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Tan Y, Wang J, Sun L, Ye Y. Repeated partial splenic artery embolization for hypersplenism improves platelet count. Open Med (Wars) 2022; 17:808-815. [PMID: 35574181 PMCID: PMC9041533 DOI: 10.1515/med-2022-0479] [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: 07/02/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/15/2022] Open
Abstract
Splenic embolization is a minimally invasive alternative to splenectomy for the treatment of hypersplenism. This was a retrospective study of 101 patients with hypersplenism caused by cirrhosis who were treated with splenic embolization and for whom 6 months of follow-up data were available. Of these patients, 65 underwent partial splenic artery embolization (PSE), including 23 who underwent repeated PSE (RPSE). The incidence of abdominal pain was significantly higher in the PSE group than in the total splenic artery embolization (TSE) group (P < 0.001), and its duration was also longer in the PSE group (P = 0.003). Biochemical markers of liver function were compared before and after the operation; aminotransferase indices decreased (alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase), total bilirubin increased slightly, and albumin and prealbumin decreased after the operation (all P < 0.001). Platelet (PLT) counts began to increase at 1 week postoperatively, peaked at 1 month postoperatively, and then decreased gradually. There was no significant intergroup (PSE and TSE) difference at any time point (1 day, 1 week, 1 month, and 6 months postoperatively, P > 0.05). There was a significant intergroup (PSE and RPSE) difference in the mean postoperative change in PLT count (P = 0.45). Splenic embolization can improve the inflammatory indicators of liver function. Performing PSE twice or more improves the PLT counts.
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Affiliation(s)
- Youwen Tan
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, Jiangsu Province, China
| | - Jiamin Wang
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, Jiangsu Province, China
| | - Li Sun
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, Jiangsu Province, China
| | - Yun Ye
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, Jiangsu Province, China
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Tan Y, Wang X, Ma K, Zhang L, Li J, Chen P, Zhang B. Risk factors for the recurrence of early hepatocellular carcinoma treated by percutaneous radiofrequency ablation with a multiple-electrode switching system: a multicenter prospective study. Int J Hyperthermia 2022; 39:190-199. [PMID: 35042449 DOI: 10.1080/02656736.2021.2024279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To investigate the long-term efficacy of radiofrequency ablation (RFA) with a multiple-electrode switching system (MESS) in the treatment of early hepatocellular carcinoma (HCC) and evaluate the patterns and risk factors of intrahepatic recurrence of HCC after RFA. METHODS In total, 139 patients with early HCC who underwent RFA with MESS as primary treatment at multiple centers were prospectively enrolled according to the inclusion criteria. We evaluated the local tumor progression (LTP), intrahepatic distant recurrence (IDR), the incidence of cumulative disease-free survival (DFS), LTP-free survival, IDR-free survival, and overall survival. We also analyzed the associated risk factors. RESULTS A total of 139 patients were included in the study and the median follow-up time was 64 months, ranging from 11 to 72 months. The complete ablation rate was 98.56%. Sixty-nine (49.64%) were found to have intrahepatic recurrence (LTP, n = 15; IDR, n = 55) during follow-up. The 1-year, 3-year and 5-year cumulative DFS, LTP-free survival, and IDR-free survival rates were 74.82, 94.46 and 78.75%; 54.68, 88.03 and 61.79%; and 51.80, 85.67 and 60.17%, respectively. In the multivariable analysis, tumor size > 4 cm was the only important risk factor for LTP. The alkaline phosphatase (ALP) level and the number of tumors were independent risk factors for IDR; α-fetoprotein (AFP) level > 400 µg/L and recurrence interval were risk factors for the overall survival period. CONCLUSIONS The MESS-RFA is an effective method for local control of tumors in early HCC. Early HCC with multiple high-ALP tumors has a higher rate of recurrence, which mainly occurs in an IDR pattern. Early HCC with high AFP levels and a shorter initial recurrence interval resulted in a poorer prognosis. Thus, treatments such as liver transplantation or surgical resection may be a good strategy in those cases. CLINICALTRIALS.GOV ID NCT02046356.
