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Yu H, Zhao F, Men X, Zhu H, Yan J, Liu Z, Liu Q, Feng Y, Wang L, Meng M, Zhu Q, Zhao X. Microwave ablation versus laparoscopic resection for hepatocellular carcinoma in patients with clinically significant portal hypertension: a propensity score-matched study of postoperative liver decompensation. Eur Radiol 2024; 34:3226-3235. [PMID: 37875593 DOI: 10.1007/s00330-023-10268-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES The study of postoperative liver decompensation after microwave ablation (MWA) for hepatocellular carcinoma (HCC) in patients with clinically significant portal hypertension (CSPH) is still lacking. The purpose of the present study was to compare the postoperative liver decompensation after MWA and laparoscopic resection (LR) for HCC in patients with CSPH. METHODS The present retrospective study enrolled 222 HCC patients with CSPH who underwent MWA (n = 67) or LR (n = 155). Postoperative liver decompensation, complications, postoperative hospital stays, and overall survival were analyzed. Factors associated with postoperative liver decompensation were identified. RESULTS After propensity score matching, the postoperative liver decompensation rate was significantly lower in the MWA group than that in the LR group (15.5% versus 32.8%, p = 0.030). The multivariable regression analysis identified that type of treatment (MWA vs. LR, odds ratio [OR] 0.44; 95% confidence interval [CI], 0.21-0.91; p = 0.026) and Child-Pugh B (OR, 2.86; 95% CI, 1.24-6.61; p = 0.014) were independent predictors for postoperative liver decompensation. The rate of complications for patients in the MWA group was significantly lower than that in the LR group (p < 0.001). And MWA showed shorter postoperative hospital stays than LR (3 days vs. 6 days, p < 0.001). Overall survival rate between the two groups was not significantly different (p = 0.163). CONCLUSION Compared with laparoscopic resection, microwave ablation has a lower rate of postoperative liver decompensation and might be a better option for HCC patients with CSPH. CLINICAL RELEVANCE STATEMENT Microwave ablation exhibited a lower incidence of postoperative liver decompensation in comparison to laparoscopic resection, thereby conferring greater advantages to hepatocellular carcinoma patients with clinically significant portal hypertension. KEY POINTS •Postoperative liver decompensation rate after microwave ablation was lower than that of laparoscopic resection for hepatocellular carcinoma in patients with clinically significant portal hypertension. •Microwave ablation showed shorter postoperative hospital stays than laparoscopic resection. •Microwave ablation had fewer complications than laparoscopic resection.
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Affiliation(s)
- Hongli Yu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China
| | - Fenglin Zhao
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China
| | - Xiaoxiao Men
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China
| | - Huaqiang Zhu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Jingrui Yan
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Zongxin Liu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China
| | - Qiqi Liu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China
| | - Yuemin Feng
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Le Wang
- Department of Geriatrics, Department of Geriatric Gastroenterology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Min Meng
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Qiang Zhu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China.
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
| | - Xinya Zhao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China.
