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1
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Wehrle CJ, Sarioglu AG, Akgun E, Berber E. The impact of Kirsten rat sarcoma (KRAS) status on local tumor progression after surgical ablation of colorectal liver metastases. Surgery 2025; 179:108807. [PMID: 39322485 DOI: 10.1016/j.surg.2024.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/17/2024] [Accepted: 07/08/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND Kirsten rat sarcoma mutation was reported to adversely affect local tumor control after percutaneous ablation of colorectal liver metastasis. Nevertheless, the effect of Kirsten rat sarcoma mutation on surgical ablation has not been investigated in the literature. The aim of this study is to analyze the impact of Kirsten rat sarcoma mutation on local recurrence after surgical ablation of colorectal liver metastasis. METHODS This was an institutional review board-approved study of patients who underwent surgical ablation of colorectal liver metastasis between 2005 and 2023 at a single center and underwent Kirsten rat sarcoma testing with ≥1 year follow-up. Local recurrence was analyzed using univariate Kaplan-Meier and multivariate Cox hazard models. RESULTS A total of 163 patients with 424 lesions fulfilled inclusion criteria. Fifty (30.7%) patients received radiofrequency ablation and 113 (69.3%) patients received microwave ablation. Fifty-seven patients (32.2%) with 177 lesions were found to have a Kirsten rat sarcoma mutation. Patients with Kirsten rat sarcoma mutation had a larger number of tumors, percentage of posteriorly located tumors, and tumor burden score compared with those with wild-type Kirsten rat sarcoma. Nevertheless, there was no difference between the groups regarding local recurrence per lesion (15% vs 17%, respectively, P = not significant). Independent predictors of local recurrence included tumor size, ablation margin, and blood vessel proximity for radiofrequency ablation compared with tumor size and ablation margin for microwave ablation. CONCLUSION There was no effect of Kirsten rat sarcoma mutations on local recurrence after surgical radiofrequency ablation or microwave ablation of colorectal liver metastasis in this study. Tumor size and ablation margin remained as independent predictors.
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Affiliation(s)
- Chase J Wehrle
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Cleveland, OH. https://twitter.com/ChaseWehrle
| | - Ali Gunduz Sarioglu
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Cleveland, OH
| | - Ege Akgun
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Cleveland, OH
| | - Eren Berber
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Cleveland, OH.
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Ndhlovu E, Zhang BX, Chen XP, Zhu P. Thermal ablation for hepatic tumors in high-risk locations. Clin Res Hepatol Gastroenterol 2024; 48:102300. [PMID: 38367803 DOI: 10.1016/j.clinre.2024.102300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/21/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
Thermal ablative techniques such as radiofrequency and microwave ablation are minimally invasive and cost-effective approaches that are currently being adopted as alternatives to surgical resection for primary and metastatic liver malignancies. However, they are considered to be relatively contraindicated for tumors in high-risk locations due to technical difficulties and a perceived increased risk of perioperative complications. Several techniques, including artificial ascites, non-touch multibipolar ablation, and laparoscopically assisted ablation, can be used to improve the outcomes of ablation for high-risk tumors. This review aims to provide a comprehensive summary of the techniques currently used to improve thermal ablation outcomes for high-risk liver tumors.
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Affiliation(s)
- Elijah Ndhlovu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Bi-Xiang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China.
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Jeon HJ, Eun HS, Kwon IS, Lee BS, Lee ES, Rou WS, Sung JK, Moon HS, Kang SH, Lee HS, Kim SH, Chun K, Kim SH. Outcomes of laparoscopic radiofrequency ablation versus percutaneous radiofrequency ablation for hepatocellular carcinoma. Surg Endosc 2023:10.1007/s00464-023-09956-1. [PMID: 36947227 DOI: 10.1007/s00464-023-09956-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 02/12/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Few studies have compared the therapeutic outcomes in patients with HCC who underwent laparoscopic radiofrequency ablation (LRFA) versus percutaneous radiofrequency ablation (PRFA) for hepatocellular carcinoma (HCC). Therefore, this study compared the recurrence and survival outcomes of the two RFA methods in patients with HCC. METHODS Recurrence and overall survival outcomes were evaluated in 307 patients who underwent LRFA (n = 151) or PRFA (n = 156) as a treatment method for de novo HCC. Inverse probability of treatment weighting (IPTW) analysis was performed to reduce the impact of treatment selection bias. RESULTS There were no significant differences in major baseline characteristics between the LRFA and PRFA groups. However, the proportion of cirrhotic patients was higher in the LRFA group, whereas the LRFA group had more tumors and a more advanced tumor-node-metastasis stage. Moreover, the mean tumor size was significantly larger in the LRFA group than in the PRFA group. In a multivariate analysis, serum albumin level, more than three tumors, and the RFA method were identified as significant predictors of recurrence-free survival. Moreover, for the overall survival of HCC patients, serum albumin levels, days of hospital stay during RFA, and the RFA method were independent predictors. In the IPTW-adjusted analysis, the LRFA group showed significantly higher recurrence-free survival and overall survival. CONCLUSIONS Our study revealed that compared with PRFA, LRFA was associated with longer recurrence-free survival and favorable overall survival in patients with HCC. Therefore, LRFA should be considered the primary therapy in patients with HCC eligible for RFA.
