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Wang L, Lu M, Zhuang M, Liang Y, Wang SS, Li JM. Microwave ablation with hydrodissection used for the treatment of vascular malformations: effectiveness and safety study. Front Oncol 2024; 14:1146972. [PMID: 38894863 PMCID: PMC11183287 DOI: 10.3389/fonc.2024.1146972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/15/2024] [Indexed: 06/21/2024] Open
Abstract
Object The aim of the study was to investigate the safety, effectiveness, and peripheral nerve protection in ultrasound-guided microwave ablation (US-guided-MWA) for vascular malformations (VMs) closely related to peripheral nerve. Materials and methods From August 2019 to February 2022, 31 patients with 39 VMs received US-guided-MWA. All lesions were confirmed to be closely related to the peripheral nerve by imaging evaluation. Hydrodissection was applied to protect surrounding normal tissue, including peripheral nerves. The patients were followed up at 1day, 2 days, 3 days, 1 week, 1 month, 3 months after operation. Measurements of lesion volume, volume reduction ratio (VRR), sensory and functional abnormalities of adjacent nerves, number of treatments, complication details, personal satisfaction, recurrence, and symptom improvement were recorded. Results Among the 39 VMs, the maximum volume is 128.58ml, while the minimum volume is 0.99ml. After a mean follow-up of 13.06 ± 4.83 months, the mean numerical rating scale (NRS) score decreased from 5.13 ± 1.65 to 0.53 ± 0.83 (P<0.0001). The mean mass volume was reduced from 18.34 ± 24.68 ml to 1.35 ± 2.09 ml (P=0.0001). The VRR of all lesions was 92.06%. However, the mean number of treatments was only 1.64 ± 0.87. All patients were satisfied with the technique, with a mean satisfaction score (SC) of 9.23 ± 1.13. There were no motor function abnormalities of the related nerves. 10 patients felt numbness in the ablation area after ablation, and gradually recovered after 1 month. Conclusion US-guided-MWA serves as a novel alternative approach for patients with VMs. Preoperative evaluation of the relationship between VMs and peripheral nerves combined with intraoperative hydrodissection is an effective and safe method to prevent nerve injury.
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Affiliation(s)
- Lu Wang
- Department of Ultrasound, Sichuan Cancer Hospital, Chengdu, China
| | - Man Lu
- Department of Ultrasound, Sichuan Cancer Hospital, Chengdu, China
| | - Min Zhuang
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ying Liang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shi Shi Wang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jia Mi Li
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
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2
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Song Y, Wu M, Zhou R, Zhao P, Mao D. Application and evaluation of hydrodissection in microwave ablation of liver tumours in difficult locations. Front Oncol 2023; 13:1298757. [PMID: 38033497 PMCID: PMC10687428 DOI: 10.3389/fonc.2023.1298757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Objective To investigate the safety and mid-term outcomes of hydrodissection-assisted microwave ablation (MWA) of hepatocellular carcinoma (HCC) in various difficult locations. Methods A total of 131 HCC patients who underwent ultrasound-guided MWA from March 2017 to March 2019 were included. Following ultrasound examination, patients with tumors at difficult locations were treated with hydrodissection-assisted MWA (hydrodissection group), while those with tumors at conventional locations received MWA (control group). Both groups were compared concerning baseline characteristics, ablation parameters, complete ablation rates, and complication rates. Kaplan-Meier curves analyzed local tumor progression and overall survival, with stratified analysis for different difficult locations (adjacent to gastrointestinal tract, diaphragm, and subcapsular tumors). Additionally, Cox regression analyses were conducted to assess the impact of different difficult locations on these outcomes. Results Complete ablation rates were similar between the hydrodissection and control groups (91.4% vs. 95.2%, P>0.05). Postoperative complications occurred in three patients, including liver abscess and biliary injury. No significant differences in major or minor complication rates were found between the groups (P>0.05). Local tumor progression was detected in 11 patients (8.4%) at the end of the follow-up period. Neither cumulative local tumor progression rate (P=0.757) nor overall survival rate (P=0.468) differed significantly between the groups. Stratified analysis showed no effect of tumor location difficulty on cumulative local tumor progression or overall survival. Tumor number and size served as independent predictors for overall survival, while minimal ablation margin ≤ 5mm independently predicted local tumor progression. In contrast, the tumor location was not statistically significant. Sensitivity analyses corroborated the robustness of the models. Conclusion Hydrodissection-assisted MWA for HCC in various difficult locations demonstrated safe and effective, with complete ablation and mid-term outcomes comparable to those for tumors in conventional locations.