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Kim HC. Chemoembolization combined with radiofrequency ablation is the best option for the local treatment of early hepatocellular carcinoma? Clin Mol Hepatol 2023; 29:984-986. [PMID: 37583053 PMCID: PMC10577345 DOI: 10.3350/cmh.2023.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023] Open
Affiliation(s)
- Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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Microwave ablation versus surgical resection for subcapsular hepatocellular carcinoma: a propensity score-matched study of long-term therapeutic outcomes. Eur Radiol 2023; 33:1938-1948. [PMID: 36114849 DOI: 10.1007/s00330-022-09135-1] [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: 07/22/2022] [Revised: 07/22/2022] [Accepted: 08/29/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The therapeutic efficacy of microwave ablation (MWA) for subcapsular hepatocellular carcinoma (HCC) has not been well characterized. We aimed to compare the long-term outcomes of MWA and surgical resection (SR) in patients with subcapsular HCC. METHODS This retrospective study comprised 321 patients with subcapsular HCC meeting the Milan criteria who received MWA (n = 99) or SR (n = 222). Local tumor progression (LTP), overall survival (OS), and disease-free survival (DFS) were analyzed using propensity score matching (PSM) to compare the therapeutic efficacy. RESULTS In the total cohort, there were no significant differences in 5-year LTP rates (14.0% vs. 8.9%, p = 0.12), OS rates (70.7% vs. 73.2%, p = 0.63), and DFS rates (38.3% vs. 41.2%, p = 0.22) between the MWA and SR groups. After PSM, the cumulative LTP rates at 1, 3, and 5 years were 9.7%, 14.0%, and 16.4% in the MWA group (n = 84) and 7.2%, 8.6%, and 10.6% in the SR group (n = 84), respectively, with no significant difference (p = 0.31). Neither corresponding OS rates (96.4%, 84.8%, and 73.0% vs. 95.2%, 85.5%, and 72.1%, p = 0.89) nor DFS rates (76.0%, 52.6%, and 38.1% vs. 76.2%, 44.7%, and 32.3%, p = 0.43) were significantly different between the MWA and SR groups. Whereas MWA obtained fewer complications for both cohorts (both p < 0.05). CONCLUSION MWA showed comparable long-term therapeutic outcomes to SR, and it might be an alternative curative option for subcapsular HCC within the Milan criteria. KEY POINTS • Microwave ablation showed comparable local tumor progression, overall survival, and disease-free survival to surgical resection for subcapsular hepatocellular carcinoma meeting the Milan criteria. • Microwave ablation obtained fewer complications and shorter postoperative hospital stay.
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Barrow B, Martin Ii RCG. Microwave ablation for hepatic malignancies: a systematic review of the technology and differences in devices. Surg Endosc 2023; 37:817-834. [PMID: 36076101 DOI: 10.1007/s00464-022-09567-2] [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: 02/16/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Microwave ablation (MWA) has become the standard thermal-based treatment for hepatic malignancies in patients who have unresectable disease based on the biology of the tumor, the patients' comorbidities, and certain disease sites. The technical effectiveness, ablation success, local recurrence rates of hepatic malignancies treated with the various commercial microwave ablation devices has not been previously published in the peer reviewed literature. The aim of this systematic review is to summarize the clinical outcomes for the various MWA devices in the use of a hepatic malignancies to best educate hepatic surgeons as well as interventional radiologists. METHODS A comprehensive review of the literature and instructions for use of each device that was published from 1/2013 to 12/2020 was performed. The main outcomes extracted were technical success, ablation success, major complications, local and new recurrence rates, recurrence-free survival, ablation volumes, time, and the number of antennas required. A qualitative review of the literature was performed. RESULTS In total, 29 studies reporting data on 3250 patients and 4500 tumors were included in this review. Median patient age was 60.5 years (range 3-91). 76.3% (2420 M/753 F) of patients were male. Hepatocellular carcinoma (55%) was the most common tumor pathology followed by colorectal liver metastasis (10%) and cholangiocarcinoma (4%). A majority of studies reported technical success (range, 91.6-100%) and ablation success (range, 73.1-100%), as well as major complications (range, 0-9.1%). Local recurrence (range, 0-50%) was reported by 21 of the studies; however, new recurrence (range, 12.2-64%) was reported less frequently (6 studies) and were further specified in 12, six, and four studies as intrahepatic distant recurrence (11.3-54.2%), extrahepatic distant recurrence (3.6-20%), and metastasis (1.1-36%). A total of three, six, and five studies report disease, progression, and recurrence-free survival rates, respectively. CONCLUSION Microwave ablation is frequently used for the treatment of hepatic malignancies. A thorough understanding of the clinical outcomes associated with different pathologies and MWA devices can improve surgeon awareness and help prepare for operative planning and patient management. More consistent reporting of key outcomes in the literature is needed to achieve such an understanding.
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Affiliation(s)
- Brooke Barrow
- Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA
| | - Robert C G Martin Ii
- Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA.