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Affiliation(s)
- Yunhua Tan
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, PR China
| | - Xin Wang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, PR China
| | - Kuansheng Ma
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, PR China
| | - Lin Zhang
- Department of Radiation, Southwest Hospital, Army Medical University, Chongqing, PR China
| | - Jing Li
- Department of Hepatobiliary Surgery, Xinqiao Hospital, Army Medical University, Chongqing, PR China
| | - Ping Chen
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, PR China
| | - Ben Zhang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, PR China
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Abstract
Avatrombopag (Doptelet®) is an orally administered second generation thrombopoietin receptor agonist (TPO-RA) approved for the treatment of primary chronic immune thrombocytopenia (ITP) in adult patients who are refractory or have an unsatisfactory response to other treatments, as well as for the treatment of thrombocytopenia in adult patients with chronic liver disease (CLD) scheduled to undergo an invasive procedure. In phase III studies, avatrombopag was associated with a significantly greater platelet response than placebo in patients with chronic ITP, and was superior to placebo in reducing the requirement for platelet transfusion or rescue procedures for bleeding caused by surgery in patients with CLD with a platelet count < 50 × 109/L at baseline. Longer term data indicate that avatrombopag is associated with high durable response rates in ITP and may have corticosteroid-sparing effects. The drug was generally well tolerated in both indications. Avatrombopag thus represents a convenient and effective second-line treatment for patients with chronic ITP and can prevent bleeding events in patients with CLD scheduled to undergo a procedure, offering a useful alternative to other available treatments in both indications. Avatrombopag (Doptelet®) is an orally administered drug that mimics the natural compound (thrombopoietin) responsible for stimulating the production of platelets, an essential component of the clotting process that prevents excessive bleeding. Several conditions can cause reduced platelet levels (thrombocytopenia) to the point that intervention is needed to prevent excessive blood loss. Avatrombopag is approved for the treatment of primary chronic immune thrombocytopenia (ITP) and to prevent bleeding caused by surgery in patients with low platelet levels caused by chronic liver disease (CLD). Clinical trials in patients with ITP show that avatrombopag quickly increases platelet levels and that this increase is maintained in the longer term in many patients. Similarly, clinical trials in patients with low platelet levels because of CLD showed that giving avatrombopag prior to surgery reduced the need for platelet transfusions or rescue procedures for bleeding. Avatrombopag is thus a convenient and effective treatment for patients with chronic ITP and can prevent bleeding events in patients with CLD scheduled to undergo a procedure. In both indications avatrombopag offers a useful alternative to other available treatments.
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Affiliation(s)
- Anthony Markham
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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4
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Baba Y, Hayashi S, Nagasato K, Higashi M, Yoshiura T. Preliminary experimental study on splenic hemodynamics of radiofrequency ablation for the spleen. MINIM INVASIV THER 2017; 26:193-199. [PMID: 28145148 DOI: 10.1080/13645706.2017.1281315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To test the splenic blood flow change after radiofrequency ablation (RFA) of the spleen in a porcine experimental model. MATERIAL AND METHODS Six pigs underwent RFA of the spleen via laparotomy. During the procedure of RFA, clamping of splenic artery (one) and both splenic artery/vein (one) was also performed. Measurement of blood flow of both splenic artery (SA) and splenic vein (SV) with flow-wire at pre- and post-RFA of the spleen was also performed. RESULTS Ablated splenic lesions were created as estimating ∼50% area of the spleen in all pigs. Resected specimens reveal not only the coagulated necrosis but also the congestion of the spleen. On the SA hemodynamics, maximum peak velocity (MPV) changed from 37 ± 7 to 24 ± 8 cm/s (normal), 11 to 10 cm/s (clamp of the SA), and 12 to 7.5 cm/s (clamp of both SA/SV), respectively. On the SV hemodynamic, MPV changed from 15 ± 5 to 13 ± 4 cm/s (normal), 17 to 15 cm/s (clamp of the SA), and 17 to 26 cm/s (clamp of both SA/SV), respectively. CONCLUSIONS RFA of the spleen could induce coagulation necrosis and reduce the splenic arterial blood flow.
