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Ierardi AM, Ascenti V, Lanza C, Carriero S, Amato G, Pellegrino G, Giurazza F, Torcia P, Carrafiello G. Is it a complication or a consequence - a new perspective on adverse outcomes in Interventional Radiology. CVIR Endovasc 2024; 7:6. [PMID: 38180623 PMCID: PMC10769947 DOI: 10.1186/s42155-023-00417-3] [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: 09/29/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
The aim of the article is to introduce a new term in post-procedural events related to the procedure itself. All the Societies and Councils report these events as complications and they are divided in mild, moderate and severe or immediate and delayed.On the other hand the term error is known as the application of a wrong plan, or strategy to achieve a goal.For the first time, we are trying to introduce the term "consequence"; assuming that the procedure is the only available and the best fit to clinical indication, a consequence should be seen as an expected and unavoidable occurrence of an "adverse event" despite correct technical execution.
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Affiliation(s)
- Anna Maria Ierardi
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| | - Velio Ascenti
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Carolina Lanza
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Serena Carriero
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Gaetano Amato
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | | | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Pierluca Torcia
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
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Yang D, Yang J, Zhu F, Hui J, Li C, Cheng S, Hu D, Wang J, Han L, Wang H. Complications and local recurrence of malignant liver tumor after ablation in risk areas: a retrospective analysis. Eur J Gastroenterol Hepatol 2023; 35:761-768. [PMID: 37272505 PMCID: PMC10234327 DOI: 10.1097/meg.0000000000002560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/24/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Microwave ablation (MWA) is an effective local treatment for malignant liver tumors; however, its efficacy and safety for liver tumors adjacent to important organs are debatable. PATIENTS AND METHODS Forty-three cases with liver tumors adjacent to important organs were the risk group and 66 cases were the control group. The complications between two groups were compared by chi-square test and t-test. Local tumor recurrence (LTR) was analyzed by log-rank test. Factors affecting complications were analyzed by logistic regression and Spearman analyses. Factors affecting LTR were analyzed by Cox regression analysis. A receiver operating characteristic curve predicted pain treated with drugs and LTR. RESULTS We found no significant difference in complications and LTR between two groups. The risk group experienced lower ablation energy and more antennas per tumor than control group. Necrosis volume after MWA was positively correlated with pain; necrosis volume and ablation time were positively correlated with recovery duration. Major diameter of tumor >3 cm increased risk of LTR by 3.319-fold, good lipiodol deposition decreased risk of LTR by 73.4%. The area under the curve (AUC) for necrosis volume in predicting pain was 0.74, with a 69.1 cm3 cutoff. AUC for major diameter of tumor in predicting LTR was 0.68, with a 27.02 mm cutoff. CONCLUSION MWA on liver tumors in at-risk areas is safe and effective, this is largely affected by proper ablation energy, antennas per tumor, and experienced doctors. LTR is primarily determined by major diameter of tumor and lipiodol deposition status.
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Affiliation(s)
- Dong Yang
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
- Oncology Department, Shandong University of Traditional Chinese Medicine, Jinan City
| | - Jundong Yang
- Radiotherapy Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, PR China
| | - Fenghua Zhu
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
| | - Jing Hui
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
| | - Changlun Li
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
| | - Shuyuan Cheng
- Radiotherapy Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, PR China
| | - Dongyu Hu
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
| | - Junye Wang
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
| | - Lei Han
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
| | - Huili Wang
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
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Early enlarging cavitation after percutaneous radiofrequency ablation of lung tumors: Incidence, risk factors and outcome. Diagn Interv Imaging 2022; 103:464-471. [DOI: 10.1016/j.diii.2022.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023]
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Chen PY, Tsai TJ, Yang HY, Chou CK, Chang LJ, Chen TH, Hsu MT, Fang CC, Su CC, Lin YL, Feng YM, Chen CY. The Incidence of Bacteremia and Risk Factors of Post-Radiofrequency Ablation Fever for Patients with Hepato-Cellular Carcinoma. Cancers (Basel) 2021; 13:cancers13215303. [PMID: 34771466 PMCID: PMC8582517 DOI: 10.3390/cancers13215303] [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: 09/13/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
Post-radiofrequency ablation (RFA) fever is a self-limited complication of RFA. The correlation between post-RFA fever and bacteremia and the risk factors associated with post-RFA fever have not been evaluated. Patients with newly diagnosed or recurrent hepatocellular carcinoma who underwent ultrasonography-guided RFA between April 2014 and February 2019 were retrospectively enrolled. Post-RFA fever was defined as any episode of body temperature >38.0 °C after RFA during hospitalization. A total of 272 patients were enrolled, and there were 452 applications of RFA. The frequency of post-RFA fever was 18.4% (83/452), and 65.1% (54/83) of post-RFA fevers occurred on the first day after ablation. Patients with post-RFA fever had a longer hospital stay than those without (9.06 days vs. 5.50 days, p < 0.001). Only four (4.8%) patients with post-RFA fever had bacteremia. The independent factors associated with post-RFA fever were younger age (adjusted odds ratio (OR) = 0.96, 95% CI, 0.94-0.99, p = 0.019), low serum albumin level (adjusted OR = 0.49, 95% CI, 0.25-0.95, p = 0.036), general anesthesia (adjusted OR = 2.06, 95% CI, 1.15-3.69, p = 0.015), tumor size (adjusted OR = 1.52, 95% CI, 1.04-2.02, p = 0.032), and tumor number (adjusted OR = 1.71, 95% CI, 1.20-2.45, p = 0.003).
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Affiliation(s)
- Po-Yueh Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Tsung-Jung Tsai
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Hsin-Yi Yang
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan;
| | - Chu-Kuang Chou
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Li-Jen Chang
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
- Min-Hwei Junior College of Health Care Management, Tainan 73658, Taiwan
| | - Tsung-Hsien Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Ming-Tse Hsu
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Chien-Chung Fang
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Chang-Chao Su
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Yu-Ling Lin
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Yu-Min Feng
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
| | - Chi-Yi Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (P.-Y.C.); (T.-J.T.); (C.-K.C.); (L.-J.C.); (T.-H.C.); (M.-T.H.); (C.-C.F.); (C.-C.S.); (Y.-L.L.); (Y.-M.F.)
- Correspondence: ; Tel.: +886-5-2765041 (ext. 62535)
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Zhang JZ, Li S, Zhu WH, Zhang DF. Microwave ablation combined with hepatectomy for treatment of neuroendocrine tumor liver metastases. World J Clin Cases 2021; 9:5064-5072. [PMID: 34307557 PMCID: PMC8283578 DOI: 10.12998/wjcc.v9.i19.5064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/13/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatectomy is the first choice for treating neuroendocrine tumor liver metastases. However, most patients with neuroendocrine tumor liver metastases are not suitable for hepatectomy. Ablation combined with hepatectomy can be an alternative to liver resection.