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Li L, Yao J, Yan X, Qi X, Liang P, Han Z, Liu F, Cheng Z, Luo Y, Zheng R, Cheng W, Wei Q, Yu S, Yu J, Yu X. Long-term efficacy and safety of microwave ablation for hepatocellular carcinoma adjacent to the gallbladder with a diameter ≤ 5 cm: a multicenter, propensity score matching study. Int J Hyperthermia 2023; 40:2248425. [PMID: 37607775 DOI: 10.1080/02656736.2023.2248425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE To compare the long-term efficacy and safety of microwave ablation (MWA) as first-line therapy for hepatocellular carcinoma (HCC) adjacent versus nonadjacent to the gallbladder. MATERIALS AND METHODS From 2006 to 2018, 657 patients with ≤5 cm HCC who underwent percutaneous ultrasound-guided MWA as first-line therapy from 5 hospitals were enrolled in this retrospective study. Patients were grouped into the adjacent group (n = 49) and the nonadjacent group (n = 608) according to whether the tumor was adjacent to the gallbladder. Propensity score matching (PSM) was used to balance baseline variables between the two groups. RESULTS Forty-eight patient pairs were matched after PSM. For the PSM cohort, during a median follow-up time of 60 months, there were no differences in PFS (hazard ratio [HR], 1.011; 95% confidence interval [CI], 0.647-1.578; p = 0.963) or OS (HR 0.925; 95% CI 0.522-1.639; p = 0.789) between the adjacent and nonadjacent groups. Univariate and multivariate analyses revealed that the tumor adjacent to the gallbladder was not an independent risk factor for PFS or OS (all p > 0.05). Subgroup analysis showed comparable PFS and OS between the two groups in the <3 cm subgroup and the 3-5 cm subgroups (all p > 0.05). In addition to more use of assistive technology (p < 0.05), the adjacent group shared comparable local tumor progression, complications, technical success rate, and hospital stay (all p > 0.05) to the nonadjacent group. CONCLUSION There were comparable long-term efficacy and complications between patients with HCC adjacent and nonadjacent to the gallbladder treated with MWA.
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Affiliation(s)
- Lijuan Li
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Jundong Yao
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Xizi Yan
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Xiaoguang Qi
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanchun Luo
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qiang Wei
- Department of Ultrasound, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Songyuan Yu
- Department of Ultrasound, Wuhan University of Science and Technology, Tianyou Hospital, Wuhan, China
| | - Jie Yu
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
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2450-MHz microwave ablation of liver metastases under 3.0 T wide-bore magnetic resonance guidance: a pilot study. Sci Rep 2022; 12:12640. [PMID: 35879411 PMCID: PMC9314346 DOI: 10.1038/s41598-022-16989-4] [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: 12/06/2021] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
To investigate the feasibility and effectiveness of 3.0 T wide-bore magnetic resonance (MR)-guided microwave ablation (MA) of liver metastases (LM). From October 2018 to May 2020, 39 patients with 63 LM were treated with 3.0 T wide-bore MR-guided 2450-MHz MA therapy. The procedure parameters, technical success, complications, biochemical index changes, local tumor response, local tumor progression (LTP), 12-month disease-free survival (DFS) and 12-month overall survival (OS) were recorded and analyzed. The mean tumor maximum diameter and total procedure time were 3.0 cm and 55.2 min, respectively. Technical success was 100%, but 5 cases (12.8%) had grade-1 complications. Alanine transaminase, aspartate transaminase and total bilirubin showed a slight transient increase on day 3 (P < 0.05) and returned to normal by day 30 (P > 0.05). The complete ablation rates for ≤ 2.5 and > 2.5 cm lesions were 100% and 92.5%, respectively. During the median follow-up of 12.0 months, the LTP rate was 4.8% (3/63), and the 12-month DFS and OS rates were 61.3% and 92.2%, respectively. 3.0 T wide-bore MR-guided MA for LM is a safe and effective approach, especially for small LM.