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Affiliation(s)
- Hong Jae Jeon
- Department of Gastroenterology, Chungnam National University Sejong Hospital, 20, Bodeum 7-ro, Sejong-si, 30099, Republic of Korea
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Hyuk Soo Eun
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Byung Seok Lee
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Eaum Seok Lee
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Woo Sun Rou
- Department of Gastroenterology, Chungnam National University Sejong Hospital, 20, Bodeum 7-ro, Sejong-si, 30099, Republic of Korea
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Jae Kyu Sung
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Hee Seok Moon
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Sun Hyung Kang
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Hyun Seok Lee
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Seok-Hwan Kim
- Department of Surgery, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
- Department of Surgery, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Kwangsik Chun
- Department of Surgery, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
- Department of Surgery, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
| | - Seok Hyun Kim
- Department of Internal Medicine, School of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
- Department of Gastroenterology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
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Effects of laparoscopy, laparotomy, and respiratory phase on liver volume in a live porcine model for liver resection. Surg Endosc 2021; 35:7049-7057. [PMID: 33398570 PMCID: PMC8599330 DOI: 10.1007/s00464-020-08220-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022]
Abstract
Background Hepatectomy, living donor liver transplantations and other major hepatic interventions rely on precise calculation of the total, remnant and graft liver volume. However, liver volume might differ between the pre- and intraoperative situation. To model liver volume changes and develop and validate such pre- and intraoperative assistance systems, exact information about the influence of lung ventilation and intraoperative surgical state on liver volume is essential. Methods This study assessed the effects of respiratory phase, pneumoperitoneum for laparoscopy, and laparotomy on liver volume in a live porcine model. Nine CT scans were conducted per pig (N = 10), each for all possible combinations of the three operative (native, pneumoperitoneum and laparotomy) and respiratory states (expiration, middle inspiration and deep inspiration). Manual segmentations of the liver were generated and converted to a mesh model, and the corresponding liver volumes were calculated. Results With pneumoperitoneum the liver volume decreased on average by 13.2% (112.7 ml ± 63.8 ml, p < 0.0001) and after laparotomy by 7.3% (62.0 ml ± 65.7 ml, p = 0.0001) compared to native state. From expiration to middle inspiration the liver volume increased on average by 4.1% (31.1 ml ± 55.8 ml, p = 0.166) and from expiration to deep inspiration by 7.2% (54.7 ml ± 51.8 ml, p = 0.007). Conclusions Considerable changes in liver volume change were caused by pneumoperitoneum, laparotomy and respiration. These findings provide knowledge for the refinement of available preoperative simulation and operation planning and help to adjust preoperative imaging parameters to best suit the intraoperative situation.
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Giglio MC, Logghe B, Garofalo E, Tomassini F, Vanlander A, Berardi G, Montalti R, Troisi RI. Laparoscopic Versus Open Thermal Ablation of Colorectal Liver Metastases: A Propensity Score-Based Analysis of Local Control of the Ablated Tumors. Ann Surg Oncol 2020; 27:2370-2380. [PMID: 32060758 DOI: 10.1245/s10434-020-08243-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laparoscopic ablation (LA) of colorectal liver metastases (CRLMs) is frequently performed in combination with laparoscopic liver resection or as a stand-alone procedure. However, LA is technically demanding and whether the results are comparable with those of open ablation (OA) has not been determined to date. This study compared the effectiveness of LA and OA in achieving local tumor control of CRLMs. METHODS Patients undergoing LA or OA of CRLMs at Ghent University Hospital between June 2007 and February 2018 were identified from a prospective database. Lesions treated by LA and OA were matched 1:1 using a propensity score based on lesions (liver segment, size, deepness, proximity to a vessel), patients, and procedural characteristics. Ablation sites were followed up with computed-tomography or magnetic resonance imaging to assess the completeness of the ablation and ablation-site recurrence (ASR). Analysis of ASR was performed with the Kaplan-Meier method and Cox regression. RESULTS In this study, 163 patients underwent the surgical ablation (78 LA, 85 OA) of 333 CRLMs (143 LA, 190 OA). After matching, 220 lesions (110 LA, 110 OA) were analyzed. Ablation was complete in 93.7% (LA) and 97.3% (OA) of the sites (p = 0.195). No difference in ASR was observed (p = 0.351), with a cumulative risk of ASR at 12 months of 9.1% (LA) and 8.2% (OA). After multivariable analysis, ASR was confirmed to be independent of the surgical approach. CONCLUSION The findings showed that LA and OA achieve a comparable local control of CRLMs. This result further supports the adoption of a laparoscopic approach for the treatment of CRLMs.
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Affiliation(s)
- Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Bram Logghe
- Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Eleonora Garofalo
- Student in Erasmus Exchange Programme, Faculty of Medicine, Sapienza University of Rome, Rome, Italy
| | - Federico Tomassini
- Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Aude Vanlander
- Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Giammauro Berardi
- Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Roberto Montalti
- Department of Public Health, Federico II University, Naples, Italy
| | - Roberto Ivan Troisi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.
- Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Ghent, Belgium.
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Song HB. Possible involvement of HSP70 in pancreatic cancer cell proliferation after heat exposure and impact on RFA postoperative patient prognosis. Biochem Biophys Rep 2019; 20:100700. [PMID: 31867446 PMCID: PMC6895569 DOI: 10.1016/j.bbrep.2019.100700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose As an alleviative treatment measured in patients with unresectable advanced pancreatic cancer, radiofrequency ablation (RFA) needed more clinical data to prove its advantages and to explore limitations in its utilization. This study was determined to observe the efficacy of RFA, and to explore its impact on perioperative periphery carcinoma as well as the normal pancreatic tissues. Methods Clinical data of 32 patients with pancreatic cancer accepted RFA surgery were collected. Followed up patients' pain degree and the changes in serum tumor markers CA19-9 and CA 242 before and after surgery. Ex vivo, gave human pancreatic cancer cell line PANC-1 heat treatment to simulate the heat exposure condition periphery carcinoma was experienced during RFA surgery, and to observe the proliferation rate and HSP70 expression change compared with control group. Results Of the 32 patients, 1 died of upper gastrointestinal hemorrhage, and 29 survived for more than 5 months, 2 of which for more than 16 months. The average CA19-9 and CA 242 levels of the patients were significantly decreased in 3 months after surgery (t = 9.873, 5.978, P < 0.001). During in vitro experiments, the proliferation rate of PANC-1 cells after heating was significantly increased, accompanied with the increased HSP70 expression. The addition of HSP70 inhibitor can inhibit the rise of proliferation after heat therapy. Conclusion Utilizing RFA treat patients with unresectable advanced pancreatic cancer, could effectively relieve the pain, decline jaundice, and deduce tumor marker levels significantly. However, it failed to extend the long-term survival rate of the patients significantly. This study found that a higher proliferative rate accompanied with a higher HSP70 expression level were observed on in vitro cultured pancreatic carcinoma cells after heat treatment, which could be altered by HSP70 inhibitor. And these findings indicated that the heat exposure might impact periphery carcinoma during RFA surgery and HSP70 might play an important role in patients' prognosis.
