief. We retrospectively analyzed the safety and efficacy of the combination of pentazocine and midazolam to relieve pain experienced by HCC patients undergoing RFA. Methods We studied 77 patients with 98 HCCs treated with RFA between January 2015 and August 2019. Patients were divided into two groups: the sedative‐free group, which included those who received pentazocine alone, and the pentazocine–midazolam group, which included those who received a combination of pentazocine and midazolam. The degrees of analgesia and sedation were evaluated using the numerical rating scale (NRS) and the Richmond Agitation‐Sedation Scale (RASS), respectively. Other parameters such as treatment time, awakening time, midazolam dosage, vital signs, local recurrence rate, and time to recurrence were also examined. Results The median NRS score and RASS score were significantly lower in the pentazocine–midazolam group. Ninety‐five percent of patients in the pentazocine–midazolam group had no memory of the RFA session. The treatment time and awakening time were prolonged for the pentazocine–midazolam group. No significant differences in oxygen saturation, recurrence rates, and time to local recurrence were observed between groups. Conclusion A combination of pentazocine and midazolam is safe and effective for pain and anxiety relief experienced by patients undergoing RFA for local treatment of HCC.
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Affiliation(s)
- Masanori Nakano
- Division of Gastroenterology and Hepatology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Yuichi Torisu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Chika Nakagawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Kaoru Ueda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Tomoya Kanai
- Division of Gastroenterology, Department of Internal Medicine Fuji City General Hospital Shizuoka Japan
| | - Chisato Saeki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Tsunekazu Oikawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
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11
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Nguyen TK, Yadav S, Truong TA, Han M, Barton M, Leitch M, Guzman P, Dinh T, Ashok A, Vu H, Dau V, Haasmann D, Chen L, Park Y, Do TN, Yamauchi Y, Rogers JA, Nguyen NT, Phan HP. Integrated, Transparent Silicon Carbide Electronics and Sensors for Radio Frequency Biomedical Therapy. ACS Nano 2022; 16:10890-10903. [PMID: 35816450 PMCID: PMC9332346 DOI: 10.1021/acsnano.2c03188] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The integration of micro- and nanoelectronics into or onto biomedical devices can facilitate advanced diagnostics and treatments of digestive disorders, cardiovascular diseases, and cancers. Recent developments in gastrointestinal endoscopy and balloon catheter technologies introduce promising paths for minimally invasive surgeries to treat these diseases. However, current therapeutic endoscopy systems fail to meet requirements in multifunctionality, biocompatibility, and safety, particularly when integrated with bioelectronic devices. Here, we report materials, device designs, and assembly schemes for transparent and stable cubic silicon carbide (3C-SiC)-based bioelectronic systems that facilitate tissue ablation, with the capability for integration onto the tips of endoscopes. The excellent optical transparency of SiC-on-glass (SoG) allows for direct observation of areas of interest, with superior electronic functionalities that enable multiple biological sensing and stimulation capabilities to assist in electrical-based ablation procedures. Experimental studies on phantom, vegetable, and animal tissues demonstrated relatively short treatment times and low electric field required for effective lesion removal using our SoG bioelectronic system. In vivo experiments on an animal model were conducted to explore the versatility of SoG electrodes for peripheral nerve stimulation, showing an exciting possibility for the therapy of neural disorders through electrical excitation. The multifunctional features of SoG integrated devices indicate their high potential for minimally invasive, cost-effective, and outcome-enhanced surgical tools, across a wide range of biomedical applications.
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Affiliation(s)
- Tuan-Khoa Nguyen
- Queensland
Micro and Nanotechnology Centre, Griffith
University, Brisbane, Queensland 4111, Australia
| | - Sharda Yadav
- Queensland
Micro and Nanotechnology Centre, Griffith
University, Brisbane, Queensland 4111, Australia
| | - Thanh-An Truong
- Queensland
Micro and Nanotechnology Centre, Griffith
University, Brisbane, Queensland 4111, Australia
- School
of Mechanical and Manufacturing Engineering, The University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Mengdi Han
- Department
of Biomedical Engineering, College of Future Technology, Peking University, Beijing 100871, China
| | - Matthew Barton
- School
of Nursing and Midwifery, Griffith University, Brisbane, Queensland 4111, Australia
- Menzies
Health Institute Queensland, Brisbane, Queensland 4222, Australia
| | - Michael Leitch
- School
of Nursing and Midwifery, Griffith University, Brisbane, Queensland 4111, Australia
| | - Pablo Guzman
- Queensland
Micro and Nanotechnology Centre, Griffith
University, Brisbane, Queensland 4111, Australia
| | - Toan Dinh
- Centre
for Future Materials, University of Southern
Queensland, Toowoomba, Queensland 4305, Australia
| | - Aditya Ashok
- Australian
Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Hieu Vu
- School
of Engineering and Built Environment, Griffith
University, Brisbane, Queensland 4215, Australia
| | - Van Dau
- School
of Engineering and Built Environment, Griffith
University, Brisbane, Queensland 4215, Australia
| | - Daniel Haasmann
- Queensland
Micro and Nanotechnology Centre, Griffith
University, Brisbane, Queensland 4111, Australia
| | - Lin Chen
- State
Key Laboratory for Mechanical Behavior of Materials, School of Materials
Science and Engineering, Xi’an Jiaotong
University, Xi’an 710049, Shaanxi, People’s Republic of China
| | - Yoonseok Park
- Querrey
Simpson Institute for Bioelectronics, Northwestern
University, Evanston, Illinois 60208, United States
- Department
of Advanced Materials Engineering for Information and Electronics, Kyung Hee University, Yongin 17104, Republic
of Korea
| | - Thanh Nho Do
- Graduate
School of Biomedical Engineering, The University
of New South Wales, Sydney, New South Wales 2032, Australia
| | - Yusuke Yamauchi
- Australian
Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland 4072, Australia
- JST-ERATO
Yamauchi Materials Space-Tectonics Project, Kagami Memorial Research
Institute for Science and Technology, Waseda
University, Tokyo 169-0051, Japan
| | - John A. Rogers
- Querrey
Simpson Institute for Bioelectronics, Northwestern
University, Evanston, Illinois 60208, United States
- Department
of Materials Science and Engineering, Department of Mechanical Engineering,
Department of Biomedical Engineering, Departments of Electrical and
Computer Engineering and Chemistry, and Department of Neurological
Surgery, Northwestern University, Evanston, Illinois 60208, United States
| | - Nam-Trung Nguyen
- Queensland
Micro and Nanotechnology Centre, Griffith
University, Brisbane, Queensland 4111, Australia
| | - Hoang-Phuong Phan
- Queensland
Micro and Nanotechnology Centre, Griffith
University, Brisbane, Queensland 4111, Australia
- School
of Mechanical and Manufacturing Engineering, The University of New South Wales, Sydney, New South Wales 2052, Australia
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12
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Okumura K, Kobayashi S, Ogi T, Sugiura T, Zhang Y, Kanatani M, Yoneda N, Kitao A, Kozaka K, Gabata T, Koda W. Transcatheter arterial embolization of iatrogenic massive arterioportal fistula in the liver. Acta Radiol 2022; 63:867-876. [PMID: 34121466 DOI: 10.1177/02841851211023995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Massive arterioportal fistula (APF) is naturally irreversible and can induce portal hypertension and portal vein thrombosis (PVT), worsening survival outcomes. PURPOSE To evaluate the clinical course and details of transarterial embolization (TAE) procedures for massive APF. MATERIAL AND METHODS This retrospective single-center observational study evaluated the time until embolization after puncture, imaging, embolization methods, and laboratory data of 10 consecutive patients who were diagnosed with massive APF after puncture and underwent TAE at our hospital from 1 April 2012 to 30 September 2019. RESULTS Out of 10 cases, eight demonstrated a simple type and the other two cases a complex network type on the digital subtraction angiography pattern of massive APF. In two simple-type cases for which re-embolization was required, other subsegmental branches were embolized. The two cases showing a complex network type had been embolized via not only the subsegmental branch, but also the extrahepatic and multiple subsegmental branches. Child-Pugh scores were improved in eight of the ten cases. PVT was seen in six cases before embolization, but disappeared after embolization in all cases, despite the fact that three cases had not received anticoagulant therapy. Six cases had digestive varices before embolization, suggesting portal hypertension, and two of the six cases with esophageal varices and one with gastric varices decreased after embolization. CONCLUSION TAE for massive APF contributed to the improvement of hepatic reserve, the disappearance of PVT, and the improvement of portal hypertension; however, embolization of multiple branches may still be required in some cases.