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Wang Y, Li X, Yu J, Cheng Z, Hou Q, Liang P. Prognostic Nutritional Index in Hepatocellular Carcinoma Patients With Hepatitis B Following US-Guided Percutaneous Microwave Ablation: A Retrospective Study With 1,047 Patients. Front Surg 2022; 9:878737. [PMID: 35846958 PMCID: PMC9276976 DOI: 10.3389/fsurg.2022.878737] [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: 02/18/2022] [Accepted: 06/03/2022] [Indexed: 12/24/2022] Open
Abstract
ObjectiveSeveral studies have revealed that the prognostic nutritional index (PNI) was associated with survival in several cancers. However, the prognostic value of PNI in hepatocellular carcinoma (HCC) patients following ultrasound-guided percutaneous microwave ablation (US-PMWA) remains unknown, especially in patients with hepatitis B virus (HBV) infection. Therefore, the present study aimed to evaluate the potential prognostic value of PNI in these patients.MaterialsThe medical records of 1,047 HCC patients with HBV infection following US-PMWA were retrospectively reviewed. The association between preoperative PNI and overall survival (OS), as well as other clinical characteristics of HCC, were analyzed using the Kaplan–Meier plot, log-rank test, multi-parameter Cox proportional hazards model, restricted cubic spline (RCS), and time-dependent receiver operating characteristic (ROC) curve analyses.ResultsPatients with a preoperative PNI more than 45 were verified to have better OS than patients with a PNI less than 45. In the multi-parameter Cox proportional hazards models, the log-transformed PNI was verified as an independent prognostic factor for OS. The result of the RCS analysis revealed that there was a nearly linear relationship between PNI and OS. The area under the time-dependent ROC curve for PNI in predicting OS was 0.56, which is relatively stable.ConclusionPreoperative PNI represents a convenient, noninvasive, and independent prognostic indicator in HCC patients with HBV infection following US-PMWA.
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Dong Y, Wang G, Zhang J, Zhang S, Chen X, Guo Q, Qu F, Shou F. Robotic laser position versus freehand in CT-guided percutaneous microwave ablation for single hepatocellular carcinoma (diameter < 3 cm): a preliminary study. Int J Hyperthermia 2022; 39:725-732. [PMID: 35584811 DOI: 10.1080/02656736.2022.2072526] [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: 10/18/2022] Open
Abstract
PURPOSE To compare the accuracy and safety of robotic laser position (RLP) versus freehand for antenna CT-guided microwave ablation (MWA) of single hepatocellular carcinoma (HCC) (diameter < 3 cm). MATERIALS AND METHODS This retrospective study was conducted between May 2020 and June 2021. A total of 40 patients with early HCC who underwent CT-guided MWA were divided into two groups: a freehand group (n = 20) and a RLP group (n = 20). Based on in-plane and out-of-plane data, the actual puncture point error (APPE), number of repositioning procedures, and operative duration were compared using the Mann-Whitney U test. Ablation-related complications were compared using the Chi-squared test. RESULTS The mean diameter of HCC patients who received MWA was 2.4 ± 0.5 cm. For in-plane APPE, APPE was comparable between the two groups (p = 0.299). However, for the out-of-plane position, the APPE in the freehand group was higher than that in the RLP group (p = 0.027). The number of repositioning procedures was 0 (range, 0-0) for RLP-guided procedures and 3 (range, 2-5) for freehand procedures, showing a statistically significant difference between the two groups (p < 0.001). The mean operative duration for freehand procedures was 39 min, compared with 26 min for RLP-guided procedures, showing a significant difference (p = 0.013). No deaths or major complications were directly related to MWA. Minor complications in the freehand group were comparable with those in the RLP group (p = 0.313). CONCLUSION RLP guidance significantly reduces the number of antenna repositioning procedures in MWA and improves puncture accuracy for target HCC out-of-plane. In addition, the operative duration of robotic guidance was shorter than that of freehand guidance.
