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Analysis of Infectious Complications after Thermal Ablation of Hepatocellular Carcinoma and the Impact on Long-Term Survival. Cancers (Basel) 2022; 14:cancers14215198. [PMID: 36358617 PMCID: PMC9657620 DOI: 10.3390/cancers14215198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 11/28/2022] Open
Abstract
Simple Summary Although thermal ablation has been widely used in treatments of HCC due to its unique advantages of less trauma, safety, postoperative complications still occur in clinical practice. Infectious complications are the third most common complication. The objective of our retrospective study was to summarize the clinical characteristics of infection after thermal ablation for HCC patients and to explore whether it affects tumor recurrence and overall survival. We enrolled 49 patients who developed postoperative infections and matched the same number of control patients, and we also summarized the clinical features and treatment of mild and severe infections. We found that postoperative infection among patients receiving ultrasound-guided thermal ablation adversely affected tumor progression. Empirical antibiotics and catheterization to reduce pressure inside the lesion should be utilized to minimize symptoms in patients with postoperative infection. Abstract Purpose: This study aims to complete a detailed record of the clinical characteristics and treatment of HCC patients with post-ablation infection and evaluate the infections on recurrence-free survival (RFS) and overall survival (OS) among patients receiving ultrasound-guided thermal ablation. Methods: 3117 patients with liver tumors receiving thermal ablation from January 2010 to December 2021 were analyzed. A total of 49 patients with infectious complications after thermal ablation were selected as the infection group. A total of 49 patients without postoperative infection were randomly selected among those who underwent ablation within three days before or after the treatment date of the infection group as the control group. The clinical characteristics of both groups were analyzed by an independent sample t-test and chi-square test. A log-rank test was performed to compare the RFS and OS data. A multivariate Cox regression model was employed to identify prognostic factors influencing RFS and OS. Subgroup analyses of mild and severe infections were conducted to explore the infection-related situation further. Results: Between mild and severe infection groups, there were statistically significant differences in the infection position (p = 0.043), positive rate of body fluid culture (p = 0.002), proportion of catheter drainage (p = 0.017), use of advanced antibiotics (p = 0.006), and outcome (p = 0.00). The Kaplan–Meier survival analysis revealed that postoperative infection was significantly correlated with tumor recurrence (p = 0.028), and severe infection was significantly associated with overall survival (p = 0.049). The cox model showed that postoperative infection was an independent variable for RFS deterioration (HR = 1.724, 95% CI: 1.038–2.862, p = 0.035). Conclusions: Postoperative infection among patients receiving ultrasound-guided thermal ablation adversely affected tumor progression. In addition, empirical antibiotics and catheterization to reduce pressure inside the lesion should be utilized to minimize symptoms in patients with postoperative infection.
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Deng Q, He M, Fu C, Feng K, Ma K, Zhang L. Radiofrequency ablation in the treatment of hepatocellular carcinoma. Int J Hyperthermia 2022; 39:1052-1063. [PMID: 35944905 DOI: 10.1080/02656736.2022.2059581] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The purpose of this article is to discuss the use, comparative efficacy, and research progress of radiofrequency ablation (RFA), alone or in combination with other therapies, for the treatment of hepatocellular carcinoma (HCC). METHOD To search and summarize the basic and clinical studies of RFA in recent years. RESULTS RFA is one of the radical treatment methods listed in the guidelines for the diagnosis and treatment of HCC. It has the characteristics of being minimally invasive and safe and can obtain good local tumor control, and it can improve the local immune ability, improve the tumor microenvironment and enhance the efficacy of chemotherapy drugs. It is commonly used for HCC treatment before liver transplantation and combined ALPPS and hepatectomy for HCC. In addition, the technology of RFA is constantly developing. The birth of noninvasive, no-touch RFA technology and equipment and the precise RFA concept have improved the therapeutic effect of RFA. CONCLUSION RFA has good local tumor control ability, is minimally invasive, is safe and has other beneficial characteristics. It plays an increasingly important role in the comprehensive treatment strategy of HCC. Whether RFA alone or combined with other technologies expands the surgical indications of patients with HCC and provides more benefits for HCC patients needs to be determined.