AIM To explore the clinical effect of microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases.
METHODS In this study, the data of patients who underwent microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases from June 2015 to January 2018 were reviewed. Before the operation, the patients did not receive any treatment for liver neuroendocrine tumors. After a multidisciplinary expert group discussion, all patients were deemed unsuitable for liver resection. All patients were diagnosed with neuroendocrine tumors by pathology. The overall survival time and progression-free survival time were followed by telephone calls and outpatient visits after surgery.
RESULTS Eleven patients with neuroendocrine tumor liver metastases were treated by microwave ablation combined with hepatectomy between June 2015 and January 2018. The median number of liver metastatic nodules was 4 (range, 2 to 43). The median number of lesions resected was 1 (range, 1 to 18), and the median number of lesions ablated was 3 (range, 1 to 38). The mean operation time was 405.6 (± 39.4) min. The median intraoperative blood loss was 600 mL (range, 50 to 3000). Ten patients had a fever after surgery. The median duration of fever was 3 d (range, 0 to 21). Elevated bilirubin levels occurred in all patients after surgery. The median bilirubin on the first day after surgery was 28.5 (range, 10.7 to 98.9) µmol/L. One patient developed respiratory failure, renal insufficiency, and pneumonia after the operation. No patient died postoperatively during hospitalization. The mean overall survival time after surgery was 34.1 (± 3.7) mo, and the median progression-free survival time was 8 (range, 2 to 51) mo. One year after surgery, ten patients survived and five patients survived without progression. Three year after surgery, eight patients survived and two patients survived without progression.
CONCLUSION Microwave ablation combined with hepatectomy not only makes the patients obtain a survival rate similar to that of patients undergoing hepatectomy, but also has a low incidence of postoperative complications.
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Affiliation(s)
- Jin-Zhu Zhang
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Shu Li
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Wei-Hua Zhu
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Da-Fang Zhang
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China
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6
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Meng H, Yang H, Jia H, Pan F, Dong X, Liu B, Li C. Efficacy and safety of CT-guided microwave ablation for stage T1a renal cell carcinoma in patients with a solitary kidney. Int J Hyperthermia 2021; 38:691-695. [PMID: 33899668 DOI: 10.1080/02656736.2021.1915503] [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: 10/21/2022] Open
Abstract
OBJECTIVE To retrospectively evaluate early clinical outcomes of percutaneous microwave ablation (MWA) for stage T1a renal cell carcinomas (RCCs) in solitary kidney patients. MATERIALS AND METHODS 15 solitary kidney patients with 16 stage T1a N0M0 biopsy-proved RCCs underwent CT-guided percutaneous microwave ablation between October 2016 and July 2020. The patients were followed up with contrast-enhanced computed tomography or magnetic resonance imaging at 1, 3, and 6 months and every 6 months thereafter. Serum creatinine levels of each patient pre MWA, 1 day after MWA and the most recent record were collected. Technical effectiveness, local recurrence, survival rates and complications were accessed. RESULTS Complete ablation was achieved in all 16 tumors (100%) including 13 clear cell carcinomas and 3 papillary carcinomas. Within the follow-up time (median: 24 months) no tumor recurrence or major complication was detected. No significant change in serum creatinine level was noted. The cancer-specific survival rate was 100% (15 of 15), and 1-, 2-, and 3-year overall survival rates were 100%, 93.3%, and 93.3%, respectively. CONCLUSION Percutaneous MWA is an effective and safe treatment option for stage T1a RCCs in solitary kidney patients; it can achieve high complete ablation rate in selected lesions of appropriate size and location.
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Affiliation(s)
- Hong Meng
- Qilu Hospital of Shandong University, Jinan, China
| | - Huan Yang
- Shandong Provincial Hospital affiliated to Shandong First Medical College, Jinan, China
| | - Haipeng Jia
- Qilu Hospital of Shandong University, Jinan, China
| | - Fengmin Pan
- Qilu Hospital of Shandong University, Jinan, China
| | - Xinzhe Dong
- Qilu Hospital of Shandong University, Jinan, China
| | - Bo Liu
- Qilu Hospital of Shandong University, Jinan, China
| | - Chunhai Li
- Qilu Hospital of Shandong University, Jinan, China
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Post-ablation syndrome after percutaneous cryoablation of small renal tumors: A prospective study of incidence, severity, duration, and effect on lifestyle. Eur J Radiol 2020; 122:108750. [DOI: 10.1016/j.ejrad.2019.108750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/03/2019] [Accepted: 11/11/2019] [Indexed: 12/19/2022]
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Verloh N, Jensch I, Lürken L, Haimerl M, Dollinger M, Renner P, Wiggermann P, Werner JM, Zeman F, Stroszczynski C, Beyer LP. Similar complication rates for irreversible electroporation and thermal ablation in patients with hepatocellular tumors. Radiol Oncol 2019; 53:116-122. [PMID: 30840591 PMCID: PMC6411026 DOI: 10.2478/raon-2019-0011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/22/2019] [Indexed: 12/14/2022] Open
Abstract
Background To compare the frequency of adverse events of thermal microwave (MWA) and radiofrequency ablation (RFA) with non-thermal irreversible electroporation (IRE) in percutaneous ablation of hepatocellular carcinoma (HCC). Patients and methods We retrospectively analyzed 117 MWA/RFA and 47 IRE procedures (one tumor treated per procedure; 144 men and 20 women; median age, 66 years) regarding adverse events, duration of hospital and intensive care unit (ICU) stays and occurrence of a post-ablation syndrome. Complications were classified according to the Clavien & Dindo classification system. Results 70.1% of the RFA/MWA and 63.8% of the IRE procedures were performed without complications. Grade I and II complications (any deviation from the normal postinterventional course, e.g., analgesics) occurred in 26.5% (31/117) of MWA/RFA and 34.0% (16/47) of IRE procedures. Grade III and IV (major) complications occurred in 2.6% (3/117) of MWA/RFA and 2.1% (1/47) of IRE procedures. There was no significant difference in the frequency of complications (p = 0.864), duration of hospital and ICU stay and the occurrence of a post-ablation syndrome between the two groups. Conclusions Our results suggest that thermal (MWA and RFA) and non-thermal IRE ablation of malignant liver tumors have comparable complication rates despite the higher number of punctures and the lack of track cauterization in IRE.