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Affiliation(s)
- Kenichiro Okumura
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Satoshi Kobayashi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
- Department of Quantum Medical Technology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Takahiro Ogi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Takumi Sugiura
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Yu Zhang
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Mao Kanatani
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Norihide Yoneda
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Azusa Kitao
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Wataru Koda
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
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Hao F, Eghbalieh N, So A, Lee EW. Hepatic Plexus Nerve Block for Microwave Ablation of Hepatic Tumors. AJR Am J Roentgenol 2021. [PMID: 34704462 DOI: 10.2214/AJR.21.26779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Seven patients underwent microwave ablation of hepatic tumors, using hepatic nerve plexus block. Mean visual analog score (VAS; pain on 1-10 scale) was 0.3±0.5 at baseline and 2.5±1.4, 2.6±1.4, and 2.3±0.9 at 1, 5, and 10 minutes during ablation. Two patients reported VAS ≥4 during ablation, which both improved to VAS of 3 after one rescue sedation dose; remaining patients required no additional sedation. No major complication occurred. No patient required conversation to general anesthesia.
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14
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Song KD, Lee MW, Rhim H, Kang TW. Hemostasis using re-radiofrequency ablation for hepatic tract bleeding after ultrasound-guided percutaneous radiofrequency ablation of hepatic tumors. Br J Radiol 2021; 94:20210353. [PMID: 34538063 DOI: 10.1259/bjr.20210353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the hemostatic efficacy of re-radiofrequency ablation (re-RFA) for hepatic tract bleeding after ultrasound-guided RFA of hepatic tumors. METHODS A total of 4679 percutaneous ultrasound-guided RFA procedures were performed for hepatic tumors at Samsung Medical Center between January 2012 and December 2020. We identified patients who had hepatic tract bleeding after RFA by reviewing radiologic reports and ultrasound images and investigated the measures taken to control the bleeding and their outcomes. We also identified patients who had a significant peritoneal hematoma on immediate post-RFA CT or underwent transarterial embolization to control hepatic bleeding after RFA of hepatic tumors. RESULTS In total, 91 patients with tract bleeding after RFA were identified. As initial measures to control the bleeding, external compression, re-RFA, and observation were performed in 71 (78%), 17 (19%), and 3 (3%) patients, respectively. Hemostasis using re-RFA was attempted to control tract bleeding in 40 patients as an initial measure or an additional measure after other initial efforts. In all 40 patients, the bleeding stopped after re-RFA on Doppler ultrasound, and there was no active bleeding on the immediate follow-up CT. During the study period, in the years when re-RFA was performed frequently, the number of transarterial embolizations to control tract bleeding and significant peritoneal hematoma formation tended to be low. CONCLUSION Hemostasis using re-RFA of the needle tract is effective in controlling tract bleeding after ultrasound-guided RFA of hepatic tumors. ADVANCES IN KNOWLEDGE Re-RFA is a simple, safe, and effective method to control tract bleeding.
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Affiliation(s)
- Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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15
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Suwa K, Seki T, Aoi K, Yamashina M, Murata M, Yamashiki N, Nishio A, Shimatani M, Naganuma M. Efficacy of microwave ablation versus radiofrequency ablation for hepatocellular carcinoma: a propensity score analysis. Abdom Radiol (NY) 2021; 46:3790-3797. [PMID: 33675382 PMCID: PMC8286931 DOI: 10.1007/s00261-021-03008-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 12/15/2022]
Abstract
Purpose To evaluate the efficacy and safety of radiofrequency ablation (RFA) and new-generation microwave ablation (MWA) for the treatment of hepatocellular carcinoma (HCC). Methods The propensity score matching method was applied to patients with HCC treated with MWA (93 patients) or RFA (156 patients) at a single institution from January 2014 to April 2020. The local tumor progression (LTP), intrahepatic distant recurrence (IDR), and recurrence-free survival (RFS) of the two matched therapies were analyzed using the Kaplan–Meier method. Cox proportional hazard models were used to identify risk factors for LTP and RFS. The therapeutic effects and complications of the two treatments were also compared. Results The LTP, IDR, and RFS of MWA and RFA were equivalent (LTP: hazard ratio [HR] = 0.87; 95% confidence interval [95% CI] 0.36- 2.07; P = 0.746, IDR: HR = 1.03; 95% CI 0.61–1.73; P = 0.890, RFS: HR = 1.15; 95% CI 0.69–1.91; P = 0.566). Para-vessel lesions was the only risk factor for LTP, whereas age, previous treatment, Albumin-Bilirubin score, and tumor diameter were risk factors for RFS. On the other hand, the ablation time per nodule (6.79 ± 2.73 and 9.21 ± 4.90 min; P = 0.008) and number of sessions per nodule required to achieve technical success (1.16 ± 0.39 and 1.34 ± 0.57; P = 0.009) were significantly lower in MWA than in RFA. The major complication rate of MWA and RFA was also equivalent. Conclusion MWA and RFA have similar therapeutic effects and safety, although MWA has advantages over RFA regarding efficacy, including shorter ablation time and fewer sessions required.
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16
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Xu C, Zheng H, Shi T, Qi J, Zhao X, Li J, Feng Y, Zhu Q. A prediction model of major complications after radiofrequency ablation for recurrent hepatocellular carcinoma patients. Eur J Radiol 2021; 140:109635. [PMID: 34024632 DOI: 10.1016/j.ejrad.2021.109635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/11/2021] [Accepted: 03/06/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Postoperative major complications are potentially fatal to recurrent hepatocellular carcinoma (RHCC) patients. We aimed to construct a prediction model of major complications after RFA for RHCC patients. METHODS We retrospectively reviewed the medical records of 407 RHCC patients who underwent RFA as second treatment. Patients were divided into two groups according to the date of RFA: training cohort (277 patients treated in 2010-2016) and validation cohort (130 patients treated in 2017-2019). 23 clinicopathological variables were recorded and analyzed. The logistic regression model was used to build a prediction model. RESULT Major complications developed in 3.6 % of RHCC patients after RFA. In the multivariate analysis, tumor adjacent vessels (p = 0.004) and hepatitis C (p = 0.022) were associated with postoperative complications. The prediction model was described as follow: Risk score (major complication) = 5.180 + 3.391*tumor location+3.389*hepatic etiology, the Youden index was 0.642, the best cut-off value of the model was 8.57 (sensitivity, 78.57 %, specificity, 84.03 %). The area under the receiver operating characteristic curve of the predictive model was 0.85 (95 % CI, 0.82 to 0.88). The validation of the model demonstrated acceptable results, the sensitivity was 80.00 %, specificity was 98.40 %. CONCLUSIONS This study developed a simple and reliable prediction model of postoperative major complications after RFA for RHCC patients.
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Affiliation(s)
- Chenghui Xu
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China
| | - Hang Zheng
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China
| | - Tongtong Shi
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China
| | - Jianni Qi
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China; Department of Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Xinya Zhao
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China; Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Jie Li
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China; Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Yuemin Feng
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China; Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Qiang Zhu
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China; Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
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17
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Uchino K, Tateishi R, Wake T, Kinoshita MN, Nakagomi R, Nakatsuka T, Minami T, Sato M, Enooku K, Nakagawa H, Shiina S, Koike K. Radiofrequency Ablation of Liver Tumors in Patients on Antithrombotic Therapy: A Case-Control Analysis of over 10,000 Treatments. J Vasc Interv Radiol 2021; 32:869-77. [PMID: 33689831 DOI: 10.1016/j.jvir.2021.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To evaluate the safety of radiofrequency ablation (RFA) for liver tumors in patients on antithrombotic therapy. MATERIALS AND METHODS A total of 10,653 consecutive RFA treatments in 3,485 patients with liver tumors were analyzed. The incidence of complications was analyzed on a treatment basis. The treatments for patients who had received antithrombotic medication up to 1 week prior to RFA comprised the antithrombotic therapy group (n = 806), and the others comprised the control group (n = 9,847). Antithrombotic agents were ceased prior to RFA (aspirin, ticlopidine, clopidogrel, and prasugrel ceased 7 days before RFA; cilostazol, 2 or 3 days before RFA; warfarin, 3 days before RFA; and direct oral anticoagulants, 1 day before RFA) and resumed as soon as possible after RFA. Logistic regression analysis was performed to assess whether the antithrombotic therapy increased the risk of hemorrhagic complications. RESULTS Hemorrhagic complications were diagnosed after 6 treatments (0.7%) in the antithrombotic group and 48 (0.5%) in the control group, and there was no significant difference between the groups (P = .30). In 3 treatments, hemorrhage was diagnosed on or after 8 days of RFA, all of which were in the antithrombotic group. Thrombotic complications were diagnosed after 2 treatments (0.2%) in the antithrombotic group and after 5 (0.1%) in the control group. In a multivariate analysis, receiving antithrombotic therapy was not an independent risk factor for hemorrhagic complications (adjusted odds ratio, 1.52; 95% confidence interval, 0.60-3.87; P = .38). CONCLUSIONS RFA of liver tumors in patients on antithrombotic therapy is generally safe with appropriate cessation and resumption. Late-onset hemorrhage should be noted in the patients on antithrombotic therapy.