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Affiliation(s)
- Qingsong Deng
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Minglian He
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chunchuan Fu
- Department of Hepatobiliary Surgery, Xuanhan County People's Hospital, Xuanhan, China
| | - Kai Feng
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Kuansheng Ma
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Leida Zhang
- Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Hofauer B, Knopf A, Strassen U, Wirth M, Mollenhauer M, Edenharter G, Heiser C. Radiofrequency resection in oral and oropharyngeal tumor surgery. Auris Nasus Larynx 2020; 47:148-153. [DOI: 10.1016/j.anl.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/21/2019] [Accepted: 05/12/2019] [Indexed: 11/24/2022]
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Shen H, Zhou S, Lou Y, Gao Y, Cao S, Wu D, Li G. Microwave-Assisted Ablation Improves the Prognosis of Patients With Hepatocellular Carcinoma Undergoing Liver Resection. Technol Cancer Res Treat 2018; 17:1533033818785980. [PMID: 29983095 PMCID: PMC6048665 DOI: 10.1177/1533033818785980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: We evaluated microwave-assisted liver resection for hepatocellular carcinoma. Patients and Methods: We enrolled 79 patients in this study, and microwave ablation was used for liver
resection. Patients were randomized to group A (50.6%; n = 40), liver resection without
microwave ablation, or group B (49.4%; n = 39), liver resection performed using
microwave ablation. Data were analyzed for statistical significance. Results: Of the participants enrolled, 60 were male, and the participant’s average age was 59.32
± 10.34 years. The mean overall tumor diameter was 4.39 (2.00) cm, and this did not
differ between groups. Intraoperative blood loss in group B was significantly less than
that in group A (P < .001). No differences were reported between the
2 groups regarding surgical time (P = .914), postoperative morbidity
(P = .718), and late postoperative complications (P
= .409). Postoperative drainage volume for group B was less than that of group A on the
first (P = .005) and third (P = .019) day after
surgery. The time of postoperative hospitalization in group B was significantly shorter
than that in group A (P < .001). Local recurrence was noted in
18.99% of cases (n = 15) in group B, which is less than that of group A
(P = 0.047), while in group B distant metastasis is less but not
statistically significant (P = 0.061). The 1-year and 3-year cumulative
survival rates were 57% and 93.7%, respectively. Conclusions: The curative effects of liver resection combined with microwave ablation during
operation are superior to only liver resection in the treatment of primary liver
cancer.
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Affiliation(s)
- Haiyuan Shen
- 1 Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Shu Zhou
- 1 Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yun Lou
- 1 Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yangjuan Gao
- 2 Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Shouji Cao
- 1 Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Du Wu
- 1 Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Guoqiang Li
- 1 Department of Liver Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Qiu J, Lu W, Yu N, Yang G, Li Y, Huang Z, Li J, Li K, Xu H, Chen S, Zeng X, Liu H. HabibTM 4X-assisted resection versus clamp-crush resection for hepatocellular carcinoma: a propensity-matching study. Oncotarget 2018; 8:4218-4227. [PMID: 27965468 PMCID: PMC5354825 DOI: 10.18632/oncotarget.13906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/01/2016] [Indexed: 02/06/2023] Open
Abstract
Long term outcome of ablation-assisted hepatic resection is unclear for hepatocellular carcinoma (HCC) patients. This study was scheduled to compare the outcome of Habib 4X ablation assisted resection (Habib group) with clamp-crush resection (CC group) for HCC. In this study, we retrospectively enrolled 81 patients from the Habib group and 103 patients from the CC group. Oncologic outcomes were analyzed using a propensity score matching (PSM) method. Compared with the CC group, the Habib group had higher levels of γ-glutamyltransferase (P=0.044) and albumin (P=0.001), larger tumor sizes (P=0.007), shorter operation times (P=0.001), less blood loss (P=0.005), and less blood transfusions (P=0.038). There were no significant differences in complications (P=0.310), recurrence-free survival rates (RFS, P=0.112), or overall survival rates (OS, P=0.203) between the two groups. For the 67 patient pairs selected from the PSM analysis, the Habib group had better RFS and OS (P=0.033 and P=0.014, respectively). A Cox proportional hazards analysis revealed that Habib-assisted resection was an independent factor for RFS and OS (P=0.008 and P=0.016, respectively). Furthermore, for the 42 patients with central and large tumors, the Habib group had better RFS and OS than the CC group (P=0.035 and P=0.038, respectively). However, the differences of RFS and OS (P=0.117 and P=0.126, respectively) were not significant among 92 patients with peripheral or small tumors. Hence, HabibTM 4X-assisted resection is safe and provides better survival for HCC patients, particularly those with central and large tumors.