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Affiliation(s)
- Niklas Verloh
- Department of Radiology, University Hospital Regensburg, RegensburgGermany
| | - Isabel Jensch
- Department of Radiology, University Hospital Regensburg, RegensburgGermany
| | - Lukas Lürken
- Department of Radiology, University Hospital Regensburg, RegensburgGermany
| | - Michael Haimerl
- Department of Radiology, University Hospital Regensburg, RegensburgGermany
| | - Marco Dollinger
- Department of Radiology, University Hospital Regensburg, RegensburgGermany
| | - Philipp Renner
- Department of Surgery, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | - Jens Martin Werner
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Trials, University Hospital Regensburg, Regensburg, Germany
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Soliman AF, Abouelkhair MM, Hasab Allah MS, El-Kady NM, Ezzat WM, Gabr HA, Elsayed EH, Saleh AI, Kamel A. Efficacy and Safety of Microwave Ablation (MWA) for Hepatocellular Carcinoma (HCC) in Difficult Anatomical Sites in Egyptian Patients with Liver Cirrhosis. Asian Pac J Cancer Prev 2019; 20:295-301. [PMID: 30678453 PMCID: PMC6485570 DOI: 10.31557/apjcp.2019.20.1.295] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and aim: Imaging guided microwave ablation (MWA) for hepatocellular carcinoma (HCC) has
become a widely used method over recent years. Tumors close to the diaphragm, gastrointestinal tract, gallbladder,
pancreas, hepatic hilum and major bile duct or vessels are generally considered relative contraindications for microwave
ablation. This study was conducted to assess the effectiveness and safety of ultrasonography-guided MWA in treating
patients with HCC in difficult anatomical sites in comparison to those in conventional sites. Patients and methods:
Eighty-eight patients were included and divided into two groups: the study group of 44 with 46 lesions lying <5mm
from the diaphragm, hepatic capsule, gall bladder (GB) or large vessel; and the control group of 44 patients with
50 lesions in non-risky sites. Each lesion was ablated using an ultrasound guided microwave probe using a detailed
protocol. Results: Most of the patients were males, with a mean age of 57.8 years. In the study group, two patients
had lesions adjacent to the GB, twelve were perivascular and 32 were subcapsular. The overall successful ablation
rates were 84.8% and 92% in the study and control groups, respectively. Within the study group, ablation rates were
100%, 75% and 87.5% for lesions close to the GB, perivascular lesions and subcapsular lesions, respectively. One
patient developed a subcutaneous abscess, with good outcome after proper treatment. Fever, pain and asymptomatic
pleural effusion were reported after ablation without statistically significant difference between the groups or among
subgroups. In conclusion: MWA for HCC in difficult anatomical sites is as effective and safe as for ordinary sites.
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Affiliation(s)
- Ahmad F Soliman
- Department of Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
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10
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Percutaneous microwave ablation of renal angiomyolipomas in tuberous sclerosis complex to improve the quality of life: preliminary experience in an Italian center. Radiol Med 2018; 124:176-183. [DOI: 10.1007/s11547-018-0967-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/04/2018] [Indexed: 12/26/2022]
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Botsa EI, Thanou IL, Papatheodoropoulou AT, Thanos LI. Thermal Ablation in the Management of Adrenal Metastasis Originating from Non-small Cell Lung Cancer: A 5-year Single-center Experience. Chin Med J (Engl) 2018; 130:2027-2032. [PMID: 28707652 PMCID: PMC5586169 DOI: 10.4103/0366-6999.210496] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Treatment of adrenal metastasis from lung carcinoma may prolong survival in the selected patients. However, not all patients can undergo surgery; thus, minimally invasive ablation procedures such as radiofrequency ablation (RFA) and microwave ablation (MWA) have gained acceptance as alternative treatment methods. This study summarized a 5-year single-center experience regarding the evaluation of safety and efficacy of computed tomography (CT)-guided thermal ablation in the management of adrenal metastasis originating from non-small cell lung cancer (NSCLC). Methods: The data of NSCLC patients ablated for adrenal metastasis at the Department of Diagnostic Imaging and Interventional Radiology, General Hospital Sotiria, were retrospectively analyzed. Patients were divided into two groups: RFA group and MWA group according to the therapeutic approaches. Preprocedural blood tests included measurement of international normalized ratio, partial thromboplastin time, and platelet enumeration. A dual-phase contrast-enhanced spiral CT was performed immediately after the procedure to assess the immediate response after ablation and to screen for related complications. Follow-up was performed with CT or magnetic resonance imaging at 1, 3, 6 months and 1 year after ablation and every 6 months thereafter. Results: A total of 99 ablation sessions in 71 patients with adrenal metastasis originating from NSCLC were included in the final analysis. Self-limited, postablation syndrome occurred in 16/99 (16.1%) of ablation sessions. All procedures were technically successful. Immediate postablation imaging showed no contrast enhancement of the ablated tumor in all patients. Follow-up imaging at 3 months revealed local tumor progression in 8 (22.8%) patients of the RFA group and 7 (19.4%) patients of MWA group, all of them underwent a second session successfully. The 1-year assessment revealed local recurrence of the ablated tumor in six patients (17.1%) of RFA group and seven patients (19.4%) of MWA group. Among these 71 patients, those with tumor size >3.5 cm had a higher local recurrence rate (65.2%, 15/23) than those with tumors ≤3.5 cm (16.7%, 8/48; P = 0.012). There was no significant difference in the median survival time between RFA (14.0 months) and MWA (14.6 months) groups (P > 0.05). Conclusions: RFA and MWA showed comparable efficacy and safety in adrenal metastasis treatment.