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Affiliation(s)
- Yasutaka Baba
- a Department of Radiology , Kagoshima University , Kagoshima , Japan.,c Department of Diagnostic Radiology , Hiroshima University , Hiroshima , Japan
| | - Sadao Hayashi
- a Department of Radiology , Kagoshima University , Kagoshima , Japan
| | - Kohei Nagasato
- a Department of Radiology , Kagoshima University , Kagoshima , Japan
| | - Michiyo Higashi
- b Department of Human Pathology , Kagoshima University , Kagoshima , Japan
| | - Takashi Yoshiura
- a Department of Radiology , Kagoshima University , Kagoshima , Japan
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Hepatectomy combined with microwave ablation of the spleen for treatment of hepatocellular carcinoma complicated with splenomegaly: A retrospective study. Mol Clin Oncol 2016; 6:204-208. [PMID: 28357095 DOI: 10.3892/mco.2016.1111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/04/2016] [Indexed: 12/14/2022] Open
Abstract
The present retrospective study aimed to investigate the mid-term safety and efficacy of hepatectomy combined with microwave ablation of the partial spleen for treatment of liver cancer complicated with hypersplenism. A retrospective analysis was performed on 23 patients who underwent hepatectomy combined with microwave ablation of the partial spleen for liver cancer, complicated with hypersplenism that was secondary to cirrhosis. The splenic and ablated volumes were calculated according to a contrast-enhanced computed tomography scan prior to and 2 weeks after the operation. Complete blood count and liver function tests were examined prior to and following the surgery, and complications and changes in the blood tests were monitored for 6 months. Over this period of investigation, the splenic volume was reduced by a mean value of 34.0%. The levels of serum alanine aminotransferase and aspartate aminotransferase were increased on the first day after the operation (P<0.05), although they recovered to the normal level within 1 week (P<0.05). The total level of bilirubin increased slightly, along with moderately decreased levels of albumin and cholinesterase on the first day, although these changes were not significant compared with the baseline (P>0.05). The white blood cell count was persistently significantly higher compared with the baseline over the course of the 6 months (P>0.05). The platelet count did not increase significantly for the first week after the operation (P>0.05); however, it was revealed to be significantly increased 1 month after the surgery (P<0.05). No significant complications were occurred during the follow-up period. In conclusion, hepatectomy combined with microwave ablation of the spleen was demonstrated to be a safe and effective procedure for patients with liver cancer and hypersplenism in the mid-term.
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Microwave Ablation for the Treatment of Hypersplenism: Short Waves, Low Cost, Big Results. Dig Dis Sci 2016; 61:6-7. [PMID: 26541991 DOI: 10.1007/s10620-015-3928-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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7
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Blencowe NS, Boddy AP, Harris A, Hanna T, Whiting P, Cook JA, Blazeby JM. Systematic review of intervention design and delivery in pragmatic and explanatory surgical randomized clinical trials. Br J Surg 2015; 102:1037-47. [PMID: 26041565 DOI: 10.1002/bjs.9808] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/13/2015] [Accepted: 02/17/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Surgical interventions are complex, with multiple components that require consideration in trial reporting. This review examines the reporting of details of surgical interventions in randomized clinical trials (RCTs) within the context of explanatory and pragmatic study designs. METHODS Systematic searches identified RCTs of surgical interventions published in 2010 and 2011. Included studies were categorized as predominantly explanatory or pragmatic. The extent of intervention details in the reports were compared with the CONSORT statement for reporting trials of non-pharmacological treatments (CONSORT-NPT). CONSORT-NPT recommends reporting the descriptions of surgical interventions, whether they were standardized and adhered to (items 4a, 4b and 4c). Reporting of the context of intervention delivery (items 3 and 15) and operator expertise (item 15) were assessed. RESULTS Of 4541 abstracts and 131 full-text articles, 80 were included (of which 39 were classified as predominantly pragmatic), reporting 160 interventions. Descriptions of 129 interventions (80.6 per cent) were provided. Standardization was mentioned for 47 (29.4 per cent) of the 160 interventions, and 22 articles (28 per cent) reported measurement of adherence to at least one aspect of the intervention. Seventy-one papers (89 per cent) provided some information about context. For one-third of interventions (55, 34.4 per cent), some data were provided regarding the expertise of personnel involved. Reporting standards were similar in trials classified as pragmatic or explanatory. CONCLUSION The lack of detail in trial reports about surgical interventions creates difficulties in understanding which operations were actually evaluated. Methods for designing and reporting surgical interventions in RCTs, contributing to the quality of the overall study design, are required. This should allow better implementation of trial results into practice.
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Affiliation(s)
- N S Blencowe
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.,Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
| | - A P Boddy
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - A Harris
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - T Hanna
- National Institute for Health Research Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospital and University of Liverpool, Liverpool, UK
| | - P Whiting
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J A Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.,Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
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Martins GLP, Bernardes JPG, Rovella MS, Andrade RG, Viana PCC, Herman P, Cerri GG, Menezes MR. Radiofrequency ablation for treatment of hypersplenism: A feasible therapeutic option. World J Gastroenterol 2015; 21:6391-6397. [PMID: 26034376 PMCID: PMC4445118 DOI: 10.3748/wjg.v21.i20.6391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/06/2014] [Accepted: 02/05/2015] [Indexed: 02/06/2023] Open
Abstract
We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation and measured the total spleen and ablated volumes with contrast-enhanced computed tomography and volumetry. No major complications occurred, thrombocytopenia was resolved, and platelet levels remained stable, which allowed for early treatment of the patient’s underlying disease. Previous work has shown that splenic radiofrequency ablation is an attractive alternative treatment for hypersplenism induced by liver cirrhosis. We aimed to contribute to the currently sparse literature evaluating the role of radiofrequency ablation (RFA) in the management of hypersplenism. We conclude that splenic RFA appears to be a viable and promising option for the treatment of hypersplenism.