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Affiliation(s)
- Jiliang Qiu
- Department of Abdominal Oncosurgery, Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Weiqun Lu
- Department of Abdominal Oncosurgery, Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Nanrong Yu
- Department of Abdominal Oncosurgery, Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Guohua Yang
- Department of Abdominal Oncosurgery, Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Yi Li
- Department of Surgery, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Zhiliang Huang
- Department of Abdominal Oncosurgery, Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Jianchang Li
- Department of Abdominal Oncosurgery, Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Kefei Li
- Department of Abdominal Oncosurgery, Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Houwei Xu
- Department of Abdominal Oncosurgery, Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Shicai Chen
- Department of Abdominal Oncosurgery, Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Xiang Zeng
- Department of Abdominal Oncosurgery, Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - Haiying Liu
- Department of Abdominal Oncosurgery, Cancer Center of Guangzhou Medical University, Guangzhou, China
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Chen ZB, Qin F, Ye Z, Shen SQ, Li W, Ding YM, Hu QY, Ma Y. Microwave-assisted liver resection vs. clamp crushing liver resection in cirrhosis patients with hepatocellular carcinoma. Int J Hyperthermia 2018; 34:1359-1366. [PMID: 29353503 DOI: 10.1080/02656736.2018.1429678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE This study aimed to evaluate the safety and effectiveness of microwave-ablation-assisted liver resection (MW-LR) and clamp crushing liver resection (CC-LR) in cirrhotic patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS From July 2005 to January 2015, cirrhotic HCC patients who underwent CC-LR (n = 191) or MW-LR (n = 112) were retrospectively analysed. We compared morbidity, mortality, disease-free survival (DFS) time and overall survival time between the CC-LR and MW-LR groups. RESULTS The blood loss volume was significantly higher in the CC-LR group (mean of 752 ml) than that in the MW-LR group (mean of 253 ml, p < 0.001). The abdominal abscess rate was higher in the MW-LR group (8.9%) than that in the CC-LR group (3.1%, p = 0.029). The 30-day mortality rate (1.5% vs. 0.8%) and postoperative complication rate (32.9% vs. 25.0%) were both similar between the CC-LR and MW-LR groups. MW-LR provided a survival benefit over CC-LR at 1, 3 and 5 years in the entire population (93.5% vs. 87.0%, 77.0% vs. 62.5% and 50.0% vs. 36.5%, respectively; p = 0.003). In a subgroup analysis, MW-LR provided a survival benefit over CC-LR for Barcelona Clinic Liver Cancer stage A (BCLC-A) HCC (p = 0.026) and stage B (BCLC-B) HCC (p = 0.035) patients and provided DFS benefits for BCLC-A HCC patients (p = 0.036). CONCLUSIONS MW-LR is a safe and feasible procedure for HCC patients with a cirrhotic liver history.