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Affiliation(s)
| | - Meng Wu
- Department of Ultrasound, The Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
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Liu Y, Wen W, Qian L, Xu R. Safety and efficacy of microwave ablation for abdominal wall endometriosis: A retrospective study. Front Surg 2023; 10:1100381. [PMID: 37143772 PMCID: PMC10151684 DOI: 10.3389/fsurg.2023.1100381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
Objectives This retrospective study aimed to evaluate the safety and feasibility of ultrasound-guided microwave ablation in the treatment of abdominal wall endometriosis (AWE). Background AWE is a rare form of endometriosis that often results in cyclic abdominal pain. The current treatment algorithm for AWE is not well established. Microwave ablation technology is a promising new thermal ablation technique for treating AWE. Methods This was a retrospective study of nine women with pathologically proven endometriosis of the abdominal wall. All patients were treated with ultrasound-guided microwave ablation. Grey-scale and color Doppler flow ultrasonography, contrast-enhanced ultrasonography, and MRI were used to observe the lesions before and after treatment. The complications, pain relief, AWE lesion volume, and volume reduction rate were recorded 12 months after treatment to evaluate the treatment efficacy. Complications were classified according to the Common Terminology Criteria for Adverse Events and the Society of Interventional Radiology classification system. Results Contrast-enhanced ultrasound showed that all lesions underwent successful treatment with microwave ablation. The average initial nodule volume was 7.11 ± 5.75 cm3, which decreased significantly to 1.85 ± 1.02 cm3 at the 12-month follow-up with a mean volume reduction rate of 68.77 ± 12.50%. Periodic abdominal incision pain disappeared at 1 month after treatment in all nine patients. The adverse events and complications were Common Terminology Criteria for Adverse Events grade 1 or Society of Interventional Radiology classification grade A. Conclusions Ultrasound-guided microwave ablation is a safe and effective technique for the treatment of AWE, and further study is warranted.
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Tan S, Yu X, Cheng Z, Zhang J, Yu J, Liu F, Gao Y, Linghu R, Han Z, Liang P. Cause Analysis and Diagnosis and Treatment of Intestinal Fistulas After Ultrasound-Guided Microwave Ablation of Abdominopelvic Lesions. Front Surg 2021; 8:675585. [PMID: 34869548 PMCID: PMC8639506 DOI: 10.3389/fsurg.2021.675585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To determine the cause and high-risk factors for the development of intestinal fistulas (IFs) after ultrasound-guided microwave ablation (MA) of abdominopelvic lesions, and to identify effective prophylactic and therapeutic actions. Methods: Clinical data were collected from patients with an IF after ultrasound-guided MA of abdominopelvic lesions in our hospital from January 1, 2010 to December 31, 2018. The cause, diagnosis, and treatment of IFs in these patients were analyzed. Results: Among 8,969 patients who underwent ultrasound-guided MA of abdominopelvic lesions, eight patients developed IF after MA, Seven patients were discharged after being cured and one died. Conclusion: Abdominopelvic lesions are close to the intestines, so histories of surgery, radiotherapy, and abdominopelvic infection are high-risk factors for IF development after MA of these lesions. Surgical treatment should be provided as soon as an IF is identified.
