Laparoscopic radiofrequency ablation in the caudate lobe for hepatocellular carcinoma before liver transplantation

Percutaneous ablative therapies for hepatocellular carcinoma in the caudate lobe of the liver: efficacy and outcome

OBJECTIVE

To assess the efficacy and outcomes of percutaneous ablative therapies for hepatocellular carcinoma (HCC) in the caudate lobe.

METHODS

Patients within Milan criteria, who underwent thermal ablation (RFA/MWA) for HCC were analyzed. Based on the inclusion-criteria, patients were categorized in two groups. Group-1 (caudate-lobe HCC) and Group-2 (non-caudate-lobe HCC). Both the groups were analyzed for technical success (TS), local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) were compared between both the groups. Predictive factors for LTP, DFS, or OS in the study cohort were analyzed using appropriate statistical analyses.

RESULTS

Twenty-one patients qualified to be in Group-1 while 130 patients fulfilled the criteria for Group-2. TS of 90.5 and 97.7% was seen after the first session of ablation for Group-1 and group-2 respectively, while a TS of 95.2% (Group-1) and 100% (Group-2) was achieved after second session. The right-intercostal-approach was used in 66.7% (n = 14) and the anterior-epigastric-approach was used in 33.3% (n = 7) of patients having caudate-lobe HCC. Procedure-related complications in both the groups were comparable. Although, statistically insignificant, LTP in the Group-1 (19.5%, n = 4) was twice that of non-caudate lobe HCC (8.5%, n = 11). The cumulative DFS rate was better in Group-2 while OS in both groups were comparable. Multivariate analysis showed: tumor size and ablative margin of 5 mm being independent predictors of LTP after percutaneous-ablation of caudate-lobe HCC.

CONCLUSION

Ablative therapies for HCC in caudate lobe is feasible and safe with comparable LTP and OS to non-caudate lobe HCC. Tumor size >2 cm and lack of 5 mm ablative margin are independent predictors of LTP.

ADVANCES IN KNOWLEDGE

1. Percutaneous ablation of caudate lobe HCC is feasible using anterior epigastric approach or right intercostal approach. 2. These approaches may allow a safe and effective ablation of caudate lobe HCC with results comparable to non-caudate HCC ablation.

Radiofrequency ablation in the treatment of hepatocellular carcinoma

OBJECTIVE

The purpose of this article is to discuss the use, comparative efficacy, and research progress of radiofrequency ablation (RFA), alone or in combination with other therapies, for the treatment of hepatocellular carcinoma (HCC).

METHOD

To search and summarize the basic and clinical studies of RFA in recent years.

RESULTS

RFA is one of the radical treatment methods listed in the guidelines for the diagnosis and treatment of HCC. It has the characteristics of being minimally invasive and safe and can obtain good local tumor control, and it can improve the local immune ability, improve the tumor microenvironment and enhance the efficacy of chemotherapy drugs. It is commonly used for HCC treatment before liver transplantation and combined ALPPS and hepatectomy for HCC. In addition, the technology of RFA is constantly developing. The birth of noninvasive, no-touch RFA technology and equipment and the precise RFA concept have improved the therapeutic effect of RFA.

CONCLUSION

RFA has good local tumor control ability, is minimally invasive, is safe and has other beneficial characteristics. It plays an increasingly important role in the comprehensive treatment strategy of HCC. Whether RFA alone or combined with other technologies expands the surgical indications of patients with HCC and provides more benefits for HCC patients needs to be determined.