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Affiliation(s)
- Zu-Bing Chen
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Feng Qin
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Zi Ye
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Shi-Qiang Shen
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Wei Li
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - You-Ming Ding
- a Department of General Surgery , Renmin Hospital of Wuhan University , Wuhan , China
| | - Qin-Yong Hu
- b Department of Oncology , Renmin Hospital of Wuhan University , Wuhan , China
| | - Yi Ma
- c Department of General Surgery , The First Affiliated Hospital, Sun Yat-Sen University , Guangzhou , China
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Reccia I, Kumar J, Kusano T, Zanellato A, Draz A, Spalding D, Habib N, Pai M. A systematic review on radiofrequency assisted laparoscopic liver resection: Challenges and window to excel. Surg Oncol 2017; 26:296-304. [PMID: 28807250 DOI: 10.1016/j.suronc.2017.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/07/2017] [Accepted: 06/13/2017] [Indexed: 12/12/2022]
Abstract
Laparoscopic liver resection has progressively gained acceptance as a safe and effective procedure in the treatment of benign and malignant liver neoplasms. However, blood loss remains the major challenge in liver surgery. Several techniques and devices have been introduced in liver surgery in order to minimize intraoperative haemorrhage during parenchymal transection. Radiofrequency (RF)-assisted liver resection has been shown to be an effective method to minimize bleeding in open and laparoscopic liver resection. A number of RF devices for parenchymal transection have been designed to assist laparoscopic liver resections. Here we have reviewed the results of various RF devices in laparoscopic liver resection. A total 15 article were considered relevant for the evaluation of technical aspects and outcomes of RF-assisted liver resections in laparoscopic procedures. In these studies, 176 patients had laparoscopic liver resection using RF-assisted parenchymal coagulation. Two monopolar and three bipolar devices were employed. Blood loss was limited in most of the studies. The need of blood transfusions was limited to two cases in all the series. Conversion was necessary due to bleeding in 3 cases. Operative and transection times varied between studies. However, RF-assisted resection with bipolar devices appeared to have taken less time in comparison to other RF devices. RF-related complications were minimum, and only one case of in-hospital death due to hepatic failure was reported. Although RF has been used in a small minority of laparoscopic liver resections, laparoscopic RF-assisted liver resection for benign and malignant disease is a safe and feasible procedure associated with reduction in blood loss, low morbidity, and lower hospital mortality rates.
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Affiliation(s)
- Isabella Reccia
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
| | - Jayant Kumar
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Tomokazu Kusano
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Artur Zanellato
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Ahmed Draz
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Duncan Spalding
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Madhava Pai
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
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8
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CT Appearance of Hepatocellular Carcinoma after Locoregional Treatments: A Comprehensive Review. Gastroenterol Res Pract 2015; 2015:670965. [PMID: 26798332 PMCID: PMC4700180 DOI: 10.1155/2015/670965] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/09/2015] [Accepted: 09/14/2015] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a major health problem worldwide, affecting more than 600,000 new patients per year. Curative treatments are available in a small percentage of patients, while most of them present in stages requiring locoregional treatments such as thermoablation, transarterial chemoembolization, and/or radioembolization. These therapies
result in specific imaging features that the general radiologist has to be aware of in order to assess the response to treatment and to correctly manage the follow-up of treated patients. Multiphasic helical computed tomography has become a popular imaging modality for detecting hypervascular tumors and characterizing liver lesions. On this basis, many staging and diagnostic systems have been proposed for evaluating response to all different existing strategies. Radiofrequencies and microwaves generate thermoablation of tumors, and transarterial chemoembolization exploits the double effect of the locoregional administration of drugs and embolizing particles. Eventually radioembolization uses a beta-emitting isotope to induce necrosis. Therefore, the aim of this comprehensive review is to analyze and compare CT imaging appearance of HCC after various locoregional treatments, with regard to specific indications for all possible procedures.
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Sasaki K, Matsuda M, Hashimoto M, Watanabe G. Liver resection for hepatocellular carcinoma using a microwave tissue coagulator: Experience of 1118 cases. World J Gastroenterol 2015; 21:10400-10408. [PMID: 26420966 PMCID: PMC4579886 DOI: 10.3748/wjg.v21.i36.10400] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/08/2015] [Accepted: 07/15/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To present our extensive experience of hepatectomy for hepatocellular carcinoma using a microwave tissue coagulator to demonstrate the effectiveness of this device.
METHODS: A total of 1118 cases (1990-2013) were reviewed, with an emphasis on intraoperative blood loss, postoperative bile leakage and fluid/abscess formation, and adaptability to anatomical resection and hepatectomy with hilar dissection.
RESULTS: The median intraoperative blood loss was 250 mL; postoperative bile leakage and fluid/abscess formation were seen in 3.0% and 3.3% of cases, respectively. Anatomical resection was performed in 275 cases, including 103 cases of hilar dissection that required application of microwave coagulation near the hepatic hilum. There was no clinically relevant biliary tract stricture or any vascular problems due to heat injury. Regarding the influence of cirrhosis on intraoperative blood loss, no significant difference was seen between cirrhotic and non-cirrhotic patients (P = 0.38), although cirrhotic patients tended to have smaller tumors and underwent less invasive operations.