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Affiliation(s)
- Shuilian Tan
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jing Zhang
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yuanjin Gao
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Runze Linghu
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
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Li X, Xia S, Ji R, Zhan W, Zhou W. Evaluation of Microwave Ablation in 4T1 Breast Tumor by a Novel VEFGR2 Targeted Ultrasound Contrast Agents. Front Oncol 2021; 11:690152. [PMID: 34354946 PMCID: PMC8329532 DOI: 10.3389/fonc.2021.690152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/28/2021] [Indexed: 02/01/2023] Open
Abstract
Objectives A novel ultrasound contrast agent (UCA) VEGFR2-targeting iron-doped silica (SiO2) hollow nanoparticles (VEGFR2-PEG-HSNs-Fe NPs) was prepared and applied in microwave ablation for breast cancer to investigate its value in the evaluation of effectiveness after tumor ablation. Methods VEGFR2-PEG-HSNs-Fe NPs were prepared by using nano-SiO2, which was regarded as a substrate and etched by ferrous acetate, and then modified with anti-VEGFR2 antibody. Laser confocal microscope and flow cytometry were used to observe its main physicochemical properties, and biological safety was also investigated. After the xenograft tumor was treated with microwave ablation, the extent of perfusion defect was evaluated by ultrasound by injecting VEGFR2-PEG-HSNs-Fe NPs. Results The average particle size of VEGFR2-PEG-HSNs-Fe was 276.64 ± 30.31 nm, and the surface potential was −13.46 ± 2.83 mV. In vitro, the intensity of ultrasound signal increased with UCA concentration. Good biosafety was performed in in vivo and in vitro experiments. The enhanced ultrasound signal was detected in tumors after injection of VEGFR2-PEG-HSNs-Fe NPs, covering the whole tumor. The lesions, which were incompletely ablated, presented as contrast agent perfusion at the periphery of the tumor, and contrast enhanced ultrasound (CEUS) was performed again after complementary ablation. It was confirmed that all the lesions were completely ablated. Conclusion Nano-targeted UCAs VEGFR2-PEG-HSNs-Fe NPs had good biosafety and ability of specific imaging, which might be used as a contrast agent in CEUS to evaluate the efficacy of tumor ablation.
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Affiliation(s)
- Xiaoyu Li
- Department of Ultrasound, RuiJin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shujun Xia
- Department of Ultrasound, RuiJin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ri Ji
- Department of Ultrasound, RuiJin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, RuiJin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, RuiJin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Department of Ultrasound, RuiJin Hospital/Lu Wan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Yu J, Yu XL, Cheng ZG, Hu B, Han ZY, Liu FY, Hu ZQ, Wang H, Dong J, Pan J, Yang B, Sai X, Guo AT, Liang P. Percutaneous microwave ablation of renal cell carcinoma: practice guidelines of the ultrasound committee of Chinese medical association, interventional oncology committee of Chinese research hospital association. Int J Hyperthermia 2021; 37:827-835. [PMID: 32635839 DOI: 10.1080/02656736.2020.1779356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Imaging-guided percutaneous microwave ablation (MWA) with high thermal efficiency comprises rapid, successful management of small renal cell carcinomas (RCCs) in selected patients. Ultrasound Committee of Chinese Medical Association, Interventional Oncology Committee of Chinese Research Hospital Association developed evidence-based guidelines for MWA of RCCs after systematically reviewing the 1969-2019 literature. Systematic reviews, meta-analyses, randomized controlled trials, cohort, and case-control studies reporting MWA of RCCs were included and levels of evidence assessed. Altogether, 146 articles were identified, of which 35 reported percutaneous MWA for T1a RCCs and 5 articles for T1b RCCs. Guidelines were established based on indications, techniques, safety, and effectiveness of MWA for RCCs, with the goal of standardizing imaging-guided percutaneous MWA treatment of RCCs. Key points Microwave ablation is recommended for managing small renal cell carcinoma in selected patients. Imaging protocols are tailored based on the procedural plan, guidance, and evaluation. Patient's selection evaluation, updated technique information, clinical efficacy, and complications are recommended to standardize management. A joint task force (multidisciplinary team) summarized the key elements of the standardized report.