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9
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Boyer TD, Habib S. Big spleens and hypersplenism: fix it or forget it? Liver Int 2015; 35:1492-8. [PMID: 25312770 DOI: 10.1111/liv.12702] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 10/09/2014] [Indexed: 12/12/2022]
Abstract
Hypersplenism is a common manifestation of portal hypertension in the cirrhotic. More than half of cirrhotics will have low platelet counts, but neutropenia is much less common. Despite being common in the cirrhotic population, the presence of hypersplenism is of little clinical consequence. The presence of hypersplenism suggests more advanced liver disease and an increase in risk of complications, but there is no data showing that correcting the hypersplenism improves patient survival. In most series, the most common indications for treating the hypersplenism is to increase platelet and white blood cell counts to allow for use of drugs that suppress the bone marrow such as interferon alpha and chemotherapeutic agents. There are several approaches used to treat hypersplenism. Portosystemic shunts are of questionable benefit. Splenectomy, either open or laparoscopically, is the most effective but is associated with a significant risk of portal vein thrombosis. Partial splenic artery embolization and radiofrequency ablation are effective methods for treating hypersplenism, but counts tend to fall back to baseline long-term. Pharmacological agents are also effective in increasing platelet counts. Development of direct acting antivirals against hepatitis C will eliminate the most common indication for treatment. We lack controlled trials designed to determine if treating the hypersplenism has benefits other than raising the platelet and white blood cell counts. In the absence of such studies, hypersplenism in most patients should be considered a laboratory abnormality and not treated, in other words forget it.
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Affiliation(s)
- Thomas D Boyer
- Liver Research Institute and Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
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10
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Abstract
Thrombocytopenia (defined as a platelet count <150×10(9)) is a well-known complication in patients with liver cirrhosis and has been observed in 76% to 85% of patients. Significant thrombocytopenia (platelet count <50×10(9) to 75×10(9)) occurs in approximately 13% of patients with cirrhosis. Thrombocytopenia can negatively impact the care of patients with severe liver disease by potentially interfering with diagnostic and therapeutic procedures. Multiple factors can contribute to the development of thrombocytopenia including splenic platelet sequestration, immunological processes, bone marrow suppression by chronic viral infection, and reduced levels or activity of the hematopoietic growth factor thrombopoietin. The present review focuses on the etiologies and management options for severe thrombocytopenia in the setting of advanced liver disease.
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11
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Tang T, Feng X, Yan J, Xia F, Li X, Ma K, Bie P. Predictive value of indocyanine green retention rate with respect to complications of radiofrequency ablation in 878 patients with hepatocellular carcinoma. Int J Hyperthermia 2014; 30:402-7. [DOI: 10.3109/02656736.2014.951404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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12
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Bruns F, Bremer M, Dettmer A, Janssen S. Low-dose splenic irradiation in symptomatic congestive splenomegaly: report of five cases with literature data. Radiat Oncol 2014; 9:86. [PMID: 24673965 PMCID: PMC3997820 DOI: 10.1186/1748-717x-9-86] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/16/2014] [Indexed: 11/27/2022] Open
Abstract
Background To show effectiveness of low-dose splenic irradiation in symptomatic congestive splenomegaly. Methods Five patients were referred to our department for symptomatic congestive splenomegaly within three years. Primary diseases were autoimmune hepatitis with liver cirrhosis (n = 2), cystic fibrosis (n = 1), granulomatous liver disease (n = 1) and Werlhof disease with liver cirrhosis (n = 1). Mean age was 54 years (range: 36–67). Patients received splenic irradiation with a total dose of 3 Gy (single dose: 0.5 Gy). One patient was re-irradiated after long-term failure with the same treatment schedule. Results In four patients long term relief of splenic pain could be observed during the follow-up time of median 20 (range: 2–36) months. Four patients showed haematological response after irradiation with an increase of erythrocytes, leucocytes and/or platelets. A slightly decrease in spleen size was found in two patients. Conclusions Low-dose splenic irradiation in symptomatic congestive splenomegaly is feasible and perhaps as effective as in lympho-and myeloproliferative malignancies regarding pain relief and haematological response.