CONCLUSION: This study demonstrated outcomes of an extensive experience of hepatectomy using heat coagulative necrosis by microwave tissue coagulator.
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10
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Zhang F, Yan J, Feng XB, Xia F, Li XW, Ma KS, Bie P. Efficiency and safety of radiofrequency-assisted hepatectomy for hepatocellular carcinoma with cirrhosis: A single-center retrospective cohort study. World J Gastroenterol 2015; 21:10159-10165. [PMID: 26401080 PMCID: PMC4572796 DOI: 10.3748/wjg.v21.i35.10159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/27/2015] [Accepted: 04/17/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the efficiency and safety of radiofrequency-assisted hepatectomy in patients with hepatocellular carcinoma (HCC) and cirrhosis.
METHODS: From January 2010 to December 2013, 179 patients with HCC and cirrhosis were recruited for this retrospective study. Of these, 100 patients who received radiofrequency-assisted hepatectomy (RF+ group) were compared to 79 patients who had hepatectomy without ablation (RF- group). The primary endpoint was intraoperative blood loss. The secondary endpoints included liver function, postoperative complications, mortality, and duration of hospital stay.
RESULTS: The characteristics of the two groups were closely matched. The Pringle maneuver was not used in the RF+ group. There was significantly less median intraoperative blood loss in the RF+ group (300 vs 400 mL, P = 0.01). On postoperative days (POD) 1 and 5, median alanine aminotransferase was significantly higher in the RF+ group than in the RF- group (POD 1: 348.5 vs 245.5, P = 0.01; POD 5: 112 vs 82.5, P = 0.00), but there was no significant difference between the two groups on POD 3 (260 vs 220, P = 0.24). The median AST was significantly higher in the RF+ group on POD 1 (446 vs 268, P = 0.00), but there was no significant difference between the two groups on POD 3 and 5 (POD 3: 129.5 vs 125, P = 0.65; POD 5: 52.5 vs 50, P = 0.10). Overall, the rate of postoperative complications was roughly the same in these two groups (28.0% vs 17.7%, P = 0.11) except that post hepatectomy liver failure was far more common in the RF+ group than in the RF- group (6% vs 0%, P = 0.04).
CONCLUSION: Radiofrequency-assisted hepatectomy can reduce intraoperative blood loss during liver resection effectively. However, this method should be used with caution in patients with concomitant cirrhosis because it may cause severe liver damage and liver failure.
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Jin Y, Lyu Y, Tang X, Zhang Y, Chen J, Zheng D, Liang Y. Lupeol enhances radiosensitivity of human hepatocellular carcinoma cell line SMMC-7721 in vitro and in vivo. Int J Radiat Biol 2015; 91:202-8. [DOI: 10.3109/09553002.2015.966209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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12
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Effect of one-off complete tumor radiofrequency ablation on liver function and postoperative complication in small hepatocellular carcinoma. Eur J Surg Oncol 2014; 40:576-583. [DOI: 10.1016/j.ejso.2013.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/29/2013] [Accepted: 12/03/2013] [Indexed: 01/16/2023] Open
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13
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Xiao WK, Chen D, Hu AB, Peng BG, Guo YZ, Fu SJ, Liang LJ, Li SQ. Radiofrequency-assisted versus clamp-crush liver resection: a systematic review and meta-analysis. J Surg Res 2014; 187:471-83. [DOI: 10.1016/j.jss.2013.10.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/21/2013] [Accepted: 10/25/2013] [Indexed: 12/20/2022]
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Agnello F, Salvaggio G, Cabibbo G, Maida M, Lagalla R, Midiri M, Brancatelli G. Imaging appearance of treated hepatocellular carcinoma. World J Hepatol 2013; 5:417-424. [PMID: 24023980 PMCID: PMC3767840 DOI: 10.4254/wjh.v5.i8.417] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/04/2013] [Accepted: 08/12/2013] [Indexed: 02/06/2023] Open
Abstract
Surgical resection and imaging guided treatments play a crucial role in the management of hepatocellular carcinoma (HCC). Although the primary end point of treatment of HCC is survival, radiological response could be a surrogate end point of survival, and has a key role in HCC decision-making process. However, radiological assessment of HCC treatment efficacy is often controversial. There are few doubts on the evaluation of surgical resection; in fact, all known tumor sites should be removed. However, an unenhancing partial linear peripheral halo, in most cases, surrounding a fluid collection reducing in size during follow-up is demonstrated in successfully resected tumor with bipolar radiofrequency electrosurgical device. Efficacy assessment of locoregional therapies is more controversial and differs between percutaneous ablation (e.g., radiofrequency ablation and percutaneous ethanol injection) and transarterial treatments (e.g., conventional transarterial chemoembolization, transarterial chemoembolization with drug eluting beads and radioembolization). Finally, a different approach should be used for new systemic agent that, though not reducing tumor mass, could have a benefit on survival by delaying tumor progression and death. The purpose of this brief article is to review HCC imaging appearance after treatment.