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18
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Affiliation(s)
- Jeffrey L Weinstein
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Muneeb Ahmed
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
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19
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Mostafa SF, El Mourad MB. Ultrasound guided erector spinae plane block for percutaneous radiofrequency ablation of liver tumors. Egyptian Journal of Anaesthesia 2020. [DOI: 10.1080/11101849.2020.1854156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Shaimaa F. Mostafa
- Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mona B. El Mourad
- Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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20
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Shi QM, Xue C, He YT, Hu XB, Yu ZJ. Massive abdominal hemorrhage after radiofrequency ablation of recurrent hepatocellular carcinoma with successful hemostasis achieved through transarterial embolization: a case report. J Int Med Res 2020; 48:300060519898012. [PMID: 32046546 PMCID: PMC7111056 DOI: 10.1177/0300060519898012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Acute massive abdominal hemorrhage after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is an infrequent and severe complication. Delayed diagnosis and treatment may be life-threatening. We herein describe a 60-year-old man with a history of postoperative HCC. A new nidus of HCC was found in his right liver lobe after abdominal magnetic resonance imaging and intraoperative angiography. The patient then underwent computed tomography-guided RFA. However, 7 hours after RFA, he suddenly developed dizziness, nausea, abdominal distension, hematuria, a decreased blood pressure, and an increased heart rate. Diagnostic abdominal puncture produced bloody liquid, and angiography demonstrated hemorrhage in the right hepatic artery. Transarterial embolization was performed following the administration of an appropriate amount of tissue emulsion to embolize the source of hemorrhage. Following this treatment, the patient had no further bleeding. Neither the hemorrhage nor the HCC lesions had recurred after 3 months of follow-up.
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Affiliation(s)
- Qing-Miao Shi
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Chen Xue
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yu-Ting He
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xiao-Bo Hu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Zu-Jiang Yu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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21
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Wang F, Ma J, Wu L, Li N, Luo R, Wei G, Yang J. Percutaneous cryoablation of subcapsular hepatocellular carcinoma: a retrospective study of 57 cases. ACTA ACUST UNITED AC 2020; 26:34-39. [PMID: 31650975 DOI: 10.5152/dir.2019.18543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aims to evaluate the safety and effectiveness of the percutaneous cryoablation for subcapsular hepatocellular carcinoma (HCC). METHODS A total of 57 patients with subcapsular (<1 cm form the liver edge) HCCs (68 lesions), who were treated with CT-guided percutaneous cryoablation in the Department of Interventional Radiology of our hospital between July 1, 2016 and September 1, 2018, were retrospectively included. Complete ablation rate, local tumor progression (LTP) and treatment-related complications were evaluated. Furthermore, the degree of intraoperative and postoperative pain was measured with the visual analog scale (VAS), and laboratory findings were compared before and after the procedure. RESULTS All patients successfully completed the treatment. The mean follow-up period was 12.8 months (range, 3-27 months), and the complete ablation rate was 97% (66/68). Local tumor progression occurred in 11 lesions (16.2%), and the 6-, 12- and 18-month cumulative LTP rates were 4.0%, 8.2% and 20.5%, respectively. Two patients (3.5%, 2/57) developed major complications, and 12 patients had minor complications (22.8%, 12/57). The mean VAS score during the operation was 1.65 points (range, 1-3 points). Postoperative pain worsened in 3 patients, and the VAS scores reached 4-5. Transient changes in biochemical and hematologic markers were observed. CONCLUSION Percutaneous cryoablation for subcapsular HCC is safe and effective, the procedure is simple and the patients suffer less pain.
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Affiliation(s)
- Fuming Wang
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jianbing Ma
- Department of Radiology, The First Hospital of Jiaxing, Zhejiang, China
| | - Linlin Wu
- Department of Oncology, Tengzhou Central People's Hospital, Shandong, China
| | - Na Li
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rong Luo
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Guangxu Wei
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jijin Yang
- Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
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22
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Ho PH, Teng W, Lin CC, Jeng WJ, Chen WT, Lin CY, Lin SM, Sheen IS. Prolonged post-ablation fever may predict one-year tumor recurrence in hepatocellular carcinoma after radiofrequency ablation. Int J Hyperthermia 2020; 37:1008-1015. [DOI: 10.1080/02656736.2020.1806363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Ping-Hung Ho
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
| | - Wei Teng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chen-Chun Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wei-Ting Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chun-Yen Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Shi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - I-Shyan Sheen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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23
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Abstract
Liver cancer is one of the most common causes of cancer death globally, and its incidence in the United States is increasing. Patients with advanced hepatocellular carcinoma (HCC) who are not candidates for surgical resection, liver transplant, or locoregional therapies can be treated with systemic therapies. Multiple agents, including sorafenib, lenvatinib, and regorafenib are approved for use as either first- or second-line therapy in this patient population, but all have relatively modest survival benefits. HCC is potentially susceptible to therapy with checkpoint inhibitors, including agents such as nivolumab and pembrolizumab, which are both approved by the Food and Drug Administration for patients previously treated with sorafenib but have not demonstrated superior overall survival in phase III trials. It is clear that more effective approaches are needed to potentiate the effects of checkpoint inhibitors in patients with HCC. This review will outline and appraise the current literature on the use of checkpoint inhibitors in HCC as part of a combination treatment involving an additional mode of therapy. The list of agents that can be paired with checkpoint inhibitors includes an additional checkpoint inhibitor, vascular endothelial growth factor or vascular endothelial growth factor receptor inhibitors, tyrosine kinase inhibitors, OX-40 agonists, and PT-112 inhibitors. The main non-pharmacologic therapies currently being studied for inclusion in a combination strategy include radiation therapy, trans-arterial chemoembolization, and ablation.
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Affiliation(s)
- Alexander Claudius Jordan
- Department of Internal Medicine, New York University School of Medicine, New York, NY 10016, United States
| | - Jennifer Wu
- Division of Hematology and Oncology, Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY 10016, United States
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24
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Choi JW, Lee JM, Kim HC, Lee M, Hur S, Jae HJ, Chung JW. Iatrogenic Arterioportal Fistula Caused by Radiofrequency Ablation of Hepatocellular Carcinoma: Clinical Course and Treatment Outcomes. J Vasc Interv Radiol 2020; 31:728-736. [PMID: 32229078 DOI: 10.1016/j.jvir.2019.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/20/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To analyze the clinical course and treatment outcomes of patients with iatrogenic arterioportal fistula (APF) caused by radiofrequency (RF) ablation of hepatocellular carcinoma (HCC). MATERIALS AND METHODS Among the 1,620 hepatocellular carcinoma patients treated by RF ablation between January 2012 and August 2017, 99 who developed APF after RF ablation were included in this retrospective study. Depending on the extent of portal vein enhancement on arterial phase images, APF was classified as massive or nonmassive. The patients' clinical course was investigated and statistically evaluated by univariable and multivariable analyses. RESULTS Thrombocytopenia (odds ratio [OR] = 3.939; 95% confidence interval [CI], 1.141-13.598) was the only risk factor for developing massive APF. Eleven patients underwent embolotherapy (technical success rate, 90.9%) and no patients experienced serious adverse events within 30 days of the procedure. Patients with massive APF (66.7%) had a significantly higher chance of a Child-Pugh score increase than did the patients with nonmassive APF (13.6%) (P < .001). Massive APF had a significantly lower chance of natural regression than did nonmassive APF (P < .001). Child-Pugh B (OR = 17.739; 95% confidence interval, 2.361-133.279) and massive APF without treatment (OR = 11.061; 95% confidence interval, 1.257-97.341) were independent risk factors for liver failure that led to death of liver transplant within 1 year after RF ablation. CONCLUSIONS Massive APF caused by RF ablation is mostly irreversible and significantly worsens patients' outcomes, but may be effectively treated with embolotherapy.
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Affiliation(s)
- Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Seoul, Korea.
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Seoul, Korea
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Seoul, Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Seoul, Korea
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Seoul, Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Seoul, Korea
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25
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Suwa K, Seki T, Tsuda R, Yamashina M, Murata M, Yamaguchi T, Nishio A, Okazaki K. Short term treatment results of local ablation with water-cooled microwave antenna for liver cancer: Comparison with radiofrequency ablation. Mol Clin Oncol 2020; 12:230-236. [PMID: 32064099 PMCID: PMC7016568 DOI: 10.3892/mco.2020.1983] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 12/06/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of the present study was to evaluate the efficacy and safety of the new-generation percutaneous microwave ablation (MWA) compared with the radiofrequency ablation (RFA) system for the treatment of hepatocellular carcinoma (HCC). A retrospective study was conducted from January 2014 to February 2019. A total of 44 patients and 52 nodules (mean tumor size, 17.2±4.9 mm) were treated with MWA, and 55 patients and 70 nodules (mean tumor size, 17.7±6.4 mm) were treated with RFA. After 4 days of treatment, the direct effects of ablation were assessed using dynamic CT, and after discharge, a follow-up dynamic CT scan was performed every 3-4 months. Treatment efficacy, complications and local recurrence were recorded. For MWA and RFA, the average number of CT sessions were 1.05±0.23 and 1.28±0.54, respectively, and the mean ablation times were 5.0±2.0 and 8.1±4.8 min. Following MWA and RFA, the ablation ranges that were evaluated with the axial images were 31.9±5.5 and 33.3±9.0 mm, respectively, in the long-axis diameter and 27.6±5.3 and 23.4±6.8 mm, respectively, in the short-axis diameter. The flatness ratios of the ablation regions were 0.13±0.09 and 0.29±0.14 (axial image) and 0.11±0.07 and 0.28±0.14 (coronal image), respectively. The rates of complete tumor necrosis were comparable. The complication rates were 13.6% (MWA) and 14.5% (RFA), which were not significantly different. The cumulative local recurrence rates were not significantly different between the two methods (one-year recurrence rate, MWA: 6.91%, RFA: 5.17%). MWA was therefore indicated to be an effective treatment for HCC in respect to session number, treatment time and spherical ablation.