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Affiliation(s)
- Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Bing Hu
- Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China.,Department of Ultrasound in Med, 6th People's Hospital of Shanghai Jiaotong, University, Shanghai, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Zhi-Quan Hu
- Department of Ultrasound, Medical Imaging Union Hospital of Tongji Medical College of HUST Wuhan, China
| | - Hui Wang
- Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China.,Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Jun Dong
- Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Jie Pan
- Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China.,Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Yang
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Xiaoyong Sai
- Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Institute of Geriatrics, Beijing, China
| | - Ai-Tao Guo
- Department of Pathology, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
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7
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Effectiveness and reliability of percutaneous microwave ablation therapy in early stage renal cell cancer: Intermediate term results. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.821632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Wu J, Yu J, Cheng Z, Han Z, Yu X, Li K, Hu P, Liu F, Liang P. Risk Factors of Ureteral Stenosis After Percutaneous Microwave Ablation of Renal Tumor, a Single-Center Experience. Front Oncol 2020; 10:521349. [PMID: 33072565 PMCID: PMC7531279 DOI: 10.3389/fonc.2020.521349] [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: 01/07/2020] [Accepted: 08/25/2020] [Indexed: 11/13/2022] Open
Abstract
Background Ureteral stenosis after percutaneous microwave ablation (MWA) of renal tumor is a rare but severe complication, and its risk factors are not apparent. Purpose This study aimed to investigate the risk factors for stenosis of ureter after MWA treatment of the renal tumor that is a rare complication. Materials and Methods Data of 211 patients who underwent MWA for the treatment of renal tumor were retrospectively analyzed from September 2006 to August 2019. Demographic characteristics, clinical features, ablation parameters, and outcomes were analyzed to find out the potential risk factors of this complication. P < 0.05 is considered significant. Results Six of 211 patients developed ureter stenosis, and the rate of this complication is 2.84%. The median time of emergence of hydronephrosis was 226 (range, 3-390) days. Univariate analysis shows the distance between ureter and tumor (P = 0.225) or ablation zone (P = 0.089) is not related to this complication. Postoperative urine routine (red blood cell, P = 0.001; white blood cell, P = 0.035) and R.E.N.A.L. score (P < 0.001) is related to this complication. But after multivariate logistic analysis, only R.E.N.A.L. score (P = 0.004) is associated with this complication. The location and growth pattern of tumor and the energy of ablation were not related to this complication independently. Conclusion The stenosis of the ureter after MWA of renal tumor is not associated with the tumor size, location, or the distance between the ureter and tumor and ablation site independently. But R.E.N.A.L. score is associated with ureter stenosis after MWA for the treatment of renal tumor, which combines the information of location, depth, and size of tumor. Preoperative evaluation of the tumor is necessary for avoiding ureter stenosis. Further studies should focus on these risk factors of this complication.