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Affiliation(s)
- Yuru Dong
- Department of Radiology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Guisheng Wang
- Department of Radiology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Jingjun Zhang
- Department of Oncology, The People's Hospital of Jianyang City, Chengdu, China
| | - Shu Zhang
- Research Center for Birth Defects Prevention and Control Technology, Chinese PLA General Hospital, Beijing, China
| | - Xiaoxia Chen
- Department of Radiology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Qing Guo
- Department of Research, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Feihuan Qu
- Readitec Medical Systems (Chengdu) Co., Ltd, Chengdu, China
| | - Feng Shou
- Department of Oncology, The People's Hospital of Jianyang City, Chengdu, China
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Safety and efficacy of microwave versus radiofrequency ablation for large hepatic hemangioma: a multicenter retrospective study with propensity score matching. Eur Radiol 2022; 32:3309-3318. [DOI: 10.1007/s00330-021-08425-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022]
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Jing X, Zhou Y, Ding J, Wang Y, Qin Z, Wang Y, Zhou H. The Learning Curve for Thermal Ablation of Liver Cancers: 4,363-Session Experience for a Single Central in 18 Years. Front Oncol 2020; 10:540239. [PMID: 33194601 PMCID: PMC7606932 DOI: 10.3389/fonc.2020.540239] [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: 03/04/2020] [Accepted: 09/22/2020] [Indexed: 12/23/2022] Open
Abstract
This study aimed to explore the special efforts required to achieve proficiency in performing thermal ablation of liver cancers, including tumors in difficult locations, and clarify the effects of handing-down teaching on the corresponding process. Major complications of patients receiving percutaneous thermal ablation of liver cancer were analyzed. Polynomial fitting was used to describe the connection between major complication rates and special experience. Learning curve of major complications was plotted both for the whole group and for each operator, respectively. Tumors in difficult locations were further studied. A total of 4,363 thermal ablation sessions were included in this study. 143 of 4,363 patients had major complications, corresponding to an incidence rate of 3.27%. 806 thermal ablation sessions were performed for tumors in difficult locations. The major complication rate of these sessions is 6.33%. According to the trend of the learning curve of the 4363 patients, the experience of the whole group can be classified into five stages, that is, the high-risk, relatively stable, unstable, proficient and stable periods. A learning curve for an individual operator can be classified into the high-risk, proficient and stable periods. The major complication rates for the chronologically first, second and third operator of the group are 3.23, 3.35, and 3.31%, respectively. The special experience needed to bypass the first stage corresponds to 410, 510, and 440 sessions, the second stage, 1850, 850, and 870 sessions, by the three operators, respectively. The major complication rates for the tumors in difficult locations for the first, second and third operator were 7.04, 5.53, and 5.98%, respectively. For the tumors in difficult locations, the special experience needed to bypass the first stage corresponds to 150, 130, and 140 sessions, the second stage, 290, 175, and 185 sessions, by the three operators, respectively. In conclusion, the learning process of an operator percutaneous thermal ablation for liver cancer can be classified into three stages. The major complication rate for tumors in difficult locations were higher than that for all tumors. Handing-down teaching can make an operator arrive at the third stage earlier but not the second stage.
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Affiliation(s)
- Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
| | - Yan Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
| | - Jianmin Ding
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
| | - Yijun Wang
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China.,Department of Hepatobiliary Surgery, Tianjin Third Central Hospital, Tianjin, China
| | - Zhengyi Qin
- Department of Ultrasound, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Yandong Wang
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
| | - Hongyu Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin, China
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ARIBAL S, KAYA E. Capsule and Ablation Tract Related Features of Local Recurrence in Ultrasound Guided Microwave Ablation of Liver Metastases. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2020. [DOI: 10.25000/acem.766188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Jin T, Liu X, Zhang H, Cao Y, Dai C, Tang S, Xu F. Ultrasound-guided percutaneous microwave ablation for hepatocellular carcinoma adjacent to large vessels: a propensity score matching analysis. Int J Hyperthermia 2020; 37:955-964. [PMID: 32781862 DOI: 10.1080/02656736.2020.1804076] [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: 12/19/2022] Open
Abstract
PURPOSE This study aimed to compare the efficacy and safety of ultrasound-guided percutaneous microwave ablation (MWA) for hepatocellular carcinoma (HCC) adjacent to large vessels with those far from large vessels. METHODS The clinical data of patients who underwent ultrasound-guided percutaneous MWA for HCC were retrospectively analyzed between January 2011 and December 2018 in Shengjing Hospital. Patients with HCC adjacent to large vessels were included in the Vessel group, the remaining patients were included in the Control group. Propensity score matching analysis was used to reduce confounding bias. The rates of complete ablation, local recurrence, recurrence-free survival (RFS), overall survival (OS) and complications were compared between the two groups. RESULTS A total of 134 patients with 157 nodules (size range, 0.6-3.8 cm) were enrolled in this study, 23 in the Vessel group and 111 in the Control group. A total of 21 patients in the Vessel group (91.3%) and 105 patients in the Control group (94.6%) achieved complete ablation (p = .902). Following 1:2 propensity score matching, 22 patients were included in the Vessel group and 40 patients were enrolled in the Control group. Local recurrence was observed in 2 (9.1%) patients in the Vessel group and 5 (12.5%) in the Control group (p = .86). No significant difference in local recurrence rate, RFS and OS were observed between the two groups. CONCLUSIONS Ultrasound-guided percutaneous MWA appears to be a safe procedure and can achieve comparable oncological efficacy for HCC abutting large vessels.