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Affiliation(s)
- Kanehiko Suwa
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka 573-1101, Japan.,Kansai Medical University Medical Center, Liver Disease Center, Moriguchi, Osaka 570-8507, Japan
| | - Toshihito Seki
- Kansai Medical University Medical Center, Liver Disease Center, Moriguchi, Osaka 570-8507, Japan
| | - Rinako Tsuda
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka 573-1101, Japan
| | - Masao Yamashina
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka 573-1101, Japan.,Kansai Medical University Medical Center, Liver Disease Center, Moriguchi, Osaka 570-8507, Japan
| | - Miki Murata
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka 573-1101, Japan.,Kansai Medical University Medical Center, Liver Disease Center, Moriguchi, Osaka 570-8507, Japan
| | - Takashi Yamaguchi
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka 573-1101, Japan
| | - Akiyoshi Nishio
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka 573-1101, Japan
| | - Kazuichi Okazaki
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka 573-1101, Japan
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26
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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: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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27
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Voizard N, Cerny M, Assad A, Billiard JS, Olivié D, Perreault P, Kielar A, Do RKG, Yokoo T, Sirlin CB, Tang A. Assessment of hepatocellular carcinoma treatment response with LI-RADS: a pictorial review. Insights Imaging 2019; 10:121. [PMID: 31853668 PMCID: PMC6920285 DOI: 10.1186/s13244-019-0801-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023] Open
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) play critical roles for assessing treatment response of hepatocellular carcinoma (HCC) after locoregional therapy. Interpretation is challenging because posttreatment imaging findings depend on the type of treatment, magnitude of treatment response, time interval after treatment, and other factors. To help radiologists interpret and report treatment response in a clear, simple, and standardized manner, the Liver Imaging Reporting and Data System (LI-RADS) has developed a Treatment Response (LR-TR) algorithm. Introduced in 2017, the system provides criteria to categorize response of HCC to locoregional treatment (e.g., chemical ablation, energy-based ablation, transcatheter therapy, and radiation therapy). LR-TR categories include Nonevaluable, Nonviable, Equivocal, and Viable. LR-TR does not apply to patients on systemic therapies. This article reviews the LR-TR algorithm; discusses locoregional therapies for HCC, treatment concepts, and expected posttreatment findings; and illustrates LI-RADS treatment response assessment with CT and MRI.
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Affiliation(s)
- Nicolas Voizard
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Milena Cerny
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Anis Assad
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Jean-Sébastien Billiard
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Damien Olivié
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Pierre Perreault
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Ania Kielar
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - An Tang
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada. .,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada. .,Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Montreal, Canada.
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28
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de Haas RJ, Lim C, Ricci C, Lahat E, Fuentes L, Salloum C, Azoulay D. Local Ablation Does Not Worsen Perioperative Outcomes After Liver Transplant for Hepatocellular Carcinoma. AJR Am J Roentgenol 2019; 213:702-9. [PMID: 31120785 DOI: 10.2214/AJR.18.20993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE. Local ablation of hepatocellular carcinoma (HCC) before liver transplant has important advantages, such as preventing disease progression, tumor downstaging, and offering a test of time. However, it might render liver transplant more technically demanding. Thus far, its potential effect on liver transplant outcomes is still unknown, and, therefore, the current study was performed. MATERIALS AND METHODS. Patients who underwent liver transplant for HCC at a single tertiary referral center between 2008 and 2016 were included and retrospectively analyzed. Patients who underwent liver resection and local ablation before liver transplant were excluded. Patients treated with local ablation before liver transplant were compared with those not treated with local ablation, both before and after propensity score matching. In addition, the local ablation group was compared with patients who underwent primary resection before liver transplant. Posttreatment mortality and morbidity were determined, and overall and disease-free survival rates were calculated. RESULTS. In total, 182 patients were included. Twenty-six patients underwent resection but not local ablation before liver transplant. Of the remaining 156 patients, 66 (42%) underwent local ablation before liver transplant and 90 (58%) did not. Perioperative mortality and morbidity were similar in both groups before and after propensity score matching (8% and 74% in the local ablation group vs 10% and 83% in the non-local ablation group, p = 0.60 and 0.17, respectively). In addition, no significant differences in long-term outcomes were observed between the groups before and after propensity score matching. Also, no differences were observed in outcomes in the local ablation group versus the liver resection group. CONCLUSION. Local ablation before liver transplant does not have a negative effect on outcomes after liver transplant for HCC.
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29
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Sato K, Taniki N, Kanazawa R, Shimizu M, Ishii S, Ohama H, Takawa M, Nagamatsu H, Imai Y, Shiina S. Efficacy and Safety of Deep Sedation in Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma. Adv Ther 2019; 36:344-354. [PMID: 30607546 DOI: 10.1007/s12325-018-0865-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) has been accepted as safe and effective for treating early-stage hepatocellular carcinoma (HCC). However, it often causes severe pain. Therefore, in this study, we performed RFA under deep sedation and investigated its efficacy and safety. METHODS We conducted a retrospective study including 511 HCC patients who received approximately 886 RFA treatments between December 2014 and November 2016 at our institution. Respiratory depression was defined as oxygen saturation of below 90%; and severe body movement was defined as movement caused by pain, which was managed by lowering the power of the generator. Factors associated with respiratory depression and severe body movement were examined via univariate and multivariate regression analyses. RESULTS Respiratory depression occurred in 15.3% of the patients and severe body movement in 26.5% of the patients. In the multivariate analysis, BMI (≥ 25 kg/m2, odds ratio [OR] = 1.75, P = 0.035) and longer ablation (≥ 10 min, OR = 2.59, P = 0.002) were significant respiratory depression-related factors. Male sex (OR = 2.02, P = 0.005), Child-Pugh class A (odds ratio = 1.96, P = 0.018), and longer ablation (≥ 10 min, OR = 3.03, P < 0.001) were significant factors related to severe body movement. CONCLUSION Deep sedation for RFA can be performed safely and effectively. Higher BMI and longer ablation were risk factors for respiratory depression and male sex, Child-Pugh class A, and longer ablation were independent predictors of severe body movement during RFA under deep sedation.
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Affiliation(s)
- Koki Sato
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Nobuhito Taniki
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryo Kanazawa
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Motonori Shimizu
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shigeto Ishii
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hideko Ohama
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Masashi Takawa
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroaki Nagamatsu
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuharu Imai
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
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30
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Wu J, Lu Y, Cao X. Different effects of oxycodone and remifentanil in patients undergoing ultrasound-guided percutaneous radiofrequency ablation of hepatic cancer: a randomized trial. Drug Des Devel Ther 2019; 13:365-372. [PMID: 30705584 PMCID: PMC6342212 DOI: 10.2147/dddt.s188728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Percutaneous radiofrequency ablation (RFA) is a recently introduced alternative technique for the treatment of hepatic cancer. Anesthesia is required for RFA of hepatic cancer to achieve patient comfort and immobilization during this painful procedure. The purpose of this study was to investigate the analgesic efficacy and evaluate the safety of a single intravenous injection of oxycodone hydrochloride for this procedure. Patients and methods A total of 120 American Society of Anesthesiologists class I–II grade patients for elective ultrasound-guided percutaneous RFA were enrolled in this randomized controlled trial. Patients were randomized (1:1) to receive either a single intravenous injection of oxycodone (group O) or continuous infusion of remifentanil (group R). Both groups received the continuous infusion of dexmedetomidine for sedation. Visual analog scale (VAS), rescue analgesic, and side effects were checked during the periprocedural period. In addition, patient and oncologist satisfaction on a scale of 1–5 were determined. Results VAS score in group O was significantly lower than in group R at 1, 2, and 3 hours after RFA, and patients in group O required analgesics significantly later and less doses in the first 24 hours after RFA. The occurrence of unwanted body movements was significantly lower in group O. We found no complications including allergic reaction, excessive sedation, and chest wall rigidity in all patients. The patient satisfaction score was significantly higher in group O than that in group R. Conclusion Ultrasound-guided percutaneous RFA for hepatic cancer can be completed both with continuous infusion of remifentanil or a single intravenous injection of oxycodone. However, oxycodone hydrochloride provides better patient experience with higher satisfactory score and less unwanted body movements, relieves post-procedural pain better, and is not associated with an increase in adverse effects.