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Affiliation(s)
- Jiapeng Wu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Kai Li
- Ultrasonic Department, The Second Affiliated Hospital of Chengdu Medical College, Nuclear Industry 416 Hospital, Chengdu, China
| | - Ping Hu
- Department of Ultrasound, First People's Hospital of Datong, Datong, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, China
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An C, Cheng Z, Yu X, Han Z, Liu F, Li X, Wu SS, Yu J, Liang P. Ultrasound-guided percutaneous microwave ablation of hepatocellular carcinoma in challenging locations: oncologic outcomes and advanced assistive technology. Int J Hyperthermia 2020; 37:89-100. [PMID: 31969036 DOI: 10.1080/02656736.2019.1711203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: To assess the oncologic outcomes of the hepatocellular carcinoma (HCC) patients in challenging locations (CLs) underwent ultrasound-guided percutaneous microwave ablation (US-PMWA) and the efficacy and safety of the advanced assistive technology (AAT).Materials and methods: Data for 489 treatment-naïve patients with HCC who met Milan criteria and subsequently underwent US-PMWA were reviewed from March 2012 to November 2016. According to the distance (<5 mm) between the tumor and surrounding structures, the patients were divided into two groups: a CL group and a non-CL group. Regarding MWA assisted by AAT, the CL group was further subdivided into two groups: an AAT group and a non-AAT group. Technique effectiveness, complications and survival outcomes (i.e., overall survival [OS] and recurrence-free survival [RFS]) were compared between CL and non-CL groups. Local tumor progression (LTP) was compared between AAT and non-AAT groups.Results: Technique effectiveness and complications in the CL group were similar to those in the non-CL group (p = .873 and p = .828, respectively). The OS and RFS in six types of CL groups were comparable with those in non-CL group (p = .131-.117) including adjacent vital structures, gallbladder, hepatic hilar regions, major vessels, diaphragm and capsule, respectively. The LTP rates in the AAT group were significantly higher than those in the non-AAT group (p = .001).Conclusions: US-PMWA assisted by AAT to treat HCC lesions in CLs was safe and effective; also, this technique had comparable success and survival outcomes with those of patients in non-CL.
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Affiliation(s)
- Chao An
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, PR China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, PR China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, PR China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, PR China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, PR China
| | - Xin Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, PR China
| | - Song Song Wu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, PR China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, PR China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, PR China
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Yu J, Zhang X, Liu H, Zhang R, Yu X, Cheng Z, Han Z, Liu F, Hao G, Mu MJ, Liang P. Percutaneous Microwave Ablation versus Laparoscopic Partial Nephrectomy for cT1a Renal Cell Carcinoma: A Propensity-matched Cohort Study of 1955 Patients. Radiology 2020; 294:698-706. [PMID: 31961239 DOI: 10.1148/radiol.2020190919] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Percutaneous microwave ablation (MWA) and laparoscopic partial nephrectomy (LPN) are two modalities indicated for early-stage renal cell carcinoma (RCC) with low extent of invasion. Purpose To compare the long-term results of percutaneous MWA and LPN in the treatment of cT1a RCC. Materials and Methods This retrospective study included 1955 patients with cT1a RCC treated with percutaneous MWA or LPN between April 2006 and November 2017. Propensity score matching was used. Oncologic outcomes were analyzed by using the Fine-and-Gray competing risk models. Results A total of 185 patients underwent percutaneous MWA (mean age, 63.2 years ± 15.2 [standard deviation]) and 1770 underwent LPN (mean age, 50.9 years ± 13.2). During the follow-up (median, 40.6 months), after propensity score matching, no difference was observed between local tumor progression (3.2% vs 0.5%, P = .10), cancer-specific survival (2.2% vs 3.8%, P = .24), and distant metastases (4.3% vs 4.3%, P = .76). Patients who underwent percutaneous MWA had worse overall survival (hazard ratio, 2.4; 95% confidence interval: 1.0, 5.7; P = .049 vs LPN) and disease-free survival (82.9% vs 91.4%, P = .003). Percutaneous MWA led to smaller drop in estimated glomerular filtration rate at discharge (6.2% vs 16.4%, P < .001), smaller estimated blood loss (4.5 mL ± 1.3 vs 54.2 mL ± 69.2), lower cost ($3150 ± 2970 vs $6045 ± 1860 U.S. dollars), shorter operative time (0.5 minute ± 0.1 vs 1.8 minutes ± 0.6), and shorter postoperative hospitalization time (5.1 days ± 2.6 vs 6.9 days ± 2.8) (all P < .001 vs LPN). There were fewer cases of fever in the percutaneous MWA group (16.2% vs 73.0%, P < .001). Conclusion There were no significant differences regarding oncologic outcomes and complications between percutaneous microwave ablation and laparoscopic partial nephrectomy for patients with cT1a renal cell carcinoma. Percutaneous microwave ablation led to smaller renal function change and lower blood loss. For patients who cannot be subjected to the risks of more invasive laparoscopic partial nephrectomy, percutaneous microwave ablation could be an alternative less invasive treatment option. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Jie Yu