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Affiliation(s)
- Evanthia I Botsa
- First Pediatric Clinic, National and Kapodistrian University of Athens, Agia Sofia Children's Hospital, Athens 11527, Greece
| | - Ioanna L Thanou
- Department of Medical Imaging and Interventional Radiology, Sotiria General Hospital for Chest Diseases, Athens 11527, Greece
| | - Aspasia T Papatheodoropoulou
- Department of Medical Imaging and Interventional Radiology, Sotiria General Hospital for Chest Diseases, Athens 11527, Greece
| | - Loukas I Thanos
- Department of Medical Imaging and Interventional Radiology, Sotiria General Hospital for Chest Diseases, Athens 11527, Greece
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Ierardi AM, Biondetti P, Coppola A, Fumarola EM, Biasina AM, Alessio Angileri S, Carrafiello G. Percutaneous microwave thermosphere ablation of pancreatic tumours. Gland Surg 2018; 7:59-66. [PMID: 29770302 DOI: 10.21037/gs.2017.11.05] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background In oncologic field, thermo-ablative procedures have spread more and more. Percutaneous microwave ablation (MWA) showed same benefits and some advantages over radiofrequency ablation (RFA). To date, a disadvantage of both was the not totally predictable size and shape of ablation volume. The aim of this study was to assess feasibility and safety of MWA in nonresectable pancreatic head cancer using a new technology of MW with high power (100 W) and frequency of 2,450 MH. Methods Five patients with pancreatic head cancer treated with percutaneous MWA under ultrasound guidance were retrospectively reviewed. Mean lesion diameter was 27.8 mm (range, 25-32 mm). Follow-up was performed by CT after 1, 3, 6 and, when possible, 12 months. The shape of the ablation volume was evaluated with multiplanar reformatting (MPR) using roundness index (RI): a value near 1 represents a more spherical ablation zone shape, and a value distant from 1 implies an oval configuration. Ablation and procedure times were registered, together with hospital stay. The feasibility, safety and quality of life (QoL) were reported. Results The procedure was feasible in all patients (100%). A spherical shape of ablation zone was achieved in all cases (mean RI =0.97). Mean ablation and procedure time were respectively of 2.48 and 28 minutes. Mean hospital stay was 4 days. No major complications were observed. Minor complications resolved during the hospital stay. An improvement in QoL was observed in all patients despite a tendency to return to preoperative levels in the months following the procedure. Conclusions Percutaneous MWA is a feasible and safe approach for the palliative treatment of advanced stage tumors of the head of the pancreas, despite its complex anatomic relations. The spherical shape of the ablation volume could be related with an improving of the effectiveness and safety.
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Affiliation(s)
- Anna Maria Ierardi
- Department of Diagnostic and Interventiona Radiology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Pierpaolo Biondetti
- Department of Diagnostic and Interventiona Radiology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Andrea Coppola
- Department of Radiology, Insubria University, Varese, Italy
| | - Enrico Maria Fumarola
- Department of Diagnostic and Interventiona Radiology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Alberto Magenta Biasina
- Department of Diagnostic and Interventiona Radiology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Salvatore Alessio Angileri
- Department of Diagnostic and Interventiona Radiology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventiona Radiology, San Paolo Hospital, University of Milan, Milan, Italy
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Focal ablation therapy for renal cancer in the era of active surveillance and minimally invasive partial nephrectomy. Nat Rev Urol 2017; 14:669-682. [PMID: 28895562 DOI: 10.1038/nrurol.2017.143] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Partial nephrectomy is the optimal surgical approach in the management of small renal masses (SRMs). Focal ablation therapy has an established role in the modern management of SRMs, especially in elderly patients and those with comorbidities. Percutaneous ablation avoids general anaesthesia and laparoscopic ablation can avoid excessive dissection; hence, these techniques can be suitable for patients who are not ideal surgical candidates. Several ablation modalities exist, of which radiofrequency ablation and cryoablation are most widely applied and for which safety and oncological efficacy approach equivalency to partial nephrectomy. Data supporting efficacy and safety of ablation techniques continue to mature, but they originate in institutional case series that are confounded by cohort heterogeneity, selection bias, and lack of long-term follow-up periods. Image guidance and surveillance protocols after ablation vary and no consensus has been established. The importance of SRM biopsy, its optimal timing, the type of biopsy used, and its role in treatment selection continue to be debated. As safety data for active surveillance and experience with minimally invasive partial nephrectomy are expanding, the role of focal ablation therapy in the treatment of patients with SRMs requires continued evaluation.
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Macchi M, Belfiore MP, Floridi C, Serra N, Belfiore G, Carmignani L, Grasso RF, Mazza E, Pusceddu C, Brunese L, Carrafiello G. Radiofrequency versus microwave ablation for treatment of the lung tumours: LUMIRA (lung microwave radiofrequency) randomized trial. Med Oncol 2017; 34:96. [PMID: 28417355 DOI: 10.1007/s12032-017-0946-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/04/2017] [Indexed: 12/24/2022]
Abstract
The LUMIRA trial evaluated the effectiveness of radiofrequency (RFA) and microwave ablation (MWA) in lung tumours ablation and defining more precisely their fields of application. It is a controlled prospective multi-centre random trial with 1:1 randomization. Fifty-two patients in stage IV disease (15 females and 37 males, mean age 69 y.o., range 40-87) were included. We randomized the patients in two different subgroups: MWA group and RFA group. For each group, we evaluated the technical and clinical success, the overall survival and complication rate. Inter-group difference was compared using Chi-square test or Fisher's exact test for categorical variables and one-way ANOVA test for continuous variables. For RFA group, there was a significant reduction in tumour size only between 6 and 12 months (p value = 0.0014). For MWA group, there was a significant reduction in tumour size between 6 and 12 months (p value = 0.0003) and between pre-therapy and 12 months (p value = 0.0215). There were not significant differences between the two groups in terms of survival time (p value = 0.883), while the pain level in MWA group was significantly less than in RFA group (1.79 < 3.25, p value = 0.0043). In conclusion, our trial confirms RFA and MWA are both excellent choices in terms of efficacy and safety in lung tumour treatments. However, when compared to RFA therapy, MWA produced a less intraprocedural pain and a significant reduction in tumour mass.
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Affiliation(s)
- M Macchi
- Department of Radiology, Circolo e Fondazione Macchi Hospital, Insubria University, Varese, Italy
| | - M P Belfiore
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Floridi
- Radiology Department, Fatebenefratelli Hospital, Milan, Italy.