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Affiliation(s)
- Hui-Bin Song
- The Third Affiliated Hospital of Qiqihar Medical College, 27 Taishun Street, Tiefeng District, Qiqihar, Heilongjiang province, China
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Eun HS, Lee BS, Kwon IS, Yun GY, Lee ES, Joo JS, Sung JK, Moon HS, Kang SH, Kim JS, Shin HJ, Kim TK, Chun K, Kim SH. Advantages of Laparoscopic Radiofrequency Ablation Over Percutaneous Radiofrequency Ablation in Hepatocellular Carcinoma. Dig Dis Sci 2017; 62:2586-2600. [PMID: 28744835 DOI: 10.1007/s10620-017-4688-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/19/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inoperable hepatocellular carcinoma (HCC) can be treated with laparoscopic radiofrequency ablation (LRFA), which is generally a more accurate and accessible procedure than percutaneous RFA (PRFA). However, few studies have compared survival outcomes between LRFA and PRFA in patients with HCC. AIMS This study aimed to compare the efficacy of LRFA and PRFA for HCC treatment. METHODS Patients who underwent PRFA or LRFA as an initial treatment modality between April 2005 and April 2016 were enrolled in this study. The overall and recurrence-free survival rates were examined for each patient. Additionally, propensity score matching was performed for both groups. RESULTS The baseline characteristics of patients in the PRFA and LRFA groups showed several minor differences. Multivariate analysis showed that the RFA method was not a critical determinant of recurrence-free or overall survival (p = 0.069 and p = 0.406). Among patients who underwent RFA as the initial treatment modality, there was no significant effect between either RFA procedures on survival. After propensity score matching, univariate analysis showed a significant difference in overall survival between PRFA and LRFA (p = 0.031). Multivariate analysis showed that LRFA is a strong factor that contributed to an improved overall survival in HCC patients (hazard ratio 0.108, p = 0.040). Furthermore, our data showed that LRFA was able to limit multiple intrahepatic recurrences, as well as prevent marginal recurrence. CONCLUSIONS LRFA appears to be superior to PRFA in terms of survival. LRFA may help reduce mortality in HCC patients.
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Affiliation(s)
- Hyuk Soo Eun
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea. .,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea.
| | - Byung Seok Lee
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Gee Young Yun
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Eaum Seok Lee
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Jong Seok Joo
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Jae Kyu Sung
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hee Seok Moon
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Sun Hyung Kang
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Ju Seok Kim
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hae Jin Shin
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Tae Kyun Kim
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Kwangsik Chun
- Department of Surgery, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
| | - Seok Hyun Kim
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea. .,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea.
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Eisele RM. Advances in local ablation of malignant liver lesions. World J Gastroenterol 2016; 22:3885-3891. [PMID: 27099433 PMCID: PMC4823240 DOI: 10.3748/wjg.v22.i15.3885] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/23/2016] [Accepted: 03/14/2016] [Indexed: 02/06/2023] Open
Abstract
Local ablation of liver tumors matured during the recent years and is now proven to be an effective tool in the treatment of malignant liver lesions. Advances focus on the improvement of local tumor control by technical innovations, individual selection of imaging modalities, more accurate needle placement and the free choice of access to the liver. Considering data found in the current literature for conventional local ablative treatment strategies, virtually no single technology is able to demonstrate an unequivocal superiority. Hints at better performance of microwave compared to radiofrequency ablation regarding local tumor control, duration of the procedure and potentially achievable larger size of ablation areas favour the comparably more recent treatment modality; image fusion enables more patients to undergo ultrasound guided local ablation; magnetic resonance guidance may improve primary success rates in selected patients; navigation and robotics accelerate the needle placement and reduces deviation of needle positions; laparoscopic thermoablation results in larger ablation areas and therefore hypothetically better local tumor control under acceptable complication rates, but seems to be limited to patients with no, mild or moderate adhesions following earlier surgical procedures. Apart from that, most techniques appear technically feasible, albeit demanding. Which technology will in the long run become accepted, is subject to future work.
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Yun D, Kim S, Song I, Chun K. Comparative analysis of Laparoscopic versus open surgical radiofrequency ablation for malignant liver tumors. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2014; 18:122-8. [PMID: 26155264 PMCID: PMC4492349 DOI: 10.14701/kjhbps.2014.18.4.122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 11/12/2014] [Accepted: 11/21/2014] [Indexed: 01/16/2023]
Abstract
Backgrounds/Aims This study aims to evaluate the comparative effectiveness of two surgical approaches on the treatment outcomes of radiofrequency ablation (RFA) for malignant liver tumors. Methods Fifty-seven patients with malignant liver tumors, hepatocellular carcinoma, cholangiocarcinoma and liver metastases, who were candidates for RFA, underwent laparoscopic or open surgical treatments. Results The patients' characteristics were comparable in the two groups that received open (n=33, 57.9%) and laparoscopic (n=24, 42.1%) surgical treatments. There were no statistically significant differences between the two groups in terms of recurrence rate (p=0.337) and overall survival (p=0.423). However, patients in the laparoscopic RFA group had significantly shorter hospital stay (14.1 vs. 5.9 days, p<0.05) and experienced fewer complications (Grade I: 62.5% vs. 26.3%, p=0.102). Conclusions Laparoscopic RFA can be performed for malignant liver tumors with lower morbidity rates, less invasiveness and lower expense compared to open surgical approach.