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Xu Zhang
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Hong Liu
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Ruiming Zhang
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Xiaoling Yu
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Zhigang Cheng
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Zhiyu Han
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Fangyi Liu
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Guoliang Hao
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Meng-Juan Mu
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Ping Liang
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
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11
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Yamagami T, Yoshimatsu R, Kajiwara K, Yamanishi T, Minamiguchi H, Karashima T, Inoue K. Protection from injury of organs adjacent to a renal tumor during percutaneous cryoablation. Int J Urol 2019; 26:785-790. [PMID: 31094038 DOI: 10.1111/iju.14013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/07/2019] [Indexed: 01/20/2023]
Abstract
Renal cryoablation has become accepted as treatment for small renal tumors as an alternative to surgery. However, parallel with the increase in the use of this therapy, there also has been increases in the number of reports of complications related to renal cryoablation. One potential complication is injury to important non-renal structures adjacent to the ablated renal tumor, such as the colon, duodenum, ureter, psoas muscle and so on. To prevent injury of adjacent organs, separating organs from the tumor is desirable. Over the past 15 years, several techniques have been developed to protect against injury of organs adjacent to renal tumors that are targets of cryoablation. The most commonly used technique for this purpose has been hydrodissection. Others include dissection with gas, balloon dissection and probe traction. To avoid injury of a ureter running near the renal tumor, pyeloperfusion is known to be useful. The rate of cases necessitating avoidance of organ injury by using these techniques is relatively high. In some cases, more than two techniques are combined. In the present review, we provided an overview of techniques currently available to protect against organ injuries, and discussed the advantages and disadvantages of each technique.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Rika Yoshimatsu
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Kenji Kajiwara
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Tomoaki Yamanishi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Takashi Karashima
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Keiji Inoue
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
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12
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Garnon J, Cazzato RL, Caudrelier J, Nouri-Neuville M, Rao P, Boatta E, Ramamurthy N, Koch G, Gangi A. Adjunctive Thermoprotection During Percutaneous Thermal Ablation Procedures: Review of Current Techniques. Cardiovasc Intervent Radiol 2018; 42:344-357. [DOI: 10.1007/s00270-018-2089-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 10/01/2018] [Indexed: 12/22/2022]
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13
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Choi SH, Kim JW, Kim JH, Kim KW. Efficacy and Safety of Microwave Ablation for Malignant Renal Tumors: An Updated Systematic Review and Meta-Analysis of the Literature Since 2012. Korean J Radiol 2018; 19:938-949. [PMID: 30174484 PMCID: PMC6082757 DOI: 10.3348/kjr.2018.19.5.938] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/10/2018] [Indexed: 02/06/2023] Open
Abstract
Objective To systematically determine the treatment outcomes of percutaneous microwave ablation (MWA) in patients with malignant renal tumor. Materials and Methods Original studies that reported the clinical outcomes of MWA in patients with malignant renal tumors were identified in MEDLINE and EMBASE from 2012 to June 30, 2017. Inverse variance and random-effects models were used to evaluate and acquire meta-analytic summary estimates of various clinical outcomes, including technical outcomes (technical success rate [TSR] and technical efficacy rate [TER]), oncologic outcomes (local tumor recurrence rate [LRR], cancer-specific survival rate [CSSR], and overall survival rate [OSR]), and complications. Results Among the 145 articles screened, 13 articles including 567 patients carrying 616 malignant renal tumors were included in the meta-analysis. The meta-analytic pooled TSR and TER were 97.3% (95% confidence interval, 94.3-99.4%; I2 = 0.0%) and 97.6% (95.0-99.4%, I2 = 48.5%), respectively. The meta-analytic pooled LRR was 2.1% (0.3-4.7%, I2 = 54.1%). At 1-, 2-, 3-, and 5-year follow-up time points, the meta-analytic pooled CSSRs were 99.1% (97.2-100.0%; I2 = 0.0%), 98.4% (95.1-100.0%; I2 = 31.2%), 97.6% (93.4-99.9%; I2 = 52.3%), and 96.9% (93.3-99.2%; I2 = 0.0%) respectively, while the OSRs were 98.3% (96.1-99.8%; I2 = 0.0%), 94.9% (91.7-97.5%; I2 = 0.0%), 86.8% (81.9-91.1%; I2 = 22.1%), and 81.9% (75.4-87.6%; I2 = 0.0%). In terms of major complications, a 1.8% (0.6-3.3%; I2 = 0.0%) rate of meta-analytic pooled incidence was found. Conclusion Microwave ablation showed favorable technical and oncologic outcomes with a low incidence of major complications. Hence, image-guided percutaneous MWA can be considered as a safe and effective treatment for malignant renal tumors.