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Affiliation(s)
- Junbei Wu
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China,
| | - Yunhong Lu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiaofei Cao
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China,
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31
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Long Y, Yan R, Li K, Luo L, Zeng Q, Tan L, Zhang M, Zheng R, Xu E. Radiofrequency ablation of liver cancers adjacent to the gallbladder without gallbladder isolation under contrast-enhanced ultrasound monitoring: a preliminary study. Int J Hyperthermia 2018; 36:139-145. [PMID: 30489164 DOI: 10.1080/02656736.2018.1539776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the feasibility, safety and efficacy of intra-procedural contrast-enhanced ultrasound (CEUS) monitoring of the radiofrequency ablation (RFA) of liver cancers adjacent to gallbladder (GB) without GB isolation. MATERIALS AND METHODS From May 2016 to July 2017, patients with liver cancers adjacent to GB (≤10 mm) who intended to undergo ultrasound-guided RFA without GB isolation in our hospital were prospectively enrolled. During the RFA procedures, CEUS was employed to evaluate the therapeutic response and the perfusion of the intact GB wall. The outcomes of GB and liver cancers were followed up and recorded. RESULTS 23 patients (18 male, 5 female) with 23 liver cancers (mean 18 mm, range 8-34 mm) adjacent to GB were enrolled. There were 12 tumors that abutted the GB while 11 tumors located within 10 mm of the GB. After the RFA procedures, intra-procedural CEUS evaluation demonstrated the perfusion of the GB wall was intact in all 23 patients and technical success rate of RFA was 100% (23/23). According to the contrast-enhanced CT/MR one month after RFA, the technical efficacy rate was 100% (23/23). During the follow-up period (range: 12-23 months, median: 17 months), no local tumor progression occurred and no major complications arised. Overall survival at 1-year was 100%. Thickening of GB wall was detected in 11 patients. The thickness of GB wall returned to the pre-ablation level in five patients. CONCLUSION CEUS-monitored RFA of liver cancers adjacent to GB without GB isolation was feasible, safe and effective.
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Affiliation(s)
- Yinglin Long
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Ronghua Yan
- b Department of Radiology, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Kai Li
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Liping Luo
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Qingjing Zeng
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Lei Tan
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Man Zhang
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Rongqin Zheng
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Erjiao Xu
- a Department of Medical Ultrasonics, Guangdong Key Laboratory of Liver Disease Research , The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
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Choi EJ, Choi YM, Kim HJ, Ok HG, Chang EJ, Kim HY, Yoon JU, Kim KH, Byeon GJ. The Effects of Thoracic Epidural Analgesia during Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma. Pain Res Manag. 2018;2018:4354912. [PMID: 30581515 PMCID: PMC6276420 DOI: 10.1155/2018/4354912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/01/2018] [Accepted: 10/31/2018] [Indexed: 12/13/2022]
Abstract
Background Percutaneous radiofrequency ablation (PRFA) is a useful and safe treatment for hepatocellular carcinoma (HCC). Pain management, during and after PRFA, is a critical component of patient care. Objectives This study reviewed the efficacy of thoracic epidural analgesia, during and after PRFA, for patients with HCC. Study Design A retrospective, observational chart review. Setting Tertiary medical center/teaching hospital. Methods Patients who had undergone PRFA for HCC in the past 5 years were divided into two groups, based on the type of anesthesia administered: thoracic epidural anesthesia group (Group E) and local anesthesia with monitored anesthesia care group (Group C). We retrospectively reviewed changes in the numeric rating scale (NRS) score during and after PRFA, opioid consumption, length of the procedure, length of hospital stay, changes in blood pressure during PRFA, and the incidence of adverse events. Results The NRS score in Group E was significantly lower than that in Group C (P < 0.05). The opioid consumption in Group E was lower than that in Group C after PRFA (P < 0.05). The procedure time was shorter in Group E (P < 0.05). Neither of the groups showed significant difference with respect to the length of hospital stay and the incidence of respiratory depression, fever, and blood pressure elevation. The incidence of nausea, vomiting, and voiding difficulty was higher in Group E. Limitations This study is limited by its retrospective design. Conclusions Thoracic epidural analgesia was associated with shorter procedure times, lower postprocedural pain, and lower opioid consumption during and after PRFA for HCC.
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Kang SJ, Kim UJ, Kim SE, An JH, Jang MO, Myung DS, Park KH, Jung SI, Cho SB, Jang HC, Joo YE. Predictive Value of Procalcitonin for Bacterial Infection after Transarterial Chemoembolization or Radiofrequency Ablation for Hepatocellular Carcinoma. Dis Markers 2018; 2018:9120878. [PMID: 29849829 DOI: 10.1155/2018/9120878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/04/2018] [Indexed: 02/07/2023]
Abstract
This prospective observational study aimed at investigating the role of procalcitonin (PCT) in diagnosing bacterial infection and guiding antibiotic therapy for hepatocellular carcinoma (HCC) patients with fever after transarterial chemoembolization (TACE) and/or radiofrequency ablation (RFA). Ninety-seven cases (84 patients) were enrolled. Serum PCT, C-reactive protein (CRP), and white blood cell (WBC) counts were measured on the day of fever onset (day 0) and days 1, 3, 5, and 7 of fever. Empirical antibiotics were initiated only if PCT was ≥0.5 ng/mL or specific infection foci were suspected. An infectious cause was found in nine cases. PCT on day 0 of fever was significantly higher in patients with bacterial infection than in those without infection (P = 0.035). The area under the receiver operating characteristic curve for PCT was 0.715 (95% confidence interval, 0.538–0.892) and was higher than that for CRP (0.598 (0.368–0.828)) or WBC counts (0.502 (0.307–0.697)). In patients undergoing TACE and/or RFA, a significantly lower number of antibiotics were prescribed during the study period than during the prestudy period (P < 0.001). In conclusion, PCT might be a biomarker for diagnosing infection and guiding antibiotic treatment to reduce unnecessary antibiotic use in patients with fever after TACE and/or RFA.
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Kim DS, Na HS, Lee JH, Shin YD, Shim JK, Shin HW, Kang H, Joung KW. Current clinical application of dexmedetomidine for sedation and anesthesia. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.4.306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Doo Sik Kim
- Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Hyo-seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Ji-hyang Lee
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Young Duck Shin
- Department of Anesthesiology and Pain Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Won Shin
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyoseok Kang
- Department of Anesthesiology and Pain Medicine, Eulji Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Kyoung-Woon Joung
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ypsilantis P, Lambropoulou M, Evagellou A, Papadopoulos N, Simopoulos C. Immune and Inflammatory Responses of the Intestinal Mucosa following Extended Liver Radiofrequency Ablation. Gastroenterol Res Pract 2017; 2017:3450635. [PMID: 29209365 DOI: 10.1155/2017/3450635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/30/2017] [Accepted: 09/07/2017] [Indexed: 02/07/2023] Open
Abstract
Background and Aim Extended liver radiofrequency ablation (RFA) has been shown to disrupt gut barrier integrity with subsequent bacterial translocation. The aim of the present project was to study the immune and inflammatory responses of the intestinal mucosa after extended RFA of the liver. Methods Twelve Wistar rats were either subjected to RFA of the left lateral hepatic lobe (approximately 30% of the liver mass) after midline laparotomy (group RFA, n = 6) or sham operation (group Sham, n = 6). Forty-eight hours later, ileal tissue specimens were excised for immunohistochemical assessment of CD68+ macrophages, CD4+ T-lymphocytes, CD8+ T-lymphocytes, mucosal addressin cell adhesion molecule-1 (MAdCAM-1), tumor necrosis factor-α (TNFα), interleukin-6 (IL-6), and nuclear factor-κB (NFκB) expression. Results Immune response biomarkers were upregulated in the RFA group. Expression of CD4+ and CD8+ T-lymphocytes was moderate, while that of CD68+ macrophages and MAdCAM-1 was high. Inflammatory response biomarkers were also upregulated in the RFA group. TNFα, IL-6, and NFκB expression was low, moderate, and high, respectively. Conclusions Extended liver RFA evokes both immune and inflammatory responses of the gut mucosa.