| | - N Serra
- Department of Radiology and Radiotherapy, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - G Belfiore
- Department of Radiology, Sant'Anna e San Sebastiano Hospital, Caserta, Italy
| | - L Carmignani
- Interventional Radiology Unit, San Jacopo Hospital, Pistoia, Italy
| | - R F Grasso
- Department of Diagnostic and Interventional Radiology, Campus Bio-Medico University, Rome, Italy
| | - E Mazza
- Interventional Radiology Unit, Careggi Hospital, Florence, Italy
| | - C Pusceddu
- Division of Interventional Radiology, Department of Oncological Radiology, Oncological Hospital "A. Businco", Cagliari, Italy
| | - L Brunese
- Department of Radiology, University of Molise, Campobasso, Italy
| | - G Carrafiello
- Department of Radiology, San Paolo Hospital, University of Milan, Milan, Italy
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Park JG, Park SY, Tak WY, Kweon YO, Jang SY, Lee YR, Hur K, Lee HJ, Lee HW. Early complications after percutaneous radiofrequency ablation for hepatocellular carcinoma: an analysis of 1,843 ablations in 1,211 patients in a single centre: experience over 10 years. Clin Radiol 2017; 72:692.e9-692.e15. [PMID: 28364952 DOI: 10.1016/j.crad.2017.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/24/2017] [Accepted: 03/01/2017] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the incidence of adverse events and associated factors after radiofrequency ablation (RFA) in patients with hepatocellular carcinoma within 30 days. MATERIALS AND METHODS The early complications that occurred within 30 days after RFA at a single institution from January 2000 to July 2010 were reviewed in order to evaluate the morbidity, mortality, and risk factors associated with the complications. In total, 1,211 patients (845 men, 70.5%) with a mean age of 68 years (range, 27-88 years) underwent 1,843 RFA procedures. RESULTS The overall incidence rate of complications was 6.8% (125 cases). Major complications (n=36, 2%) included liver abscess (n=15, 0.8%), intraperitoneal bleeding (n=8, 0.4%), liver failure (n=5, 0.3%), variceal bleeding (n=3, 0.2%), haemothorax (n=2, 0.1%), cholecystitis (n=2, 0.1%), and bowel perforation (n=1, 0.1%). Among the minor complications (n=89, 4.8%), the most common was the post RFA syndrome accompanied by pain and fever (n=75, 4.1%). Other minor complications included significant pleural effusion (n=7, 0.4%), skin wound infection (n=4, 0.2%), and thermal injuries to the skin (n=3, 0.2%). Procedural infections significantly increased with tumour size (OR=1.379; 95% confidence interval [CI], 1.191-1.579; p<0.001), and multiple overlapping ablations (OR=1.118; 95% CI, 1.019-1.227, p=0.018). Thrombocytopenia (<50,000/μl), prothrombin time, and serum albumin level were significantly associated with post-RFA bleeding episodes (p=0.041, p=0.021, and p=0.003, respectively). The overall mortality rate was 0.3% (three cases of hepatic failure, two case of sepsis, and one case of renal failure). CONCLUSIONS RFA is a safe and effective local treatment for hepatocellular carcinoma. Careful selection of patients and appropriate RFA planning could decrease procedural mortality and morbidity.
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Affiliation(s)
- J G Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - S Y Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - W Y Tak
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Y O Kweon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - S Y Jang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Y R Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - K Hur
- Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - H J Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - H W Lee
- Department of Pathology, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Republic of Korea
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Correas JM, Delavaud C, Gregory J, Le Guilchet T, Lamhaut L, Timsit MO, Méjean A, Hélénon O. Ablative Therapies for Renal Tumors: Patient Selection, Treatment Planning, and Follow-Up. Semin Ultrasound CT MR 2017; 38:78-95. [DOI: 10.1053/j.sult.2016.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Ierardi AM, Coppola A, Lucchina N, Carrafiello G. Treatment of lung tumours with high-energy microwave ablation: a single-centre experience. Med Oncol 2016; 34:5. [PMID: 27900591 DOI: 10.1007/s12032-016-0861-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/22/2016] [Indexed: 12/28/2022]
Abstract
The purpose of our study is to report safety, technical success, effectiveness, local progression-free survival (LPFS) and overall survival of percutaneous microwave ablation (MWA) to treat lung tumours unsuitable for surgery. Nineteen patients with thirty-one tumours (mean diameter 2.4 cm) underwent percutaneous MWA in 28 sessions. Microwave ablation was carried out using a 2450-MHz generator (Emprint/Covidien, Boulder, CO, USA). Procedures were performed under cone-beam CT (CBCT) and under fluoro-CT (one session) guidance. Safety, technical success, effectiveness, LPFS and overall survival (OS) were evaluated. Safety was defined as the frequency of major and minor complications. The efficacy was evaluated on the basis of imaging characteristics, using RECIST criteria. CT follow-up was performed at 1, 3 and 6 months and yearly. LPFS was defined as the interval between MWA treatment and evidence of local recurrence, if there was any. OS was defined as the percentage of patients who were still alive. We registered one major complication (purulent hydro-pneumothorax). Minor complications were spontaneously resolved (pneumothorax and perilesional haemorrhagic effusion). Technical success was 100%. Residual disease was registered in two cases, one of whom was retreated. Complete ablation was obtained in the remaining cases (90.3%). During available follow-up (mean 9.6 months), 9/31 tumours demonstrated local recurrence. Five tumours were retreated, and none of them presented residual disease during follow-up (LPFS 22.6%). Overall survival was 93.8%. Percutaneous high-energy MWA is a safe, effective and confident technique to treat lung tumours not suitable for surgery.
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Affiliation(s)
- Anna Maria Ierardi
- Department of Radiology, Interventional Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy
| | - Andrea Coppola
- Department of Radiology, Interventional Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy
| | - Natalie Lucchina
- Department of Radiology, Interventional Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy
| | - Gianpaolo Carrafiello
- Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, University of Milan, Via A di Rudinì 8, 20142, Milan, Italy.
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Wong J, Cooper A. Local Ablation for Solid Tumor Liver Metastases: Techniques and Treatment Efficacy. Cancer Control 2016; 23:30-5. [PMID: 27009454 DOI: 10.1177/107327481602300106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Treatment options for liver metastases from solid tumors, such as colon cancer, breast cancer, neuroendocrine tumors, and sarcomas, have expanded in recent years and now include nonresection methods. METHODS The literature focused on the treatment of liver metastases was reviewed for technique, perioperative, and long-term outcomes specifically related to local ablation techniques for liver metastases. RESULTS Ablation modalities have become popular as therapies for patients who are not appropriate candidates for surgical resection. Use of these techniques, alone or in combination with other liver-directed therapies (and often systemic therapy), has extended the rate of survival for patients with liver metastases and, at times, offers nearly equivalent disease-free survival rates to surgical resection. CONCLUSIONS Although surgical resection remains the optimal treatment for liver metastasis, local options, including microwave ablation and radiofrequency ablation, can offer similar long-term local control in appropriately selected patients.
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Affiliation(s)
- Joyce Wong
- Department of Surgical Oncology, Penn State Hershey Medical Center, Hershey, PA 17033, USA.