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Affiliation(s)
- Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Hao G, Hao Y, Cheng Z, Zhang X, Cao F, Yu X, Han Z, Liu F, Mu M, Dou J, Li X, Dupuy DE, Yu J, Liang P. Local tumor progression after ultrasound-guided percutaneous microwave ablation of stage T1a renal cell carcinoma: risk factors analysis of 171 tumors. Int J Hyperthermia 2018; 35:62-70. [PMID: 29807450 DOI: 10.1080/02656736.2018.1475684] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To retrospectively review long-term oncologic outcomes after ultrasound (US)-guided percutaneous microwave ablation (MWA) of T1a renal cell carcinoma (RCC) and to identify the incidence and risk factors that predict local tumor progression (LTP) after MWA of RCC. MATERIALS AND METHODS The present study was approved by the institutional review board. A total of 162 patients with 171 RCC nodules (mean size, 2.6 ± 0.8 cm; range, 0.6-4.0 cm) were treated by MWA between April 2006 and January 2017. The influence of eight factors (age; sex; longest tumor diameter; tumor number, location and pathology type; ablation power and time) affecting the risk of LTP was assessed. Univariate Kaplan-Meier and Cox proportional hazard models were used for statistical analysis. RESULTS LTP occurred in five patients (5 tumors) after US-guided percutaneous MWA of stage T1a RCC. The overall occurrence of LTP was 2.9% per tumor and 3.0% per patient with a median follow-up of 45.5 months. Among the 162 patients, there were no instances of LTP-related deaths; however, 20 patients died of other diseases. All patients with LTP survived through follow-up. The survival rate of LTP-free patients at 1, 3 and 5 years were 98.7%, 89.5% and 82.1%, respectively (p = .38). Univariate and multivariate analysis identified tumor location to be the only independent predictor of LTP. CONCLUSIONS US-guided percutaneous MWA for T1a RCC achieved a relatively low LTP incidence rate. Tumors adjacent to the renal pelvis or bowel increased the potential of LTP occurrence.
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Affiliation(s)
- Guoliang Hao
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Yanan Hao
- b Department of Ultrasound , The First Hospital Shijiazhuang , Shijiazhuang , China
| | - Zhigang Cheng
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Xu Zhang
- d Department of Urological Surgery , Chinese PLA General Hospital , Beijing , China
| | - Feng Cao
- c Department of Cardiovascular Medicine , Chinese PLA General Hospital , Beijing , China
| | - Xiaoling Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Zhiyu Han
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Fangyi Liu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Mengjuan Mu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Jianping Dou
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Xin Li
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Damian Edward Dupuy
- e Department of Diagnostic Imaging , American Rhode Island Hospital , Providence , RI , USA
| | - Jie Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Ping Liang
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
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