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Choi TW, Lee JM, Lee DH, Lee JH, Yu SJ, Kim YJ, Yoon JH, Han JK. Percutaneous Dual-Switching Monopolar Radiofrequency Ablation Using a Separable Clustered Electrode: A Preliminary Study. Korean J Radiol 2017; 18:799-808. [PMID: 28860897 PMCID: PMC5552463 DOI: 10.3348/kjr.2017.18.5.799] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 03/04/2017] [Indexed: 12/12/2022] Open
Abstract
Objective To prospectively evaluate the safety and therapeutic effectiveness of dual-switching monopolar (DSM) radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC), and to retrospectively compare the results with those of single-switching monopolar (SSM) RFA in a historical control group. Materials and Methods This study was approved by the Institutional Review Board, with informed consent obtained from all patients. Fifty-two HCC patients who underwent DSM-RFA using a separable clustered electrode and dual-generators were prospectively enrolled. Technical parameters, complications, technical success, technical effectiveness, and local tumor progression (LTP) rates were evaluated by means of post-procedural and follow-up imaging. Thereafter, the outcome of DSM-RFA was compared with those of 249 retrospectively included HCC patients treated with SSM-RFA. Results There were two major complications (3.8%, 2/52) including pleural and pericardial effusion in the DSM-RFA group. The DSM-RFA yielded a 100% technical success rate, a 98.1% technical effectiveness rate, and a 4.3% 2-year LTP rate. In a retrospective comparison between the two groups, DSM-RFA created significantly larger ablation volume (4.20 ± 2.07 cm3/min vs. 3.03 ± 1.99 cm3/min, p < 0.01), and delivered higher energy (1.43 ± 0.37 kcal/min vs. 1.25 ± 0.50 kcal/min, p < 0.01) per given time, than SSM-RFA. There was no significant difference in major procedure-related complications (3.8% vs. 4.4%) and technical effectiveness rate (98.1% vs. 96.4%) between the two groups (p = 1.00). In addition, the 2-year LTP rate of DSM-RFA and SSM-RFA were 4.3% and 10.1%, respectively (p = 0.15). Conclusion DSM-RFA using a separable clustered electrode is safe and provides high local tumor control and good preliminary clinical outcome for small HCCs, which are at least comparable to those of SSM-RFA.
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Affiliation(s)
- Tae Won Choi
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.,Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Su Jong Yu
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Yoon Jun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.,Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
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Kambadakone A, Baliyan V, Kordbacheh H, Uppot RN, Thabet A, Gervais DA, Arellano RS. Imaging guided percutaneous interventions in hepatic dome lesions: Tips and tricks. World J Hepatol 2017; 9:840-849. [PMID: 28740595 PMCID: PMC5504359 DOI: 10.4254/wjh.v9.i19.840] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/06/2017] [Accepted: 04/24/2017] [Indexed: 02/06/2023] Open
Abstract
Percutaneous hepatic interventions are generally safe given the fact that liver closely abuts the abdominal wall and hence it is easily accessible. However, the superior portion of liver, adjacent to the diaphragm, commonly referred as the “hepatic dome”, presents unique challenges for interventionists. Percutaneous access to the hepatic dome may be restricted by anatomical factors and special considerations may be required to avoid injury to the surrounding organs. The purpose of this review article is to discuss certain specific maneuvers and techniques that can enhance the success and safety of interventions in the hepatic dome.
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Qi H, Zhang H, Wan C, Xie L, Song Z, Fan W. CT-guided microwave ablation through the lungs for treating liver tumors near the diaphragm. Oncotarget 2017; 8:79270-8. [PMID: 29108305 DOI: 10.18632/oncotarget.17422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/20/2017] [Indexed: 01/29/2023] Open
Abstract
Purpose To explore the short-term efficacy and safety of CT-guided microwave ablation (MWA) for treating liver tumors near the diaphragm. Results The complete response (CR) rate for CT-guided MWA through the lung was 94.7% (124/131). The incomplete response (ICR) rate was 5.3% (7/131), of which 6 patients with ICRs achieved CRs after MWA. The CR rate for Group I was higher than Group II (99.0% vs. 80.0%, P=0.001). The mean follow-up time was 11.2 ±7.50 months. The total local recurrence (LR) rate was 15.3% (20/131). The complication rate was 26.5%, and no severe complications were recorded. All complications were controllable and treatable. The incidence of diaphragmatic thickening during the MWA was 18.8% (P>0.05); the incidence of exudative changes inside the lungs was 6.8% (P>0.05). Conclusions CT-guided MWA can detect changes in liver tissue, in the diaphragm and nearby lung tissues during the ablation process. It's safe and effective to treat tumors close to the diaphragm by CT-guided MWA through the lung. Methods CT-guided MWA was used on 131 tumors that were close to the diaphragm (distance between tumor and diaphragm ≤ 5 mm) in 117 patients with liver cancer. The tumors were divided into a < 3.0 cm group (Group I, n= 101) and a ≥ 3.0 cm group (Group II, n= 30) based on tumor diameters. The complications within 2 weeks following treatment were counted, and the safety and short-term efficacy of MWA were analyzed.
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Park JG, Park SY, Tak WY, Kweon YO, Jang SY, Lee YR, Hur K, Lee HJ, Lee HW. Early complications after percutaneous radiofrequency ablation for hepatocellular carcinoma: an analysis of 1,843 ablations in 1,211 patients in a single centre: experience over 10 years. Clin Radiol 2017; 72:692.e9-692.e15. [PMID: 28364952 DOI: 10.1016/j.crad.2017.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/24/2017] [Accepted: 03/01/2017] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the incidence of adverse events and associated factors after radiofrequency ablation (RFA) in patients with hepatocellular carcinoma within 30 days. MATERIALS AND METHODS The early complications that occurred within 30 days after RFA at a single institution from January 2000 to July 2010 were reviewed in order to evaluate the morbidity, mortality, and risk factors associated with the complications. In total, 1,211 patients (845 men, 70.5%) with a mean age of 68 years (range, 27-88 years) underwent 1,843 RFA procedures. RESULTS The overall incidence rate of complications was 6.8% (125 cases). Major complications (n=36, 2%) included liver abscess (n=15, 0.8%), intraperitoneal bleeding (n=8, 0.4%), liver failure (n=5, 0.3%), variceal bleeding (n=3, 0.2%), haemothorax (n=2, 0.1%), cholecystitis (n=2, 0.1%), and bowel perforation (n=1, 0.1%). Among the minor complications (n=89, 4.8%), the most common was the post RFA syndrome accompanied by pain and fever (n=75, 4.1%). Other minor complications included significant pleural effusion (n=7, 0.4%), skin wound infection (n=4, 0.2%), and thermal injuries to the skin (n=3, 0.2%). Procedural infections significantly increased with tumour size (OR=1.379; 95% confidence interval [CI], 1.191-1.579; p<0.001), and multiple overlapping ablations (OR=1.118; 95% CI, 1.019-1.227, p=0.018). Thrombocytopenia (<50,000/μl), prothrombin time, and serum albumin level were significantly associated with post-RFA bleeding episodes (p=0.041, p=0.021, and p=0.003, respectively). The overall mortality rate was 0.3% (three cases of hepatic failure, two case of sepsis, and one case of renal failure). CONCLUSIONS RFA is a safe and effective local treatment for hepatocellular carcinoma. Careful selection of patients and appropriate RFA planning could decrease procedural mortality and morbidity.
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Affiliation(s)
- J G Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - S Y Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - W Y Tak
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Y O Kweon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - S Y Jang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Y R Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - K Hur
- Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - H J Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - H W Lee
- Department of Pathology, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Republic of Korea
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Fu JJ, Wang S, Yang W, Gong W, Jiang AN, Yan K, Chen MH. Protective and Heat Retention Effects of Thermo-sensitive Basement Membrane Extract (Matrigel) in Hepatic Radiofrequency Ablation in an Experimental Animal Study. Cardiovasc Intervent Radiol 2017; 40:1077-85. [PMID: 28271330 DOI: 10.1007/s00270-017-1617-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 03/02/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the protective effect of using thermo-sensitive basement membrane extract (Matrigel) for hydrodissection to minimize thermal injury to nearby structures and to evaluate its heat sink effect on the ablation zone in radiofrequency ablation (RFA) of the liver. MATERIALS AND METHODS First, the viscosity profile and heat sink effect of Matrigel were assessed during RFA in vitro and ex vivo. Fresh pig liver tissue was used, and the temperature changes in Matrigel and in 5% dextrose in water (D5W) during RFA were recorded. Then, the size of the ablation zone in the peripheral liver after RFA was measured. Second, in an in vivo study, 45 Sprague-Dawley rats were divided into three groups of 15 rats each (Matrigel, D5W and control). In the experimental groups, artificial ascites with 10 ml of Matrigel or D5W were injected using ultrasound guidance prior to RFA. The frequency of thermal injury to the nearby organs was compared among the three groups, with assessments of several locations: near the diaphragm, the abdominal wall and the gastrointestinal (GI) tract. Finally, the biological degradation of Matrigel by ultrasound was evaluated over 60 days. RESULTS First, Matrigel produced a greater heat retention (less heat sink) effect than D5W during ex vivo ablation (63 ± 9 vs. 26 ± 6 °C at 1 min on the surface of the liver, P < 0.001). Hepatic ablation zone volume did not differ between the two groups. Second, thermal injury to the nearby structures was found in 14 of 15 cases (93.3%) in the control group, 8 of 15 cases (53.3%) in the D5W group, and 1 of 15 cases (6.7%) in the Matrigel group. Significant differences in the thermal injury rates for nearby structures were detected among the three groups (P < 0.001). The most significant difference in the thermal injury rate was found in locations near the GI tract (P = 0.003). Finally, Matrigel that was injected in vivo was gradually degraded during the following 60 days. CONCLUSIONS Using thermo-sensitive Matrigel as a hydrodissection material might help reduce the frequency of collateral thermal injury to nearby structures, especially in locations close to the GI tract, compared to conventional D5W. Additionally, Matrigel did not increase the heat sink effect on the ablation zone during ablation and was degraded over time in vivo.