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19
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Dong X, Li X, Yu J, Yu MA, Yu X, Liang P. Complications of ultrasound-guided percutaneous microwave ablation of renal cell carcinoma. Onco Targets Ther 2016; 9:5903-5909. [PMID: 27713644 PMCID: PMC5045230 DOI: 10.2147/ott.s109783] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To retrospectively review the complications of ultrasound (US)-guided percutaneous microwave ablation (MWA) of renal cell carcinoma. Patients and methods In this study, 101 patients with 105 tumors seen from April 2006 to Feb 2014 were enrolled retrospectively. The patients were treated with US-guided percutaneous MWA and were followed up with contrast-enhanced US and computed tomography or magnetic resonance imaging at 1, 3, and 6 months and every 6 months thereafter. Results Technical success was achieved in 99 of 105 tumors (94.3%). The median follow-up time was 25 (range 1.13–93.23) months. Among the 105 tumors, 26 complications in 24.8% of patients and 23 minor complications (Clavien–Dindo Grades I and II) in 21.9% of patients were noted, accounting for 88.5% of all complications. All the minor complications were cured. Three major complications (Clavien–Dindo Grade ≥III) occurred in 2.9% of the patients, accounting for 11.5% of all complications: hydrothorax in two patients and bowel injury in one. The two patients who had hydrothorax post-MWA had a history of cirrhosis and were treated with catheter drainage. The bowel injury was treated surgically. In all patients, the changes in serum creatinine and urea nitrogen levels from before to after the procedure were small. Conclusion US-guided percutaneous MWA is a beneficial treatment for renal cell carcinoma in selected patients; however, if the renal tumor is close to the bowel, or the patient has serious comorbidities or has undergone abdominal surgery, the procedure must be performed more carefully.
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Affiliation(s)
- Xuejuan Dong
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xin Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ming-An Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, People's Republic of China
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Ierardi AM, Petrillo M, Xhepa G, Laganà D, Piacentino F, Floridi C, Duka E, Fugazzola C, Carrafiello G. Cone beam computed tomography images fusion in predicting lung ablation volumes: a feasibility study. Acta Radiol 2016; 57:188-96. [PMID: 25824206 DOI: 10.1177/0284185115574874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 02/03/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Recently different software with the ability to plan ablation volumes have been developed in order to minimize the number of attempts of positioning electrodes and to improve a safe overall tumor coverage. PURPOSE To assess the feasibility of three-dimensional cone beam computed tomography (3D CBCT) fusion imaging with "virtual probe" positioning, to predict ablation volume in lung tumors treated percutaneously. MATERIAL AND METHODS Pre-procedural computed tomography contrast-enhanced scans (CECT) were merged with a CBCT volume obtained to plan the ablation. An offline tumor segmentation was performed to determine the number of antennae and their positioning within the tumor. The volume of ablation obtained, evaluated on CECT performed after 1 month, was compared with the pre-procedural predicted one. Feasibility was assessed on the basis of accuracy evaluation (visual evaluation [VE] and quantitative evaluation [QE]), technical success (TS), and technical effectiveness (TE). RESULTS Seven of the patients with lung tumor treated by percutaneous thermal ablation were selected and treated on the basis of the 3D CBCT fusion imaging. In all cases the volume of ablation predicted was in accordance with that obtained. The difference in volume between predicted ablation volumes and obtained ones on CECT at 1 month was 1.8 cm(3) (SD ± 2, min. 0.4, max. 0.9) for MW and 0.9 cm(3) (SD ± 1.1, min. 0.1, max. 0.7) for RF. CONCLUSION Use of pre-procedural 3D CBCT fusion imaging could be useful to define expected ablation volumes. However, more patients are needed to ensure stronger evidence.
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Affiliation(s)
- Anna Maria Ierardi
- Interventional Radiology Department, Radiology Unit, University of Insubria, Varese, Italy
| | - Mario Petrillo
- Department of Radiology, Second University of Naples, Naples, Italy
| | - Genti Xhepa
- Interventional Radiology Department, Radiology Unit, University of Insubria, Varese, Italy
| | - Domenico Laganà
- Interventional Radiology Department, Radiology Unit, University of Insubria, Varese, Italy
| | - Filippo Piacentino
- Interventional Radiology Department, Radiology Unit, University of Insubria, Varese, Italy
| | - Chiara Floridi
- Interventional Radiology Department, Radiology Unit, University of Insubria, Varese, Italy
| | - Ejona Duka
- Interventional Radiology Department, Radiology Unit, University of Insubria, Varese, Italy
| | - Carlo Fugazzola
- Interventional Radiology Department, Radiology Unit, University of Insubria, Varese, Italy
| | - Gianpaolo Carrafiello
- Interventional Radiology Department, Radiology Unit, University of Insubria, Varese, Italy
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Simo KA, Halpin LE, McBrier NM, Hessey JA, Baker E, Ross S, Swan RZ, Iannitti DA, Martinie JB. Multimodality treatment of intrahepatic cholangiocarcinoma: A review. J Surg Oncol 2016; 113:62-83. [DOI: 10.1002/jso.24093] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 10/31/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Kerri A. Simo
- Hepatobiliary and Pancreas Surgery; ProMedica Health System; Toledo Ohio
- ProMedica Cancer Institute; ProMedica Health System; Toledo Ohio
- Department of Surgery; University of Toledo Medical College; Toledo Ohio
| | - Laura E. Halpin
- Department of Surgery; University of Toledo Medical College; Toledo Ohio
| | - Nicole M. McBrier
- Hepatobiliary and Pancreas Surgery; ProMedica Health System; Toledo Ohio
- ProMedica Cancer Institute; ProMedica Health System; Toledo Ohio
| | | | - Erin Baker
- Hepatobiliary and Pancreas Surgery; Carolinas Medical Center; Charlotte North Carolina
| | - Samuel Ross
- Hepatobiliary and Pancreas Surgery; Carolinas Medical Center; Charlotte North Carolina
| | - Ryan Z. Swan
- Hepatobiliary and Pancreas Surgery; Carolinas Medical Center; Charlotte North Carolina
| | - David A. Iannitti
- Hepatobiliary and Pancreas Surgery; Carolinas Medical Center; Charlotte North Carolina
| | - John B. Martinie
- Hepatobiliary and Pancreas Surgery; Carolinas Medical Center; Charlotte North Carolina
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22
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Kumar SK, Oon OK, Horgan P, Leen E. Early Diagnosis of Intrahepatic Pseudoaneurysm during Radiofrequency Ablation using Contrast-Enhanced Ultrasound. Malays J Med Sci 2015; 22:58-62. [PMID: 28223887 PMCID: PMC5295758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/08/2014] [Indexed: 06/06/2023] Open
Abstract
Radiofrequency ablation is one of the more established forms of local treatment in patients with unresectable tumours, including colorectal hepatic metastases. Complications associated with this method of intervention include thermal and mechanical injuries, including vascular insults resulting in haemorrhage or pseudoaneurysm formation. This is the first case demonstrating the detection of post-ablation acute pseudoaneurysm formation identified on the table using contrast-enhanced ultrasound (CEUS) and the subsequent successful management.