Applications of Elastography in Ablation Therapies: An Animal Model In Vivo Study

Background: Ablation therapies are one of the main local treatments for solid organ tumors. After applying any ablation therapy, few days should be waited to perform an imaging study and analyze the result. In this work, we analyzed the correlation between elastography monitoring after procedure and the result of ablation. The objective of this study is to determine tissue changes in vivo in short term after the application of ablation systems using different diagnostic imaging methods. Materials and Methods: Descriptive study in an in vivo swine model. Different types of ablation therapies (radiofrequency ablation, microwave ablation [MWA], and LASER ablation [LA]) were applied in the liver and kidneys. We compared their results by medical image monitoring (ultrasound, computed tomography, elastography) and macroscopic analysis. Results: All the animals survived the procedures. No major intraoperative complications were reported. We determined the characteristics of each procedure. MWA session was faster than the other types of ablation therapies. Regarding ablation area diameters, the largest was achieved with MWA and the smallest with LA. Macroscopically, we observed a central ablation zone, a peripheral ablation zone, and surrounding normal tissue. It was correlated with elastography images. Conclusion: Monitoring of the results of ablation therapies shortly after their application is possible through imaging studies. It allows determining the size of the ablation zone, its characteristics, ruling out complications, and its early results. Elastography could efficiently support this goal.

Totally robotic isolated caudate-lobe liver resection for hydatid disease: report of a case

BACKGROUND

Hepatic caudatectomy has always been considered a challenging procedure, because of the complex anatomy and deep location of this segment. Herein we report the first case of a totally robotic isolated caudate-lobe liver resection ever performed for hydatid disease.

METHODS

A 55 year-old man was referred to our institution after diagnosis was made of a 5.6 cm hepatic lesion of the caudate lobe. Radiological suspicion was for hydatid disease. The patient underwent robotic-assisted hepatic caudatectomy.

RESULTS

The operative time was 280 min and the estimated blood loss was 200 ml. The postoperative course was uneventful. The drain was removed on post-operative day 3 and the patient was discharged on post-operative day 6.

CONCLUSION

Robotic resection of the caudate lobe is a technically feasible procedure, which nevertheless requires high hepato-pancreato-biliary surgery skills, both in open an mini-invasive approaches. It provides several technical advantages in the field of mini-invasive surgery, yet assuring patient safety. Copyright © 2015 John Wiley & Sons, Ltd.

Value of radiofrequency ablation in the treatment of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a malignant disease that substantially affects public health worldwide. It is especially prevalent in east Asia and sub-Saharan Africa, where the main etiology is the endemic status of chronic hepatitis B. Effective treatments with curative intent for early HCC include liver transplantation, liver resection (LR), and radiofrequency ablation (RFA). RFA has become the most widely used local thermal ablation method in recent years because of its technical ease, safety, satisfactory local tumor control, and minimally invasive nature. This technique has also emerged as an important treatment strategy for HCC in recent years. RFA, liver transplantation, and hepatectomy can be complementary to one another in the treatment of HCC, and the outcome benefits have been demonstrated by numerous clinical studies. As a pretransplantation bridge therapy, RFA extends the average waiting time without increasing the risk of dropout or death. In contrast to LR, RFA causes almost no intra-abdominal adhesion, thus producing favorable conditions for subsequent liver transplantation. Many studies have demonstrated mutual interactions between RFA and hepatectomy, effectively expanding the operative indications for patients with HCC and enhancing the efficacy of these approaches. However, treated tumor tissue remains within the body after RFA, and residual tumors or satellite nodules can limit the effectiveness of this treatment. Therefore, future research should focus on this issue.

Contemporary strategies in the management of hepatocellular carcinoma

Liver transplantation is the treatment of choice for selected patients with hepatocellular carcinoma (HCC) on a background of chronic liver disease. Liver resection or locoregional ablative therapies may be indicated for patients with preserved synthetic function without significant portal hypertension. Milan criteria were introduced to select suitable patients for liver transplant with low risk of tumor recurrence and 5-year survival in excess of 70%. Currently the incidence of HCC is climbing rapidly and in a current climate of organ shortage has led to the re-evaluation of locoregional therapies and resectional surgery to manage the case load. The introduction of biological therapies has had a new dimension to care, adding to the complexities of multidisciplinary team working in the management of HCC. The aim of this paper is to give a brief overview of present day management strategies and decision making.