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Affiliation(s)
- Tianqiang Jin
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaolin Liu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China.,Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Heyue Zhang
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuqing Cao
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chaoliu Dai
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shaoshan Tang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Feng Xu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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Qi C, Gao H, Zhao Q, Zhang L. Computed Tomography-Guided Percutaneous Cryoablation for Subcardiac Hepatocellular Carcinoma: Safety, Efficacy, Therapeutic Results and Risk Factors for Survival Outcomes. Cancer Manag Res 2020; 12:3333-3342. [PMID: 32494197 PMCID: PMC7229785 DOI: 10.2147/cmar.s250652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/23/2020] [Indexed: 01/10/2023] Open
Abstract
Objective To investigate the clinical safety, efficacy, therapeutic outcomes and risk factors of computed tomography-guided percutaneous cryoablation (CT-PCRA) for subcardiac hepatocellular carcinoma (HCC). Patients and Methods In this study, patients with single HCC nodules located on the left lobe who subsequently underwent CT-PCRA were reviewed from July 2012 to August 2016. According to the definition of subcardiac HCC, the patients were grouped into the subcardiac HCC group (n=33) and the non-subcardiac HCC group (n=40). The technical success rates, tumour response rates, oncological outcomes including overall survival (OS) and recurrence-free survival (RFS) and complications were compared. Multivariate analysis was performed on clinicopathological variables to identify factors affecting long-term outcomes. Results Seventy-three patients with subcardiac HCC were included in this study. After a median follow-up time of 37.8 months, 27.4% (20/73) of the patients died. The technical success and complete response rates were not significantly different between the two groups (p = 1.000; p = 0.590). The cumulative OS and RFS of the subcardiac HCC group were comparable to those of the non-subcardiac HCC group (p =0.820, p =0.922). Two major complications, intra-abdominal bleeding and right pleural effusion, were found at 2.2 and 3.1 months in the subcardiac HCC group, which were comparable with those in the non-subcardiac HCC group (p = 0.683). The multivariate analysis results showed that older age (hazard ratio [HR]: 2.382, 95% confidence interval [CI]: 1.884–7.823; p = 0.038) and ALBI grade 2–3 (HR: 3.398, 95% CI: 1.950–6.058; p = 0.021) may be predictors of poor OS and that tumour size ≥3 cm in diameter (HR: 3.302, 95% CI: 2.232–8.293; p = 0.012) may be a predictor of poor RFS. Conclusion CT-PCRA for subcardiac HCC can be performed safely and efficiently and contribute to improving survival prognosis.
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Affiliation(s)
- Chunhou Qi
- Department of Interventional Medicine, Linyi City Central Hospital, Yishui, Shandong, People's Republic of China
| | - Hongfei Gao
- Department of Interventional Medicine, Linyi City Central Hospital, Yishui, Shandong, People's Republic of China
| | - Qinghua Zhao
- Department of Emergency Medicine, Yishui County People's Hospital, Yishui, Shandong, People's Republic of China
| | - Lei Zhang
- Department of Interventional Radiology, Shandong Medical Imaging Research Institute, Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
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