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Shamim F, Asghar A, Tauheed S, Yahya M. Radiofrequency ablation of hepatocellular carcinomas: A new spectrum of anesthetic experience at a tertiary care hospital in Pakistan. Saudi J Anaesth 2017; 11:21-25. [PMID: 28217048 PMCID: PMC5292847 DOI: 10.4103/1658-354x.197367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Radiofrequency ablation (RFA) is a minimally invasive technique of tumor destruction for patients with hepatic cancer who are not candidates for conventional therapy. The therapy required general anesthesia (GA) or sedation to ensure patient safety and comfort. The study is aimed to report and evaluate factors that influenced the periprocedural anesthetic management, drugs used, and complications during and immediately after RFA procedure for hepatocellular carcinoma. Methods: For this retrospective study, we included 46 patients who underwent percutaneous RFA under GA or conscious sedation from January 2010 to June 2013 in Aga Khan University Hospital, Pakistan. The patients' characteristics, hepatic illness severity (Child-Pugh classification), anesthetic techniques, drugs, and complications of procedure were collected on a predesigned approved form. The data were assessed and summarized using descriptive statistics. Results: The majority of patients were female (57%) and mostly classified as American Society of Anesthesiologist III (65.2%). The preoperative hepatic illness severity in most patients was Child-Pugh Class A (76.10%). Thirty-eight patients (69.09%) had only single lesion and majority number of lesions were <3 cm (65.45). GA was the main anesthetic technique (87%) with laryngeal mask airway as an airway adjunct predominantly (70%). The mainly used anesthetic agents for hypnosis and analgesia were propofol and fentanyl, respectively. Pain was the only significant complaint in postoperative period but only in nine (19%) patients and mild in nature. Conclusions: Percutaneous RFA is a safe treatment of hepatocellular cancer. The procedure required good anesthetic support in the form of sedation-analgesia or complete GA that ensures maximum patient comfort and technical success of the procedure.
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Affiliation(s)
- Faisal Shamim
- Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Ali Asghar
- Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Saman Tauheed
- Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Yahya
- Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan
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Kim JW, Shin JH, Kim PN, Shin YM, Won HJ, Ko GY, Yoon HK. Embolization for Bleeding after Hepatic Radiofrequency Ablation. J Vasc Interv Radiol 2016; 28:356-365.e2. [PMID: 28012690 DOI: 10.1016/j.jvir.2016.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To evaluate safety and clinical efficacy of embolization for management of bleeding after hepatic radiofrequency (RF) ablation. MATERIALS AND METHODS From January 2000 to December 2014, 5,196 patients with 9,743 tumors underwent 8,303 RF ablation sessions. Of these patients, 62 experienced bleeding after hepatic RF ablation; 15 patients (12 men and 3 women; mean age 62 y; range, 49-76 y) underwent embolization and composed the final study cohort. Tumors were hepatocellular carcinomas in 13 (87%) patients and metastatic adenocarcinomas from colorectal cancer in 2 (13%) patients. Mean number of tumors was 1.5 (22 nodules; range, 1-3). Tumor locations were segment I (n = 1), segment II (n = 2), segment III (n = 1), segment IV (n = 1), segment V (n = 3), segment VI (n = 5), segment VII (n = 1), and segment VIII (n = 9). Mean tumor size was 2.3 cm (range, 0.9-5 cm). RESULTS Median time interval between presentation and angiography was 22 hours (mean 38.4 h; range, 3-168 h). On angiography, contrast extravasation with or without pseudoaneurysm was seen in all 15 patients; 14 patients underwent transarterial embolization, and 1 patient underwent percutaneous transhepatic portal vein embolization. Successful hemostasis was achieved in all patients. There was no rebleeding within 30 days after embolization. No embolization-related major complications were observed. CONCLUSIONS Embolization is safe and effective for controlling bleeding related to hepatic RF ablation without the need for surgery.
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Affiliation(s)
- Jong Woo Kim
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea; Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea.
| | - Pyo Nyun Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea
| | - Yong Moon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea
| | - Hyung Jin Won
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea
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Lee DH, Lee JM, Yoon JH, Kim YJ, Han JK. Thermal Injury-induced Hepatic Parenchymal Hypoperfusion: Risk of Hepatocellular Carcinoma Recurrence after Radiofrequency Ablation. Radiology 2016; 282:880-891. [PMID: 27643670 DOI: 10.1148/radiol.2016152322] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To retrospectively evaluate whether thermal injury-induced hepatic parenchymal hypoperfusion can be a significant risk factor for tumor recurrence after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). Materials and Methods The institutional review board approved this retrospective study, and the requirement to obtain informed consent was waived. The study population comprised 130 patients (87 men, 43 women; mean age, 61.4 years ± 8.95; age range, 39-84 years) with single nodular HCCs smaller than 5 cm who underwent RFA between January 2011 and December 2012. The development of RFA-induced hepatic parenchymal hypoperfusion was assessed with follow-up computed tomography (CT). After a mean follow-up of 36.7 months ± 10.8, the authors analyzed the overall and recurrence-free survival and the cumulative incidence of each type of recurrence (ie, local tumor progression [LTP], intrahepatic distant recurrence [IDR], and extrahepatic metastasis) by evaluating prognostic factors with use of the Kaplan-Meier method and Cox proportional hazard regression model. Results RFA-induced hepatic parenchymal hypoperfusion developed in 41 of the 130 patients (31.5%) but did not have a significant effect on overall survival (P = .634). However, the estimated 3-year recurrence-free survival rate was 43.3% in the 41 patients with RFA-induced hepatic parenchymal hypoxia and 61.9% in the 89 patients without hypoxia, a statistically significant difference (P = .019). The 3-year cumulative incidence of IDR was significantly higher in patients with RFA-induced hepatic parenchymal hypoperfusion than in those without hypoxia (33.3% vs 54.1%, P = .006). Conversely, the 3-year cumulative incidence of LTP and extrahepatic metastases showed no significant differences (P > .05 for both). Conclusion The development of RFA-induced hepatic parenchymal hypoperfusion is a significant predictive factor of recurrence (of IDR in particular) after RFA of a single nodular HCC. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Dong Ho Lee
- From the Departments of Radiology (D.H.L., J.M.L., J.K.H.) and Internal Medicine (J.H.Y., Y.J.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (D.H.L., J.M.L., J.K.H.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.)
| | - Jeong Min Lee
- From the Departments of Radiology (D.H.L., J.M.L., J.K.H.) and Internal Medicine (J.H.Y., Y.J.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (D.H.L., J.M.L., J.K.H.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.)
| | - Jung Hwan Yoon
- From the Departments of Radiology (D.H.L., J.M.L., J.K.H.) and Internal Medicine (J.H.Y., Y.J.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (D.H.L., J.M.L., J.K.H.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.)
| | - Yoon Jun Kim
- From the Departments of Radiology (D.H.L., J.M.L., J.K.H.) and Internal Medicine (J.H.Y., Y.J.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (D.H.L., J.M.L., J.K.H.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.)
| | - Joon Koo Han
- From the Departments of Radiology (D.H.L., J.M.L., J.K.H.) and Internal Medicine (J.H.Y., Y.J.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (D.H.L., J.M.L., J.K.H.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.)