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Affiliation(s)
- Frank Bruns
- Department of Radiation Oncology, Hannover Medical School, 30625 Hannover, Germany.
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Lardière-Deguelte S, de Mestier L, Amroun K, Volet J, Cart P, Bouche O, Kianmanesh A. Laparoscopic thermal ablation of splenic metastases initial experience and present aspects. J Visc Surg 2013; 150:355-8. [DOI: 10.1016/j.jviscsurg.2013.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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14
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Shi B, Zhu H, Liu YJ, Lü L, Jin CB, Ran LF, Zhou K, Yang W, Wang ZB, Mei ZC. Experimental studies and clinical experiences on treatment of secondary hypersplenism with extracorporeal high-intensity focused ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1911-1917. [PMID: 22975039 DOI: 10.1016/j.ultrasmedbio.2012.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 07/05/2012] [Accepted: 07/18/2012] [Indexed: 06/01/2023]
Abstract
The aim of this study is to investigate the efficacy and safety of extracorporeal high-intensity focused ultrasound (HIFU) in treatment of hypersplenism. Fifteen adult dogs, weighing 13-18 kg were divided into three groups: sham group, SVL group undergoing splenic vein ligation (SVL) after laparotomy, and SVL + HIFU group receiving SVL followed by extracorporeal HIFU. Pathologic and hematologic analyses were performed. We also reviewed the clinical data of 19 patients with secondary hypersplenism caused by liver cirrhosis or hepatocellular carcinoma who underwent extracorporeal HIFU. Extracorporeal HIFU significantly diminished the volume of the spleen of animals, coupled with occurrence of coagulation necrosis and fibrosis in the target area. Both platelet and red blood cell counts were significantly restored by HIFU intervention. Similarly, HIFU treatment improved the hematologic parameters in patients with hypersplenism, and no major complications were encountered. Extracorporeal HIFU intervention is effective and safe in managing secondary hypersplenism.
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Affiliation(s)
- Bing Shi
- Department of Digestive Diseases, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Feng K, Yan J, Li X, Xia F, Ma K, Wang S, Bie P, Dong J. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol 2012; 57:794-802. [PMID: 22634125 DOI: 10.1016/j.jhep.2012.05.007] [Citation(s) in RCA: 546] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 05/07/2012] [Accepted: 05/11/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The aim of this study was to compare the efficacy of radiofrequency ablation (RFA) with surgical resection (RES) in the treatment of small hepatocellular carcinoma (HCC). METHODS A total of 168 patients with small HCC with nodular diameters of less than 4 cm and up to two nodules were randomly divided into RES (n=84) and RFA groups (n=84). Outcomes were carefully monitored and evaluated during the 3-year follow-up period. RESULTS The 1-, 2-, and 3-year survival rates for the RES and RFA groups were 96.0%, 87.6%, 74.8% and 93.1%, 83.1%, 67.2%, respectively. The corresponding recurrence-free survival rates for the two groups were 90.6%, 76.7%, 61.1% and 86.2%, 66.6%, 49.6%, respectively. There were no statistically significant differences between the two groups in overall survival rate (p=0.342) or recurrence-free survival rate (p=0.122). Multivariate analysis demonstrated that the independent risk factors associated with survival were multiple occurrences of tumors at different hepatic locations (relative risk of 2.696; 95% CI: 1.189-6.117; p=0.018) and preoperative indocyanine green retention rate at 15 min (ICG-15) (relative risk of 3.853; 95% CI: 1.647-9.015; p=0.002). CONCLUSIONS In patients with small hepatocellular carcinomas, percutaneous RFA may provide therapeutic effects similar to those of RES. However, percutaneous RFA is more likely to be incomplete for the treatment of small HCCs located at specific sites of the liver, and open or laparoscopic surgery may be the better choice.
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Affiliation(s)
- Kai Feng
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
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16
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Wang LN, He JX, Jin X, Liu ZC, Li FX. Radiotherapy versus interventional therapy for hepatogenic hypersplenism: An analysis of 75 cases. Shijie Huaren Xiaohua Zazhi 2012; 20:2296-2301. [DOI: 10.11569/wcjd.v20.i24.2296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the clinical effects, adverse reactions and hospitalization expenses of external irradiation therapy, three dimensional conformal radiation therapy and interventional therapy for the treatment of hepatogenic hypersplenism.