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Affiliation(s)
- Duhwan Yun
- Department of Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Seokhwan Kim
- Department of Surgery, Asan Medical Center, Seoul, Korea
| | - Insang Song
- Department of Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Kwangsik Chun
- Department of Surgery, Chungnam National University Hospital, Daejeon, Korea
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10
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Shimonov M, Ezri T, Blecher M, Cherniak A, Azamfirei L. Hemodynamic effects of sevoflurane versus propofol anesthesia for laparoscopic radiofrequency ablation of liver tumors. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2006.10872456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Shah KN, Clary BM. Endoscopic and Percutaneous Approaches to the Treatment of Biliary Tract and Primary Liver Tumors. Surg Oncol Clin N Am 2014; 23:207-30. [DOI: 10.1016/j.soc.2013.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Wong J, Lee KF, Yu SCH, Lee PSF, Cheung YS, Chong CN, Ip PCT, Lai PBS. Percutaneous radiofrequency ablation versus surgical radiofrequency ablation for malignant liver tumours: the long-term results. HPB (Oxford) 2013; 15:595-601. [PMID: 23458320 PMCID: PMC3731580 DOI: 10.1111/hpb.12014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/18/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) has been used to treat hepatocellular carcinoma (HCC) and liver metastases for more than 10 years with promising early outcomes. Preliminary results comparing percutaneous and surgical approaches have shown no difference in short-term outcomes. In this study, the longer-term outcomes were presented. METHODS Patients with liver malignancies treated by RFA were prospectively studied from 2003 to 2011. Post-ablation assessment by computed tomography (CT) scan and serum biochemistry was performed at regular intervals. Recurrence rates and long-term survival were analysed. RESULTS A total of 233 patients with liver malignancies (75.5% HCC and 24.5% liver metastases) were analysed. Three RFA approaches were used (percutaneous 58.4%, laparoscopic 9.4% and open 32.2%). The median follow-up time was 29 months. Complete ablation was achieved in 83.7%, with no difference between the two approaches. More wound and chest complications were observed in the surgical group. Intra-hepatic recurrences were observed in 69.5%; extra-hepatic recurrences were detected in 22.3%, with no difference between the two groups. There was no statistical difference between the two approaches in overall 1-, 3- and 5-year survival. CONCLUSION An extended period of follow-up in patients with liver malignancies showed that RFA is an effective treatment. No difference was demonstrated between the percutaneous and surgical approach, in terms of recurrence and survival.
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Affiliation(s)
- John Wong
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
| | - Kit-Fai Lee
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
| | - Simon Chun-Ho Yu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
| | - Paul Sing-Fun Lee
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
| | - Yue-Sun Cheung
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
| | - Ching-Ning Chong
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
| | - Philip Ching-Tak Ip
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
| | - Paul Bo-San Lai
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SAR, China
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Shah DR, Green S, Elliot A, McGahan JP, Khatri VP. Current oncologic applications of radiofrequency ablation therapies. World J Gastrointest Oncol 2013; 5:71-80. [PMID: 23671734 PMCID: PMC3648666 DOI: 10.4251/wjgo.v5.i4.71] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/10/2013] [Accepted: 03/15/2013] [Indexed: 02/05/2023] Open
Abstract
Radiofrequency ablation (RFA) uses high frequency alternating current to heat a volume of tissue around a needle electrode to induce focal coagulative necrosis with minimal injury to surrounding tissues. RFA can be performed via an open, laparoscopic, or image guided percutaneous approach and be performed under general or local anesthesia. Advances in delivery mechanisms, electrode designs, and higher power generators have increased the maximum volume that can be ablated, while maximizing oncological outcomes. In general, RFA is used to control local tumor growth, prevent recurrence, palliate symptoms, and improve survival in a subset of patients that are not candidates for surgical resection. It’s equivalence to surgical resection has yet to be proven in large randomized control trials. Currently, the use of RFA has been well described as a primary or adjuvant treatment modality of limited but unresectable hepatocellular carcinoma, liver metastasis, especially colorectal cancer metastases, primary lung tumors, renal cell carcinoma, boney metastasis and osteoid osteomas. The role of RFA in the primary treatment of early stage breast cancer is still evolving. This review will discuss the general features of RFA and outline its role in commonly encountered solid tumors.
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Moyano-Cuevas JL, Sánchez-Margallo FM, Maestre-Antequera J, Dávila-Gómez L, Pagador JB, Sánchez-Peralta LF, Latorre R. Effects of pneumoperitoneum and body position on the morphology of abdominal vascular structures analyzed in MRI. J Magn Reson Imaging 2012; 36:177-82. [DOI: 10.1002/jmri.23615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 01/13/2012] [Indexed: 11/10/2022] Open
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Anatomical changes due to pneumoperitoneum analyzed by MRI: an experimental study in pigs. Surg Radiol Anat 2010; 33:389-96. [PMID: 21181160 DOI: 10.1007/s00276-010-0763-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 12/06/2010] [Indexed: 12/17/2022]
Abstract
PURPOSE Different effects on cardiovascular and respiratory systems and liver are associated with pneumoperitoneum. This study aimed to determine the morphological changes in the abdominal anatomy as a result of increased intra-abdominal pressure due to pneumoperitoneum using MRI. METHODS Ten healthy female pigs were used in this study. MRI studies of the abdomen in supine position were made before the creation of pneumoperitoneum and 1 h after increasing the pressure to 14 mmHg. Changes in area, volume, and longitudinal and transverse length of the liver were measured. The diameters of the lumen of the abdominal aorta, the inferior vena cava and portal vein were observed in three positions along the abdominal cavity. The position of the diaphragm after the induction of pneumoperitoneum was also analyzed. RESULTS After induction of pneumoperitoneum, volume and transverse length of the liver was significantly increased, while peak area was decreased. Stenosis in the aortic lumen was observed (P < 0.05). Longitudinal and transverse diameters of the portal lumen were reduced, but significant differences were only found in the longitudinal diameter. Alterations in the diameter of the inferior vena cava lumen were obtained in three analyzed positions, but differences were significant only in two of them. A mean cranial displacement of the diaphragm equal to 25 mm was also observed. CONCLUSION Increasing abdominal pressure up to laparoscopic pressure (14 mmHg) provokes morphological changes in the liver, vascular structures and diaphragm. These changes could be related to functional alterations that different organs experience after the induction of pneumoperitoneum.