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Song KD, Lee MW, Rhim H, Kim YS, Kang TW, Shin SW, Cho SK. Aggressive Intrasegmental Recurrence of Hepatocellular Carcinoma After Combined Transarterial Chemoembolization and Radiofrequency Ablation. AJR Am J Roentgenol. 2016;207:1122-1127. [PMID: 27575338 DOI: 10.2214/ajr.16.16080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The goal of this study is to evaluate the outcomes of combined transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) in terms of the frequency of aggressive intrasegmental recurrence. MATERIALS AND METHODS Sixty-one patients (43 men and 18 women; mean [± SD] age, 65.8 ± 8.6 years; age range, 44-82 years) with 71 HCCs (mean [± SD] size, 2.8 ± 0.9 cm; range, 0.7-4.2 cm) underwent combined TACE and RFA. Aggressive intrasegmental recurrence was defined as initial tumor recurrence at least 6 months after treatment and the simultaneous development of recurrence of multiple (at least three) nodular or infiltrative tumors in the treated segment. Tumor contact with a thick (diameter, ≥ 3 mm) portal vein (i.e., periportal HCC) was evaluated. The frequency of aggressive intrasegmental recurrence, the local tumor progression (LTP) rate, and the complication rate were assessed. RESULTS The median follow-up period was 25.6 months (range, 6.1-75.5 months). Twenty-two HCCs (31%) were in contact with a thick portal vein. Aggressive intrasegmental recurrence was observed in one patient (representing 1.4% of all treated HCCs and 4.5% of periportal HCCs) after treatment of a 4.0-cm periportal HCC. The cumulative LTP rates at 1, 3, and 5 years were 6.7%, 21.0%, and 30.5%, respectively. The rate of major complications was 6.6%. CONCLUSION The frequency of aggressive intrasegmental recurrence after combined TACE and RFA for HCCs was very low.
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Fonseca AZ, Saad WA, Ribeiro Jr. MA. Complications after Radiofrequency Ablation of 233 Hepatic Tumors. Oncology 2015; 89:332-6. [DOI: 10.1159/000439089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 07/30/2015] [Indexed: 11/19/2022]
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Galun D, Basaric D, Zuvela M, Bulajic P, Bogdanovic A, Bidzic N, Milicevic M. Hepatocellular carcinoma: From clinical practice to evidence-based treatment protocols. World J Hepatol 2015; 7:2274-91. [PMID: 26380652 PMCID: PMC4568488 DOI: 10.4254/wjh.v7.i20.2274] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 07/06/2015] [Accepted: 08/30/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the major malignant diseases in many healthcare systems. The growing number of new cases diagnosed each year is nearly equal to the number of deaths from this cancer. Worldwide, HCC is a leading cause of cancer-related deaths, as it is the fifth most common cancer and the third most important cause of cancer related death in men. Among various risk factors the two are prevailing: viral hepatitis, namely chronic hepatitis C virus is a well-established risk factor contributing to the rising incidence of HCC. The epidemic of obesity and the metabolic syndrome, not only in the United States but also in Asia, tend to become the leading cause of the long-term rise in the HCC incidence. Today, the diagnosis of HCC is established within the national surveillance programs in developed countries while the diagnosis of symptomatic, advanced stage disease still remains the characteristic of underdeveloped countries. Although many different staging systems have been developed and evaluated the Barcelona-Clinic Liver Cancer staging system has emerged as the most useful to guide HCC treatment. Treatment allocation should be decided by a multidisciplinary board involving hepatologists, pathologists, radiologists, liver surgeons and oncologists guided by personalized -based medicine. This approach is important not only to balance between different oncologic treatments strategies but also due to the complexity of the disease (chronic liver disease and the cancer) and due to the large number of potentially efficient therapies. Careful patient selection and a tailored treatment modality for every patient, either potentially curative (surgical treatment and tumor ablation) or palliative (transarterial therapy, radioembolization and medical treatment, i.e., sorafenib) is mandatory to achieve the best treatment outcome.
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Affiliation(s)
- Danijel Galun
- Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dragan Basaric
- Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Marinko Zuvela
- Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Predrag Bulajic
- Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Aleksandar Bogdanovic
- Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nemanja Bidzic
- Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miroslav Milicevic
- Danijel Galun, Dragan Basaric, Marinko Zuvela, Predrag Bulajic, Aleksandar Bogdanovic, Nemanja Bidzic, Miroslav Milicevic, Clinic of Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Yu MH, Lee JY, Jun SR, Kim KW, Kim SH, Han JK, Choi BI. Radiofrequency Ablation with an Internally Cooled Monopolar Directional Electrode: Ex Vivo and in Vivo Experimental Studies in the Liver. Radiology 2015; 278:395-404. [PMID: 26172531 DOI: 10.1148/radiol.2015142269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the feasibility of using an internally cooled directional electrode (ICDE) to create sufficient directional ablation in the desired area and to investigate whether use of the ICDE reduces thermal injury to the adjacent organs. MATERIALS AND METHODS The animal care and use committee approved this animal study. In ex vivo studies of bovine livers and colons, temperature was measured in both ablation and nonablation directions with the ICDE, temperature at the liver-colon interface and the presence of burns on the colon were evaluated with each ICDE and internally cooled conventional electrode (ICCE), and the ablation area with the use of three ICDEs in the switching multichannel mode was evaluated. In an in vivo study of 10 pigs, 11 ablations were performed by using three ICDEs in the switching multichannel mode. In addition, the difference in thermal injury to the gallbladder and stomach was compared between use of the ICDE and the ICCE. Mann-Whitney test and the Fisher exact test were used for statistical analysis. RESULTS In the ex vivo study, the hepatic temperature in the nonablation direction was lower than 50°C; temperature higher than 47°C was maintained for less than 3 minutes, even 0.5 cm away from the ICDE; and the temperature at the liver-colon interface did not increase above 50°C. In the switching multichannel mode, a fused coagulation zone was created. In the in vivo study, confluent ablation was created in the inner circle of three ICDEs with a mean interelectrode distance of less than 2.6 cm. Use of the ICDE did not create a moderate-to-severe gallbladder wall injury in any of the pigs, but use of the ICCE caused injury in three of the five pigs (P > .05). The ICDE caused moderate-to-severe gastric wall injury at one of eight ablations, and the ICCE caused injury at eight of nine ablations (P < .05). CONCLUSION Use of an ICDE can create a sufficient ablation in the desired direction and can decrease thermal injury to the adjacent organs.
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Affiliation(s)
- Mi Hye Yu
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Jae Young Lee
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Su Ryoung Jun
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Kyung Won Kim
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Se Hyung Kim
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Joon Koo Han
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Byung Ihn Choi
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
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Talasso MS, Lanzoni V, Goldenberg A, Garcia RG, Moura-Franco RMA, Fernandes OOC, Mesquita RDS, Carlotto JRM, Matos D, Lopes-Filho GDJ, Linhares MM. An evaluation of the protective effect of an infusion of chilled glucose solution on thermal injury of the bile ducts caused by radiofrequency ablation of the liver. Acta Cir Bras 2015; 30:34-45. [DOI: 10.1590/s0102-86502015001000005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/15/2014] [Indexed: 11/22/2022] Open
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Romero Gutiérrez M, Ruano Díaz L, Muñoz López D, Artaza Varasa T, González de Frutos C, Sánchez Ruano JJ, de la Cruz Pérez G, Gómez Rodríguez R. [Percutaneous ablation of hepatocellular carcinoma in older patients in clinical practice]. Gastroenterol Hepatol 2014; 38:54-61. [PMID: 25499846 DOI: 10.1016/j.gastrohep.2014.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 10/05/2014] [Accepted: 11/03/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION A high percentage of older patients with early-stage hepatocellular carcinoma (HCC) are potential candidates for percutaneous ablation. MATERIAL AND METHODS We prospectively assessed data from patients older than 70 years with HCC. We determined their demographic and clinical characteristics, the treatment provided and the response, complications and survival among those treated with radiofrequency ablation (RFA) and/or percutaneous ethanol injection (PEI). RESULTS Of 194 patients with HCC, 84 were older than 70 years (43.3%). The mean age was 76.8 ± 4.5 years. Seventy-five percent were male and 91.7% had cirrhosis. Cancer was initially identified by a surveillance program in 61.9%. According to the Barcelona Clinic Liver Cancer staging system, 60.7% were classified as having early stage cancer (0-A), 19% as stage B, 12% as stage C, and 8.3% as stage D. Potentially curative initial treatment was provided in 38.2% (surgical resection in 4.8%, PEI in 22.6%, RFA in 4.8%, PEI+RFA in 6%), transarterial chemoembolization in 20.2%, and sorafenib in 3.6%. Twenty-five percent of patients were not treatment candidates and 13% refused the recommended treatment. The median follow-up after percutaneous ablation was 23 months (IQR 14.2-40.6). The mean number of sessions was 3.5 ± 2.2 for PEI and 1.8 ± 1.6 for RFA. The complications rate per session was 4%. Remission was achieved in 35.7%. The overall median survival was 45.7 months (95% CI 20.8-70.6). CONCLUSIONS Almost half of the patients with HCC in our sample were elderly and more than half were diagnosed at an early stage. Percutaneous ablation was performed in one-third of the sample, achieving remission in 37.5%. There were few complications. Therefore, these patients should be assessed for percutaneous ablation.
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Affiliation(s)
- Marta Romero Gutiérrez
- Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España.
| | - Lucía Ruano Díaz
- Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España
| | - Diego Muñoz López
- Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España
| | - Tomás Artaza Varasa
- Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España
| | | | - Juan José Sánchez Ruano
- Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España
| | - Gema de la Cruz Pérez
- Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España
| | - Rafael Gómez Rodríguez
- Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España
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