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Long Y, Zeng Q, He X, Wu Y, Ye H, Xu J, Chen J, Yuan L, Li H, Li K. Anatomical thermal ablation as an alternative to surgical resection for subcapsular hepatocellular carcinoma. Abdom Radiol (NY) 2024; 49:1144-1153. [PMID: 38289353 DOI: 10.1007/s00261-023-04150-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 03/22/2024]
Abstract
PURPOSE To simulate the advantages of anatomical resection, a new strategy of anatomical thermal ablation was proposed. The objective of this study was to evaluate the clinical value of anatomical thermal ablation (ATA) to treat subcapsular hepatocellular carcinoma by comparing it with anatomical resection (AR) and non-anatomical resection (NAR). METHODS This retrospective cohort study enrolled hepatocellular carcinoma patients with subcapsular tumor diameter ≤ 50 mm treated by ATA or surgical resection at our center from October 2015 to December 2018. ATA features ablation of the Glisson capsule, ablation of the liver parenchyma between the tumor and hepatic veins or inferior vena cava and then puncture from the surrounding part to the central part of the tumor. Outcome parameters were compared. RESULTS Seventy-six patients were grouped into ATA group, 95 patients into AR group and 41 patients into NAR group. The 1-, 2-, and 3-year local recurrence rates were 0.0%, 0.0%, 0.0% for ATA group, 0.0%, 1.4%, 1.4% for the AR group and 0.0%, 0.0%, and 0.0% for the NAR group, respectively (P = 0.449). The 1-, 2-, and 3-year progression-free survival rates were 90.6%, 80.9%, and 74.6% for ATA group, 91.5%, 80.2%, and 80.2% for the AR group and 82.9%, 73.8%, and 73.8% for the NAR group, respectively (P = 0.608). The 1-, 2-, and 3-year overall survival rates were 100.0%, 95.2%, and 95.2% for the ATA group, 96.8%, 95.6%, and 95.6% for the AR group and 97.6%, 95.0%, and 95.0% for the NAR group, respectively (P = 0.970). No difference was found in major complication rate among these groups (P = 0.091). CONCLUSION For subcapsular hepatocellular carcinoma, ATA could be an alternative to surgical resection with its comparable treatment effect and safety.
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Affiliation(s)
- Yinglin Long
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Qingjing Zeng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Xuqi He
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Yuxuan Wu
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Huolin Ye
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China
| | - Jianliang Xu
- Department of Liver Surgery, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, China
| | - Jianning Chen
- Department of Pathology, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, China
| | - Lianxiong Yuan
- Department of Science and Research, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, China
| | - Hua Li
- Department of Liver Surgery, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, China
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road No. 600, Guangzhou, 510630, Guangdong, China.
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Shimizu R, Ida Y, Kitano M. Predicting Outcome after Percutaneous Ablation for Early-Stage Hepatocellular Carcinoma Using Various Imaging Modalities. Diagnostics (Basel) 2023; 13:3058. [PMID: 37835800 PMCID: PMC10572637 DOI: 10.3390/diagnostics13193058] [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: 07/30/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Percutaneous ablation is a low-invasive, repeatable, and curative local treatment that is now recommended for early-stage hepatocellular carcinoma (HCC) that is not suitable for surgical resection. Poorly differentiated HCC has high-grade malignancy potential. Microvascular invasion is frequently seen, even in tumors smaller than 3 cm in diameter, and prognosis is poor after percutaneous ablation. Biopsy has a high risk of complications such as bleeding and dissemination; therefore, it has limitations in determining HCC tumor malignancy prior to treatment. Advances in diagnostic imaging have enabled non-invasive diagnosis of tumor malignancy. We describe the usefulness of ultrasonography, computed tomography, magnetic resonance imaging, and 18F-fluorodeoxyglucose positron emission tomography for predicting outcome after percutaneous ablation for HCC.
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Affiliation(s)
- Ryo Shimizu
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
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Zhang HL, Yu SY, Cao CW, Zhu JE, Li JX, Sun LP, Xu HX. Uterine artery embolization combined with percutaneous microwave ablation for the treatment of prolapsed uterine submucosal leiomyoma: A case report. World J Clin Cases 2023; 11:3052-3061. [PMID: 37215407 PMCID: PMC10198079 DOI: 10.12998/wjcc.v11.i13.3052] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/24/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Vaginal myomectomy is the most common form of radical treatment for prolapsed submucosal leiomyoma and is typically performed under general anesthesia. However, an alternative treatment approach is needed for patients who cannot tolerate general anesthesia. We describe a case with such a patient who was successfully treated via a minimally invasive method under local anesthesia.
CASE SUMMARY A 46-year-old female suffered from abnormal uterine bleeding, severe anemia, and a reduced quality of life attributed to a massive prolapsed submucosal leiomyoma. She could not tolerate general anesthesia due to a congenital thoracic malformation and cardiopulmonary insufficiency. A new individualized combined treatment, consisting uterine artery embolization (UAE), percutaneous microwave ablation (PMWA) of the pedicle and the endometrium, and transvaginal removal of the leiomyoma by twisting, was performed. The lesion was completely removed successfully under local anesthesia without any major complications. The postoperative follow-up showed complete symptom relief and a significant improvement in the quality of life.