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Affiliation(s)
- Francesco Agnello
- Francesco Agnello, Giuseppe Salvaggio, Roberto Lagalla, Massimo Midiri, Giuseppe Brancatelli, Section of Radiological Sciences, DIBIMEF, University of Palermo, 90127 Palermo, Italy
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Li M, Zhang W, Li Y, Li P, Li J, Gong J, Chen Y. Radiofrequency-assisted versus clamp-crushing parenchyma transection in cirrhotic patients with hepatocellular carcinoma: a randomized clinical trial. Dig Dis Sci 2013; 58:835-40. [PMID: 23007732 DOI: 10.1007/s10620-012-2394-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 08/28/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Surgical resection remains the optimal therapy for cirrhotic patients with hepatocellular carcinoma (HCC) that are not suitable for liver transplantation (LT). Recently, various innovative techniques for liver resection have been developed. AIM The aim of the study was to compare radiofrequency-assisted parenchyma transection (RF-PT) with the traditional clamp-crushing (CC) technique to explore the preferred therapy in cirrhotic patients with HCC. METHODS From January 2009 to December 2010, 75 cirrhotic patients with HCC who underwent hepatectomy were randomized to RF-PT (group 1, n = 38) or CC-PT (group 2, n = 37) groups. The primary endpoint was intraoperative blood loss. The secondary endpoints included hepatic transection time, total operating time, postoperative morbidity, mortality, length of intensive care unit and hospital stays, and liver function. RESULTS The characteristics of the two patient groups were closely matched. The Pringle maneuver was not used in RF-PT patients. The blood loss of the RF-PT group, total or during transection, was significantly lower than that of the CC-PT group (385 vs. 545 ml, p = 0.001; 105 vs. 260 ml, p = 0.000, respectively). Compared with CC-PT patients, the morbidity of the RF-PT group was lower though not statistically significant (28.9 vs. 38.8 %, p = 0.197). One death occurred in the RF-PT group 12 days postoperative due to a large area cerebral embolism. CONCLUSION RF-PT is a safe and feasible surgical resection method for patients with cirrhosis and concomitant HCC. In addition, RF-PT results in lower blood loss and lower morbidity than the CC technique during liver resection.
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Affiliation(s)
- Min Li
- Department of Hepatobiliary Surgery, 2nd College of Clinical Medicine of Chongqing University of Medical Science, Chongqing, 400010, China.
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Sandonato L, Soresi M, Cipolla C, Bartolotta TV, Giannitrapani L, Antonucci M, Galia M, Latteri MA. Minor Hepatic Resection for Hepatocellular Carcinoma in Cirrhotic Patients: Kelly Clamp Crushing Resection Versus Heat Coagulative Necrosis with Bipolar Radiofrequency Device. Am Surg 2011. [DOI: 10.1177/000313481107701139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hemorrhage and postoperative liver insufficiency are frequent and serious complications of hepatic resection in cirrhotic patients. The aim of this study was to assess retrospectively whether the surgical techniques using Kelly clamp crushing resection or heat coagulative necrosis with a bipolar radiofrequency device can reduce the incidence of the above complications and an eventual recurrence of neoplasia on the liver slice. We retrospectively reviewed the results of 35 patients who had undergone resection for monofocal hepatocellular carcinoma at our center. Thirteen patients (Group A) had undergone liver resection with Kelly clamp crushing resection, 22 patients (Group B) had had liver resection assisted with a bipolar radiofrequency device. Radiofrequency-assisted liver resection was associated with diminished blood loss ( P < 0.0001), a lower blood transfusion rate ( P < 0.005), reduced operative time ( P < 0.0001), and better postoperative serum albumin levels ( P < 0.03). This nonrandomized retrospective study suggests that radiofrequency-assisted liver resection is associated with better results than the Kelly clamp crushing resection technique in cirrhotic patients with focal hepatocellular carcinoma and preserved liver function. These results should now be assessed prospectively in a randomized clinical trial.