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Young JL, Louie MK, Ortiz-Vanderdys CG, McCormick DW, Huynh VB, Kaplan AG, Jain NS, Pick DL, Andrade LA, Osann KE, Kolla SB, Sountoulides P, Kaufmann OG, McDougall EM, Clayman RV. Impact of pneumoperitoneum on renal cryotherapy. J Endourol 2009; 23:1451-5. [PMID: 19694533 DOI: 10.1089/end.2009.0396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Pneumoperitoneum is known to decrease blood flow to the kidney during laparoscopy. We investigated if this change in blood flow would increase the size of the cryolesion. MATERIALS AND METHODS Twelve Yorkshire swine underwent laparoscopy-guided percutaneous cryoablation of the upper and lower pole of each kidney at four randomized pneumoperitoneum pressures (10, 15, 20, and 25 mm Hg). Cryolesions were made with a 1.47-mm IceRod (Galil Medical, Plymouth Meeting, PA). Each site underwent two 10-minute freeze cycles separated by a 5-minute active thaw with pressurized helium gas. At the conclusion of each freeze cycle, the iceball volume was measured with intraoperative ultrasound. After completion of the four cryolesions, the kidneys were harvested, and the cryolesion surface area was calculated. The lesions were fixed in 10% buffered formalin and then excised with a 1-mm margin to obtain a volume measurement using fluid displacement. RESULTS Iceball volume was 3.41, 2.85, 3.44, and 2.36 cm(3) for freeze cycle 1 (p = 0.16) and 3.67, 3.34, 4.88, 3.95 cm(3) for freeze cycle 2 (p = 0.20) at 10, 15, 20, and 25 mm Hg, respectively. Cryolesion volume by fluid displacement was 4.06, 3.77, 3.97, and 3.93 cm(3) (p = 0.86) and cryolesion surface area was 4.55, 4.38, 4.39, and 4.20 cm(2) (p = 0.71) at 10, 15, 20, and 25 mm Hg, respectively. CONCLUSIONS In this study, pneumoperitoneum pressure between 10 and 25 mm Hg did not affect iceball size as measured by intraoperative ultrasound, cryolesion volume by fluid displacement, or cryolesion surface.
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Affiliation(s)
- Jennifer L Young
- Department of Urology, University of California Irvine, Orange, California, USA.
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Eisele RM, Neumann U, Neuhaus P, Schumacher G. Open surgical is superior to percutaneous access for radiofrequency ablation of hepatic metastases. World J Surg 2009; 33:804-11. [PMID: 19184639 DOI: 10.1007/s00268-008-9905-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE This study was designed to determine the best approach to radiofrequency ablation (RFA) in the liver. METHODS From a total of 41 procedures, 37 patients with 47 tumors were treated with RFA for metastatic disease. Indications included colorectal cancer (n=28, 68%), neuroendocrine tumors (n=2, 5%), gynecological primaries (n=4, 10%), pancreatic/duodenal cancer (n=2, 5%), and miscellaneous entities (n=5, 12%). Mean follow-up period was 18 (median, 18) months. All ways of approach to RFA were applied: percutaneous was chosen in 17 (41.5%), laparoscopic and hand-assisted laparoscopic in 5 (12.2%), and open surgical in 19 cases (46.3%), and in 10 cases, RFA was combined with hepatic resection. The average maximum tumor size was 2.3 (range, 0.8-6) cm, and the mean number of nodules treated per patient in a single session was 1.3 (range, 1-3). RESULTS Overall survival was 59.5% at 2 years, recurrence-free 2-year survival was 12.6%, local tumor recurrence rate was 34%, and overall recurrence was 75.6%. Local tumor recurrence and disease-free survival were significantly improved in the open surgically treated patients compared with the percutaneous treatment group (15.8% [n=3] vs. 58.8% [n=10] and 11.5 vs. 7.9 months, p<0.01 [chi2 test] and p<0.05 [log-rank test], respectively). CONCLUSIONS Open surgical approach is superior to percutaneous access for RFA in metastatic hepatic disease.
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Affiliation(s)
- Robert M Eisele
- Department of General, Visceral, and Transplantation Surgery, Charité Virchow-Clinic, Augustenburger Pl. 1, 13353, Berlin, Germany.
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Raggi MC, Schneider A, Härtl F, Wilhelm D, Wirnhier H, Feussner H. A family of new instruments for laparoscopic radiofrequency ablation of malignant liver lesions. MINIM INVASIV THER 2009; 15:42-7. [PMID: 16687330 DOI: 10.1080/13645700500495840] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Primary and secondary liver tumors may be treated with radiofrequency ablation (RFA) to improve tumor control and to increase patient survival. Lesions are punctured percutaneously or during open surgery. However, not all of the lesions are accessible percutaneously due to their localization: Adjacent structures could be endangered and/or the treatment would cause severe pain. Open surgery is an option in these cases but significantly more invasive. Laparoscopic RFA (LRFA) is an additional possibility in those cases: It offers a better access to difficult lesions than via the percutaneous route and is also less invasive than open surgery. The precision of targeting, however, in LRFA still has to be improved. In an in-vivo feasibility study we used a tumor mimic model in pigs to examine the applicability of laparoscopic RFA in combination with laparoscopic ultrasound using a set of dedicated new instruments to handle the RFA probe. To increase the ablation volume, the liver blood flow was reduced performing a Pringle maneuver. It is demonstrated that this set of specially designed instruments is indeed applicable and facilitates the targeting of liver lesions of any localization. Accordingly, it could significantly enlarge the applicability of LRFA.