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Affiliation(s)
- S Krishna Kumar
- 11 Hospital Drive, National Cancer Centre, Singapore 169610, Singapore
| | - Ong Keh Oon
- 585 North Bridge Road, Raffles Hospital, Singapore 188770, Singapore
| | - Paul Horgan
- New Lister Building, Alexandra Parade, Glasgow Royal Infirmary, Glasgow G31 2ER, United Kingdom
| | - Edward Leen
- Du Cane Rd, London W12 0HS, Hammersmith Hospital, London, United Kingdom
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23
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Masaoka Y, Hiraki T, Gobara H, Iguchi T, Fujiwara H, Matsui Y, Toyooka S, Soh J, Kiura K, Kanazawa S. Fever after lung radiofrequency ablation: Prospective evaluation of its incidence and associated factors. Eur J Radiol 2015. [DOI: 10.1016/j.ejrad.2015.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, Chen MH, Choi BI, de Baère T, Dodd GD, Dupuy DE, Gervais DA, Gianfelice D, Gillams AR, Lee FT, Leen E, Lencioni R, Littrup PJ, Livraghi T, Lu DS, McGahan JP, Meloni MF, Nikolic B, Pereira PL, Liang P, Rhim H, Rose SC, Salem R, Sofocleous CT, Solomon SB, Soulen MC, Tanaka M, Vogl TJ, Wood BJ, Goldberg SN. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. J Vasc Interv Radiol 2014; 25:1691-705.e4. [PMID: 25442132 PMCID: PMC7660986 DOI: 10.1016/j.jvir.2014.08.027] [Citation(s) in RCA: 336] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/11/2014] [Accepted: 03/26/2014] [Indexed: 12/12/2022] Open
Abstract
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.
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Affiliation(s)
- Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center 1 Deaconess Rd, WCC-308B, Boston, MA 02215.
| | - Luigi Solbiati
- Department of Radiology, Ospedale Generale, Busto Arsizio, Italy
| | - Christopher L Brace
- Departments of Radiology, Biomedical Engineering, and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David J Breen
- Department of Radiology, Southampton University Hospitals, Southampton, England
| | | | | | - Min-Hua Chen
- Department of Ultrasound, School of Oncology, Peking University, Beijing, China
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Thierry de Baère
- Department of Imaging, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Gerald D Dodd
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Damian E Dupuy
- Department of Diagnostic Radiology, Rhode Island Hospital, Providence, Rhode Island
| | - Debra A Gervais
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Gianfelice
- Medical Imaging, University Health Network, Laval, Quebec, Canada
| | | | - Fred T Lee
- Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Edward Leen
- Department of Radiology, Royal Infirmary, Glasgow, Scotland
| | - Riccardo Lencioni
- Department of Diagnostic Imaging and Intervention, Cisanello Hospital, Pisa University Hospital and School of Medicine, University of Pisa, Pisa, Italy
| | - Peter J Littrup
- Department of Radiology, Karmonos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | - David S Lu
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John P McGahan
- Department of Radiology, Ambulatory Care Center, UC Davis Medical Center, Sacramento, California
| | | | - Boris Nikolic
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Philippe L Pereira
- Clinic of Radiology, Minimally-Invasive Therapies and Nuclear Medicine, Academic Hospital Ruprecht-Karls-University Heidelberg, Heilbronn, Germany
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Hyunchul Rhim
- Department of Diagnostic Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Steven C Rose
- Department of Radiology, University of California, San Diego, San Diego, California
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, Illinois
| | | | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael C Soulen
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Bradford J Wood
- Radiology and Imaging Science, National Institutes of Health, Bethesda, Maryland
| | - S Nahum Goldberg
- Department of Radiology, Image-Guided Therapy and Interventional Oncology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Vogl TJ, Farshid P, Naguib NNN, Darvishi A, Bazrafshan B, Mbalisike E, Burkhard T, Zangos S. Thermal ablation of liver metastases from colorectal cancer: radiofrequency, microwave and laser ablation therapies. Radiol Med 2014; 119:451-61. [PMID: 24894923 DOI: 10.1007/s11547-014-0415-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/26/2014] [Indexed: 12/14/2022]
Abstract
Surgery is currently considered the treatment of choice for patients with colorectal cancer liver metastases (CRLM) when resectable. The majority of these patients can also benefit from systemic chemotherapy. Recently, local or regional therapies such as thermal ablations have been used with acceptable outcomes. We searched the medical literature to identify studies and reviews relevant to radiofrequency (RF) ablation, microwave (MW) ablation and laser-induced thermotherapy (LITT) in terms of local progression, survival indexes and major complications in patients with CRLM. Reviewed literature showed a local progression rate between 2.8 and 29.7 % of RF-ablated liver lesions at 12-49 months follow-up, 2.7-12.5 % of MW ablated lesions at 5-19 months follow-up and 5.2 % of lesions treated with LITT at 6-month follow-up. Major complications were observed in 4-33 % of patients treated with RF ablation, 0-19 % of patients treated with MW ablation and 0.1-3.5 % of lesions treated with LITT. Although not significantly different, the mean of 1-, 3- and 5-year survival rates for RF-, MW- and laser ablated lesions was (92.6, 44.7, 31.1 %), (79, 38.6, 21 %) and (94.2, 61.5, 29.2 %), respectively. The median survival in these methods was 33.2, 29.5 and 33.7 months, respectively. Thermal ablation may be an appropriate alternative in patients with CRLM who have inoperable liver lesions or have operable lesions as an adjunct to resection. However, further competitive evaluation should clarify the efficacy and priority of these therapies in patients with colorectal cancer liver metastases.
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Affiliation(s)
- Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany,
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Microwave ablation of pancreatic head cancer: safety and efficacy. J Vasc Interv Radiol 2014; 24:1513-20. [PMID: 24070507 DOI: 10.1016/j.jvir.2013.07.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 07/02/2013] [Accepted: 07/02/2013] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of percutaneous microwave (MW) ablation treatment in locally advanced, nonresectable, nonmetastatic pancreatic head cancer. MATERIALS AND METHODS Ten patients with pancreatic head cancer treated with percutaneous (n = 5) or laparotomic (n = 5) MW ablation were retrospectively reviewed. The MW generator used (45 W at 915 MHz) was connected by coaxial cable to 14-gauge straight MW antennas with a 3.7- or 2-cm radiating section. One or two antennae were used, with an ablation time of 10 minutes. Ultrasonographic (US) and combined US/cone-beam computed tomographic (CT) guidance were used in five patients each. Follow-up was performed by CT after 1, 3, 6, and, when possible, 12 months. Tumor response was assessed per Response Evaluation Criteria In Solid Tumors (version 1.1) and Choi criteria. The feasibility, safety, and major and minor complications associated with quality of life (QOL) were recorded prospectively. RESULTS The procedure was feasible in all patients (100%). One late major complication was observed in one patient, and no visceral injury was detected. No patient had further surgery, and all minor complications resolved during the hospital stay. An improvement in QOL was observed in all patients despite a tendency to return to preoperative levels in the months following the procedure, without the influence of minor complications. No repeat treatment was performed. CONCLUSIONS Despite the small number of patients, the present results can be considered encouraging, showing that MW ablation is a feasible approach in the palliative treatment of pancreatic tumors.