METHODS: Sixty patients with hypersplenism secondary to liver cirrhosis and 15 patients with hypersplenism secondary to liver cancer were selected. Patients with hypersplenism secondary to liver cirrhosis were divided into two groups: one was treated with external irradiation and the other with interventional therapy. Patients with hypersplenism secondary to liver cancer were treated with three dimensional conformal radiation therapy. Spleen size, blood routine index, adverse reactions and hospitalization expenses were compared among the three groups.
RESULTS: Spleen size was reduced and white blood cell count, hemoglobin and platelet count increased significantly in all the three groups of patients after treatment (all P < 0.05). But no significant differences were observed in spleen size and routine blood parameters between the three groups after treatment (P > 0.05). Fever index and pain index were significantly reduced in the external irradiation and three dimensional conformal radiation therapy groups compared to the interventional therapy group (0.57 ± 0.55, 0.64 ± 0.51 vs 1.80 ± 1.21; 0.36 ± 0.63, 1.67 ± 1.12 vs 4.59 ± 3.22, all P < 0.05). The hospitalization expenses were reduced in the external irradiation group compared to the other two groups.
CONCLUSION: External irradiation and three dimensional conformal radiation therapy can achieve the same effects as the interventional therapy and are associated with reduced side effects and hospitalization expenses in the treatment of hepatogenic hypersplenism.
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Singh AK, Shankar S, Gervais DA, Hahn PF, Mueller PR. Image-guided percutaneous splenic interventions. Radiographics 2012; 32:523-34. [PMID: 22411947 DOI: 10.1148/rg.322115135] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the spleen, image-guided interventional procedures such as biopsy and catheter drainage have not been widely performed because of the perceived increased risk of complications. The ability of image-guided biopsy to allow tissue diagnosis of a focal splenic mass without the need for splenectomy is the driving force behind use of this procedure in oncology patients. The literature on image-guided splenic biopsy suggests that the highest biopsy yield is achieved with core biopsy and the lowest complication rate is achieved with fine-needle aspiration. Image-guided catheter drainage is an effective alternative to splenectomy for management of infected splenic collections. In clinical practice, image-guided splenic biopsy, fluid aspiration, and catheter drainage have high success rates. Image-guided alcohol ablation is effective in treatment of splenic cysts. The literature on splenic radiofrequency ablation (RFA) is sparse; therefore, further studies are needed to determine the role of RFA in management of splenic neoplasms and hypersplenism. Image-guided percutaneous thrombin injection can be used to treat splenic artery pseudoaneurysms. Awareness of the correct interventional techniques and their limitations is important for safe performance of image-guided percutaneous splenic interventions.
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Affiliation(s)
- Ajay K Singh
- Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA.
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Misselwitz B, Bachli EB, Kaiser P, Goede JS. Diagnosis of hypersplenism with the epinephrine stimulation test. Swiss Med Wkly 2012; 142:w13324. [DOI: 10.57187/smw.2012.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PRINCIPLES: Hypersplenism can be defined by thrombocytopenia and/or neutropenia resulting from blood cell sequestration in an enlarged spleen. In multimorbid patients the differential diagnosis of cytopenia is challenging and currently there is no established test for diagnosing hypersplenism.
METHODS: The epinephrine stimulation test (EST) measures changes in platelets, neutrophil counts and spleen size following a subcutaneous epinephrine injection. We retrospectively analysed the results of EST in 228 patients.
RESULTS: Increases in neutrophils and platelets after epinephrine injection were significantly greater in patients with enlarged than in patients with normal size spleens. Using cutoffs of low, intermediate and high confidence EST was positive in 69.8% vs. 41.3% (low confidence), 49.6% vs. 17.4% (intermediate confidence) and 38.8% vs. 10.9% (high confidence) in patients with enlarged vs. normal size spleens. Changes in platelet and neutrophil counts correlated with each other and with changes in spleen size, confirming cell release from the spleen during EST. When stratified according to the underlying diagnosis, patients with liver disease had the strongest response to EST, patients with malignant haematological diseases the weakest. In addition the response to EST was significantly related to changes in platelet and neutrophil counts after splenectomy, confirming the validity of our test. No serious side effects occurred during EST.
CONCLUSION: When used in a large patient cohort, EST is a safe and simple diagnostic test. In this exploratory study EST is of value in evaluating patients with cytopenia and a positive EST argues strongly for hypersplenism. Future studies should prospectively evaluate EST for the management of patients with splenomegaly.
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