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Affiliation(s)
- M C Raggi
- Department of Surgery, Hospital "Rechts der Isar", Technical University, Munich, Germany
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Rossi S, Gallati M, Rosa L, Marini A, Viera FT, Maestri M, Dionigi P. Effect of hyperbarism on radiofrequency ablation outcome. AJR Am J Roentgenol 2007; 189:876-82. [PMID: 17885060 DOI: 10.2214/ajr.07.2319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Our objective was to investigate whether increases in atmospheric or local tissue pressure would affect the outcome of radiofrequency ablation procedures and the size of the created thermal lesions. MATERIALS AND METHODS Thermal lesions were produced in specimens of explanted bovine liver inside a hyperbaric chamber at 101 (atmospheric), 141, 202, 273, and 364 kPa using radiofrequency power settings of 20, 30, 40, and 50 W. In subsequent in vivo experiments, thermal lesions were produced in the livers of anesthetized pigs with or without occlusion of the hepatic vein draining the ablation site. RESULTS At each radiofrequency power setting, progressive increases in applied pressure were paralleled by decreases in minimum impedance and increases in maximum tissue temperatures at the electrode tip (reflecting tissue-fluid boiling points), delivery time, total energy delivered, and thermal lesion volumes. Similar increases were observed in radiofrequency ablation procedures performed in vivo under occlusion of the vein draining the ablation site. CONCLUSION By elevating the tissue-fluid boiling point, increased pressure delays the desiccation of tissue in contact with the radiofrequency electrode tip and the related sharp increase in impedance. The result is prolonged delivery of larger amounts of radiofrequency energy and larger thermal lesions.
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Affiliation(s)
- Sandro Rossi
- VI Department of Internal Medicine, Policlinico San Matteo Foundation, IRCCS, Piazzale Golgi, no.1, 27100 Pavia, Italy.
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20
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Schumacher G, Eisele R, Spinelli A, Schmidt SC, Jacob D, Pratschke J, Neuhaus P. Indications for hand-assisted laparoscopic radiofrequency ablation for liver tumors. J Laparoendosc Adv Surg Tech A 2007; 17:153-9. [PMID: 17484640 DOI: 10.1089/lap.2006.0001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Radiofrequency ablation has established itself as the preferred treatment for irresectable liver tumors. It can be performed either percutaneously, laparoscopically, or by open surgery. The choice of approach depends on the patient and tumor-related variables. The laparoscopic approach appears to be the safest and most effective method for small tumors on the liver surface. It also provides additional information on the intrahepatic tumor burden with the use of intraoperative ultrasound and staging laparoscopy. Furthermore, the pneumoperitoneum reduces the flow of the portal vein and increases the efficacy of the ablation. Depending on the location of the tumor, mobilization of the liver or lysis of adhesions from previous surgery can require open surgery. Our aim was to study the combined use of laparoscopy and laparotomy by using hand-assisted laparoscopic radiofrequency ablation. MATERIALS AND METHODS We performed hand-assisted laparoscopy to ablate nine tumors in seven patients, enabling us to combine most of the advantages of laparoscopy and open surgery. The radiofrequency ablation was technically simple to perform. A laparoscopy of the entire abdominal cavity and a thorough examination of the entire liver via ultrasound was also performed. RESULTS The electrode was accurately placed in all patients. In four patients, a complete mobilization of the right lobe was performed to obtain the easiest possible access to the tumor. In three patients, severe adhesions from previous surgeries were removed prior to insertion of the laparoscopic tools. The ablation was completed safely and successfully in all patients. CONCLUSION Our overall impression of the hand-assisted laparoscopic approach is that it seems to have a major advantage in comparison with simple laparoscopy, specifically for adhesions from previous surgeries and when the right liver lobe requires mobilization. Also, needle placement seems to be far more accurate than with simple laparoscopy.
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Affiliation(s)
- Guido Schumacher
- Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Klinikum, Berlin, Germany.
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Laeseke PF, Sampson LA, Brace CL, Winter TC, Fine JP, Lee FT. Unintended thermal injuries from radiofrequency ablation: protection with 5% dextrose in water. AJR Am J Roentgenol 2007; 186:S249-54. [PMID: 16632684 DOI: 10.2214/ajr.04.1240] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Radiofrequency ablation of hepatic tumors can lead to thermal injury of surrounding structures. Both saline and 5% dextrose in water (D5) have been used to displace these surrounding structures before radiofrequency ablation. The purpose of this study was to determine the relative effectiveness of these two fluids for protecting the diaphragm and lung during radiofrequency ablation. MATERIALS AND METHODS Ten female domestic swine (mean weight, 45 kg) underwent radiofrequency ablation at open surgery. Group 1 (n = 12 lesions) was pretreated with peritoneal D5 before radiofrequency ablation. Group 2 (n = 11 lesions) was pretreated with peritoneal 0.9% saline. A 2.7-mm spacer was placed between the liver surface and diaphragm in groups 1 and 2. Group 3 (n = seven lesions) served as a control group with no pretreatment regimen. Group 4, an additional control group (n = eight lesions), consisted of animals pretreated with D5 in which a larger spacer was used. After radiofrequency ablation, the animals were sacrificed and the liver, diaphragm, and lung were removed. The extent of thermal injury to the surface of each organ was recorded. RESULTS The animals in the D5 and saline pretreatment groups experienced fewer diaphragm injuries than the control animals (D5, p = 0.02). The smallest lesions in the lung and diaphragm were in the D5 group, followed by the saline and control groups (diaphragm, p = 0.0001; lung, p = 0.13). Diaphragm lesions were significantly smaller in the D5 and saline groups than in the control group (p = 0.0001 and 0.01, respectively). CONCLUSION Instillation of D5 into the peritoneal cavity before hepatic radiofrequency ablation decreases the risk and severity of diaphragm and lung injuries compared with no pretreatment or pretreatment with 0.9% saline in this animal model. Pretreatment with D5 may increase both the safety of and the number of patients eligible for treatment with thermal therapies.