CONCLUSION UAE combined with PMWA can be performed under local anesthesia and is a promising alternative treatment for patients who cannot tolerate general anesthesia.
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Affiliation(s)
- Hui-Li Zhang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Shanghai 200072, China
| | - Song-Yuan Yu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Shanghai 200072, China
| | - Chuan-Wu Cao
- Department of Interventional and Vascular Surgery, Shanghai Tenth People’s Hospital, Shanghai 200072, China
| | - Jing-E Zhu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Shanghai 200072, China
| | - Jia-Xin Li
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Shanghai 200072, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Shanghai 200072, China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Shanghai 200032, China
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Li H, Wang Q, Sui G, Lin Y, Luo Q, Dong P, Zhu L, Wang H, Teng D. Value of CEUS combined with feeding artery ablation in the microwave ablation of large solid benign thyroid nodules. Eur Radiol 2023; 33:2407-14. [PMID: 36472698 DOI: 10.1007/s00330-022-09313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the value of contrast-enhanced ultrasound (CEUS) combined with feeding artery ablation in the microwave ablation (MWA) of large solid benign thyroid nodules (LSBTNs) with a diameter ≥ 4 cm. METHODS We retrospectively analyzed 122 patients with LSBTN ≥ 4 cm in diameter treated with MWA. During evaluations before and after MWA, 53 patients who underwent conventional ultrasound examination were classified as the routine group, and 69 patients who underwent CEUS combined with feeding artery ablation were classified as the union group. The differences in ablation energy required per milliliter (AERPM), complication rate, regrowth rate, and volume reduction rate (VRR) were compared between the two groups. RESULTS The AERPM of the union group was significantly less than that of the routine group (956.3 ± 38.5 J/mL vs. 1025.9 ± 121.5 J/mL, p < 0.001). The complication rate of the routine group was significantly higher than that of the union group (13.2% vs. 2.9%, p = 0.031). The regrowth rate of the routine group (22.6%, 12/53) was significantly higher than that of the union group (7.2%, 5/69) (p = 0.015). At the 1st, 3rd, 6th, 12th, 18th, and 24th month after ablation, the mean VRRs of the routine group were significantly less than those of the union group, with p values of < 0.001, < 0.001, 0.002, 0.007, 0.013, and < 0.001, respectively. CONCLUSIONS The application of CEUS combined with feeding artery ablation in the MWA of LSBTNs is helpful to reduce the regrowth rate, improve the ablation efficiency, and reduce bleeding. KEY POINTS • CEUS combined with feeding artery ablation in MWA of LSBTNs is helpful to reduce regrowth rate. • CEUS combined with feeding artery ablation can help improve ablation efficiency than conventional ultrasound in LSBTNs. • CEUS combined with feeding artery ablation helps reduce the incidence of bleeding during MWA.
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Li X, Zhang X, Shi L, Huang G, Lin M, Xie X, Xu M. Feeding Vessel Ablation: A Novel Subsegmental Devascularization Technique for the Treatment of Hepatocellular Carcinoma Located at the Liver Marginal Angle. Ultrasound Med Biol 2022; 48:546-553. [PMID: 34972571 DOI: 10.1016/j.ultrasmedbio.2021.11.011] [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: 06/17/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
This pilot clinical study evaluated primarily the efficacy of feeding vessel ablation (FVA) in the treatment of hepatocellular carcinoma (HCC) located at the liver marginal angle (LMA). Nine patients with nine unresectable HCC lesions were prospectively included in this study. The target tumors (mean: 3.0 cm, interquartile range: 2.4-3.6 cm) were located at the LMA (segment 2/3/6) and adjacent to the gastrointestinal tract. Artificial ascites was attempted and failed. Multimode ultrasound technologies, including 2-D and real-time 3-D contrast-enhanced ultrasound, were used to identify the morphology and structure of the feeding vessels for the target tumors. During the treatment, a unipolar cool-tip electrode was used to ablate the feeding vessels, and the target ablation point was set in subsegmental or more distal vessels to induce a downstream ischemia region. Therapeutic outcomes were assessed after FVA, including the rates of technical success, tumor response, local tumor progression (LTP), overall survival (OS) and major complications. Cumulative LTP and OS were estimated with the Kaplan-Meier method. The technical success rate determined immediately after radiofrequency ablation was 7 of 9 (77.8%). Complete response (CR) was achieved in 7 of 7 tumors (100%) at the 1-mo evaluation. During a median follow-up period of 15.6 mo (range: 4.3-53.3 mo), CR remained in 6 of 7 tumors (85.7%), with LTP observed in 1 of 7 tumors (14.3%) 4.7 mo after treatment. The cumulative 1-, 3- and 5-y LTP-free rates were all 83.3%, and the cumulative 1-, 3- and 5-y OS rates were 42.9%, 28.6% and 0%, respectively. No major complications occurred. We concluded that FVA can induce subsegmental devascularization and has the potential to serve as an effective and safe alternative technique for local control of unresectable HCC located at the LMA when artificial ascites fails.
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Affiliation(s)
- Xiaoju Li
- Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoer Zhang
- Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Shi
- Department of Medical Ultrasonics, Hainan General Hospital, Haikou, China
| | - Guangliang Huang
- Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Manxia Lin
- Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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