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Affiliation(s)
- Luigi Sandonato
- Department of Oncology, Division of General and Oncological Surgery, Italy
| | - Maurizio Soresi
- Department of Clinical Medicine and Emerging Pathologies, Division of Internal Medicine and Hepatology, Italy
| | - Calogero Cipolla
- Department of Oncology, Division of General and Oncological Surgery, Italy
| | - Tommaso V. Bartolotta
- Department of Medical Biotechnology and Legal Medicine, Division of Radiological Science, Interdepartmental Unit for Hepatic Neoplastic Disease, University of Palermo, Italy
| | - Lydia Giannitrapani
- Department of Clinical Medicine and Emerging Pathologies, Division of Internal Medicine and Hepatology, Italy
| | - Michela Antonucci
- Department of Oncology, Division of General and Oncological Surgery, Italy
| | - Massimo Galia
- Department of Medical Biotechnology and Legal Medicine, Division of Radiological Science, Interdepartmental Unit for Hepatic Neoplastic Disease, University of Palermo, Italy
| | - Mario A. Latteri
- Department of Oncology, Division of General and Oncological Surgery, Italy
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Abstract
Nomenclature describing liver anatomy and liver resection has been standardized with the Brisbane 2000 terminology. When performing liver resection, blood loss should be minimized by using low central venous pressure (CVP) anesthesia and vascular occlusion as appropriate. There are many options for transection of the liver parenchyma, and although no technique has been shown to be superior to clamp-crushing, hepatic surgeons should be familiar with the techniques available.
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Affiliation(s)
- Scott A Celinski
- Division of Surgical Oncology, Baylor University Hospital, Dallas, TX, USA
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Techniques of radiofrequency-assisted precoagulation in laparoscopic liver resection. Surg Endosc 2010; 25:1143-7. [PMID: 20844897 DOI: 10.1007/s00464-010-1330-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 08/07/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although radiofrequency-assisted (RF) precoagulation has been described for open resections, there is little data evaluating precoagulation options in laparoscopic liver resection. The purpose of this study is to provide an algorithm for the use of monopolar and bipolar RF devices in laparoscopic liver resection. METHODS Patients undergoing laparoscopic liver resection utilizing precoagulation during the period 2007-2009 were identified from a prospectively maintained, institutional review board-approved database. RF-assisted precoagulation was performed using a second-generation monopolar RF ablation catheter (Starburst XL, AngioDynamics) or bipolar RF device (Habib 4X, AngioDynamics). RESULTS Precoagulation was utilized in 31cases (monopolar, n = 19, and bipolar, n = 12). Procedures performed included segmentectomy/wedge resection in 19 patients and bisegmentectomy in 12 patients. The bipolar RF device was used for left lateral sectionectomies (90%) in which there was linear transaction, whereas the monopolar RF catheter was used for nonlinear segmental and wedge resections involving the right lobe (95%). Time required for precoagulation was 22.5 ± 7.2 min for the bipolar and 33.6 ± 15.9 min for the monopolar device. No patient developed postoperative bleeding, bile duct injury, or liver abscess. At follow-up, one patient in the monopolar group developed a suspected local recurrence. CONCLUSIONS We have suggested an algorithm to select a given device based on tumor location and type of resection. With approximately 30 min of time spent for precoagulation, the blood loss and rate of local recurrence were favorable. There also could be an oncologic benefit due to additional functional margin obtained with the RF effect.
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Torzilli G, Donadon M, Montorsi M, Makuuchi M. Concerns about ultrasound-guided radiofrequency-assisted segmental liver resection. Ann Surg 2010; 251:1191-2; author reply 1192-3. [PMID: 20485119 DOI: 10.1097/sla.0b013e3181e0452f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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