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Affiliation(s)
- Paul F Laeseke
- Department of Radiology, University of Wisconsin, Madison, WI 53792-3252, USA
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Mulier S, Ni Y, Frich L, Burdio F, Denys AL, De Wispelaere JF, Dupas B, Habib N, Hoey M, Jansen MC, Lacrosse M, Leveillee R, Miao Y, Mulier P, Mutter D, Ng KK, Santambrogio R, Stippel D, Tamaki K, van Gulik TM, Marchal G, Michel L. Experimental and Clinical Radiofrequency Ablation: Proposal for Standardized Description of Coagulation Size and Geometry. Ann Surg Oncol 2007; 14:1381-96. [PMID: 17242989 DOI: 10.1245/s10434-006-9033-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Accepted: 04/03/2006] [Indexed: 12/22/2022]
Abstract
BACKGROUND Radiofrequency (RF) ablation is used to obtain local control of unresectable tumors in liver, kidney, prostate, and other organs. Accurate data on expected size and geometry of coagulation zones are essential for physicians to prevent collateral damage and local tumor recurrence. The aim of this study was to develop a standardized terminology to describe the size and geometry of these zones for experimental and clinical RF. METHODS In a first step, the essential geometric parameters to accurately describe the coagulation zones and the spatial relationship between the coagulation zones and the electrodes were defined. In a second step, standard terms were assigned to each parameter. RESULTS The proposed terms for single-electrode RF ablation include axial diameter, front margin, coagulation center, maximal and minimal radius, maximal and minimal transverse diameter, ellipticity index, and regularity index. In addition a subjective description of the general shape and regularity is recommended. CONCLUSIONS Adoption of the proposed standardized description method may help to fill in the many gaps in our current knowledge of the size and geometry of RF coagulation zones.
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Affiliation(s)
- Stefaan Mulier
- Department of Radiology, Gasthuisberg University Hospital, Herestraat 49, 3000 Leuven, Belgium
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Sato S, Miyake T, Mishiro T, Furuta K, Azumi T, Oshima N, Takahashi Y, Rumi MAK, Ishihara S, Adachi K, Amano Y, Kinoshita Y. Kinetics of indocyanine green removal from blood can be used to predict the size of the area removed by radiofrequency ablation of hepatic nodules. J Gastroenterol Hepatol 2006; 21:1714-9. [PMID: 16984595 DOI: 10.1111/j.1440-1746.2006.04417.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM The size of radiofrequency ablation (RFA) in the liver can be negatively influenced by the surrounding blood flow. The indocyanine green (ICG) test can be used to evaluate the effective blood flow in the liver, and distance from the hilus can affect local blood flow. The aim of this study was to assess whether the ICG test or distance from the hilus could be used to predict the size of the ablated area in liver by RFA treatment of hepatocellular carcinoma (HCC) nodules. METHODS The RFA measurements of 44 HCC nodules in 39 patients were retrospectively studied. Cases were included if they met the following criteria: (i) no catheter treatment before RFA; (ii) no movement of the RFA device; (iii) strict ablation time; and (iv) only one ablation. In all patients, ICG-R15 testing was done immediately before RFA and the initial therapeutic efficacy was evaluated by dynamic computed tomography scanning 2-5 days after RFA. The correlation between the maximum size of the RFA area and the ICG test results or the distance of the target area from the hilus (site of first portal vein divergence) were analyzed statistically. RESULTS The ICG-R15 result was significantly correlated with the maximum diameter of the ablated area both in 2 cm-electrode tip length (R2 = 0.35, P = 0.0012), and in 3 cm-tip length (R2 = 0.26, P = 0.0377). Multiple-regression analysis showed that the electrode tip length (P = 0.0010) and ICG-R15 (P = 0.0046) were independent factors that could predict the maximum diameter of the RFA area. CONCLUSION The results of ICG testing can be used to predict the size of the area that will be ablated at a target liver site before RFA treatment.
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Affiliation(s)
- Shuichi Sato
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Shimane, Japan.
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Schumacher G, Eisele R, Spinelli A, Neuhaus P. The surgical approach for radiofrequency ablation of liver tumors. Recent Results Cancer Res 2006; 167:53-68. [PMID: 17044296 DOI: 10.1007/3-540-28137-1_4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Radiofrequency ablation for the treatment of liver tumors is one of the best alternative treatment modalities when surgical resection is not possible. To find the right indication for the treatment, every patient should be treated in a high-volume center for the treatment of liver tumors in an interdisciplinary conference consisting of liver surgeons, interventional radiologists, medical oncologists, and gastroenterologists. With a multimodal approach including anatomic segmental and wedge resection of the liver, RFA, and chemotherapy, a median survival of 36 months was achieved in technically unresectable patients with colorectal liver metastases (Elias et al. 2005). This survival doubles the survival rate of any other treatment modality in this group of patients. These interdisciplinary conferences also serve to determine the approach for RFA, whether it should be percutaneous, laparoscopic, or open surgery. The safest ablation with the fewest adverse events from RFA is the open surgical approach, followed by the laparoscopic approach. The approach with the highest risk of injury to organs in proximity to the liver is the percutaneous approach. Therefore, many variables must be evaluated before making definite decisions. After choosing RFA as the best alternative treatment option after evaluation of all variables for a particular patient, it offers a treatment option with a potential cure. A major advantage is the possible combination with liver resection, which extends the indication for surgical or ablative therapy.
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Affiliation(s)
- Guido Schumacher
- Dept. of General, Visceral and Transplantation Surgery, Charité Campus Virchow-Klinikum, Berlin, Germany
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25
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Aloni Y, Evron S, Ezri T, Medalion B, Protianov M, Szmuk P, Zimlichman R, Muggia-Sullam M. Morbidly obese patients are hemodynamically stable during laparoscopic surgery: a thoracic bioimpedance study. J Clin Monit Comput 2006; 20:261-6. [PMID: 16791444 DOI: 10.1007/s10877-006-9034-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Accepted: 05/22/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE Morbid obesity caries an increased risk of cardiovascular morbidity and might be associated with intraoperative hemodynamic instability. Based on clinical observation, we hypothesized that during laparoscopic surgery, morbidly obese patients behave hemodynamically similar to the nonobese patients and remain hemodynamically stable. METHODS In a prospective trial, thirty nonobese and tthirty morbidly obese (BMI > or = 35 kg/m(2)) patients scheduled for elective laparoscopic surgery were assigned to receive standard balanced anesthesia. We aimed at equianesthetic levels by keeping the BIS (bispectral index) value between 40-50 throughout surgery. End-tidal isoflurane was measured every 5 min. Noninvasive hemodynamic measurements included cardiac index (CI), mean arterial pressure (MAP) and heart rate (HR), recorded every 5 min and at specific predetermined times. Systemic vascular resistance (SVR) was calculated. Episodes of MAP < or = 60 and MAP > or = 130 mmHg or HR < or = 50 and HR > or = 110 bpm occurring throughout surgery and requiring pharmacological intervention were considered main end-points. Additionally, hemodynamic variables were compared at specific time points and overall throughout surgery. Secondary end-points were CI and SVRI. RESULTS Heart rate was higher in obese patients in head-up position (79 +/- 15 mmHg vs. 65 +/- 12 mmHg - P=0.011). SVR was higher in the nonobese group with head-up position (1978 +/- 665 dynes s cm(-5) vs. 1394 +/- 496 dynes s cm(-5) P=0.01). Mean overall intraoperative MAP, HR, CI and SVR were similar. There were no episodes of MAP < or = 60 and > or =130 mmHg or HR < or = 50 and > or =110 bpm in either of the groups. CONCLUSION Our study confirmed our hypothesis that for the most periods of laparoscopic surgery, obese patients are hemodynamically as stable as their nonobese counterparts.
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Affiliation(s)
- Yoela Aloni
- Department of Surgery "B", The Edith Wolfson Medical Center, Holon, Sackler School of Medicine, Tel Aviv, Israel
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Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 2005; 242:158-71. [PMID: 16041205 PMCID: PMC1357720 DOI: 10.1097/01.sla.0000171032.99149.fe] [Citation(s) in RCA: 543] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the factors that influence local recurrence after radiofrequency coagulation of liver tumors. SUMMARY BACKGROUND DATA Local recurrence rate varies widely between 2% and 60%. Apart from tumor size as an important risk factor for local recurrence, little is known about the impact of other factors. METHODS An exhaustive literature search was carried out for the period from January 1, 1990 to January 1, 2004. Only series with a minimal follow-up of 6 months and/or mean follow-up of 12 months were included. Univariate and multivariate meta-analyses were carried out. RESULTS Ninety-five independent series were included, allowing the analysis of the local recurrence rate of 5224 treated liver tumors. In a univariate analysis, tumor-dependent factors with significantly less local recurrences were: smaller size, neuroendocrine metastases, nonsubcapsular location, and location away from large vessels. Physician-dependent favorable factors were: surgical (open or laparoscopic) approach, vascular occlusion, general anesthesia, a 1-cm intentional margin, and a greater physician experience. In a multivariate analysis, significantly less local recurrences were observed for small size (P < 0.001) and a surgical (versus percutaneous) approach (P < 0.001). CONCLUSIONS Radiofrequency coagulation by laparoscopy or laparotomy results in superior local control, independent of tumor size. The percutaneous route should mainly be reserved for patients who cannot tolerate a laparoscopy or laparotomy. The short-term benefits of less invasiveness for the percutaneous route do not outweigh the longer-term higher risk of local recurrence.
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Affiliation(s)
- Stefaan Mulier
- Department of Surgery, University Hospital of Mont-Godinne, Catholic University of Louvain, Yvoir, Belgium
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Abstract
Radiofrequency ablation (RFA) has been widely practiced to treat unresectable malignant liver tumors. It has the merits of localized tumor ablation and preservation of maximal normal liver parenchyma. In recent years, there has been a tremendous expansion in the application of RFA for patients with malignant liver tumors. However, the therapeutic effect of this local ablation treatment needs to be balanced against its risks and possible local failure. This review focuses on the current status of RFA for malignant liver tumors, with special attention to the indication, approaches, complications, survival benefits, combination therapies, and comparison with other treatment modalities. Although the results of most clinical studies of RFA seem favorable, the associated risks and tumor recurrence should not be underestimated. Careful patient selection, meticulous RFA techniques, and prompt treatment of residual and recurrent tumors are necessary to ensure a better outcome after RFA. Until recently, there has been no strong evidence showing that RFA can replace any other treatment modalities in the management of liver tumors. Nonetheless, more convincing evidence by randomized trials is required for the establishment of a treatment protocol of RFA for patients with malignant liver tumors.
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Affiliation(s)
- Kelvin K Ng
- Department of Surgery, Centre for the Study of Liver Disease, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
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