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Andreano A, Galimberti S, Franza E, Knavel EM, Sironi S, Lee FT, Meloni MF. Percutaneous microwave ablation of hepatic tumors: prospective evaluation of postablation syndrome and postprocedural pain. J Vasc Interv Radiol 2013; 25:97-105.e1-2. [PMID: 24286938 DOI: 10.1016/j.jvir.2013.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/01/2013] [Accepted: 09/04/2013] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To prospectively investigate the frequency and severity of postablation syndrome (PAS) and postprocedural pain in a cohort of patients undergoing hepatic microwave ablation. MATERIALS AND METHODS From March 2009 to November 2011, 54 consecutive patients undergoing microwave ablation for liver tumors were enrolled. A questionnaire was administered to investigate PAS and pain at 1, 7, and 40 days after ablation. Four patients did not complete all three questionnaires and were excluded from the analysis. Additionally, laboratory tests with results known to significantly increase or decrease after ablation were performed, and ablation parameters were recorded. Potential predictors of PAS and pain at 1 and 7 days were evaluated by a logistic regression model. RESULTS Fifty patients underwent a single microwave ablation session, 33 for hepatocellular carcinoma (HCC) and 17 for liver metastasis. Median ablation volumes on computed tomography were 31 cm(3) for HCC and 42 cm(3) for metastasis. Sixty percent of patients experienced PAS in the first week. Aspartate aminotransferase (AST) levels after ablation were significantly associated with PAS during postprocedure days 1-7. Median visual analog scale scores for pain at the puncture site were 1 and 0.24 at 1 and 7 days, respectively. The risk of having at least moderate pain in the first week was significantly related to ablation volume and time and postablation increase in AST level. CONCLUSIONS The incidence and severity of PAS with hepatic microwave ablation is similar to that reported for radiofrequency ablation, with the best predictive factor being postablation AST level elevation. Postablation pain was best predicted by total ablation volume and AST level.
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Affiliation(s)
- Anita Andreano
- Department of Health Sciences, University of Milano-Bicocca, Monza; Centre of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza
| | - Stefania Galimberti
- Department of Health Sciences, University of Milano-Bicocca, Monza; Centre of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza
| | - Elvira Franza
- Department of Health Sciences, University of Milano-Bicocca, Monza
| | - Erica M Knavel
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Sandro Sironi
- Department of Health Sciences, University of Milano-Bicocca, Monza
| | - Fred T Lee
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Maria Franca Meloni
- Department of Health Sciences, University of Milano-Bicocca, Monza; Department of Radiology, Ospedale Valduce, via Dante 11, Como 22100, Italy.
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Parra-Membrives P, Martínez-Baena D, Lorente-Herce JM. Flu-like symptoms following radiofrequency liver transection: a new variety of the post-radiofrequency syndrome. J INVEST SURG 2013; 27:7-13. [PMID: 24088180 DOI: 10.3109/08941939.2013.826309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND/AIMS The aim of our study was to determine whether post-radiofrequency syndrome may also develop following hepatectomy using saline-cooled radiofrequency coagulation. METHODS We retrospectively reviewed 95 consecutive patients who underwent 110 liver resections between May 2000 and September 2012. We stated that 80.9% of the resections were carried out employing the saline-cooled radiofrequency device. All medical records were searched for the occurrence of flu-like symptoms, without evidence of sepsis or infection, in the first two postoperative weeks. RESULTS Eleven patients (11.5%) developed flu-like symptoms after hepatectomy without evidence of sepsis or infection. All their hepatectomies were performed employing the saline-cooled radiofrequency probe (p = .089), and all cases but one appeared following colorectal liver metastases surgery (p = .042). Eight of them were readmitted to the hospital because of their symptoms. In all 11 cases, a fluid collection was present, 8 of them with gas presence. Nine patients underwent a percutaneous drainage whose cultures were negative. Ten patients recovered without treatment or with the intake of nonsteroidal anti-inflammatory drugs within 1 week, but one patient developed a secondary infection with gram-positive bacteria after percutaneous drainages that prolonged his hospital stay. CONCLUSION Liver splitting using saline-cooled radiofrequency coagulation may cause postoperative symptoms that may mimic surgical site infection. Surgeons employing this device should keep this in mind to avoid potentially unwarranted treatments that may be unnecessary, expensive, and even harmful.
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Abstract
Percutaneous ablation in the kidney is now performed as a standard therapeutic nephron-sparing option in patients who are poor candidates for resection. Its increasing use has been largely prompted by the rising incidental detection of renal cell carcinomas with cross-sectional imaging and the need to preserve renal function in patients with comorbid conditions, multiple renal cell carcinomas, and/or heritable renal cancer syndromes. Clinical studies to date indicate that radiofrequency ablation and cryoablation are effective therapies with acceptable short- to intermediate-term outcomes and with a low risk in the appropriate setting, with attention to pre-, peri-, and postprocedural detail. The results following percutaneous radiofrequency ablation and cryoablation in the treatment of renal cell carcinoma are reviewed in this article, including those of several larger scale studies of ablation of T1a tumors. Clinical and technical considerations unique to ablation in the kidney are presented, and potential complications are discussed.
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Affiliation(s)
- Aradhana M Venkatesan
- Department of Radiology and Imaging Sciences, NIH Clinical Center, 10 Center Dr, Bldg 10, Room 1C369, MSC 1182, Bethesda, MD 20892, USA.
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Carrafiello G, Mangini M, Fontana F, Di Massa A, Ierardi AM, Cotta E, Piacentino F, Nocchi Cardim L, Pellegrino C, Fugazzola C. Complications of microwave and radiofrequency lung ablation: personal experience and review of the literature. Radiol Med 2011; 117:201-13. [PMID: 22020434 DOI: 10.1007/s11547-011-0741-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Accepted: 02/08/2011] [Indexed: 01/04/2023]
Abstract
PURPOSE Complications correlated with percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) of lung tumours were retrospectively reviewed to compare them with data from the literature and to assess risk factors related with the procedures. MATERIALS AND METHODS From January 2003 to January 2009, 29 patients (36 lung lesions) were treated with RFA; from January 2007 to January 2009, 16 patients (17 lung lesions) were treated with MWA. Complications recorded at our institution are reported following the Society of Interventional Radiology guidelines. A systematic review of the literature was performed. RESULTS Any major complication of RFA or MWA was recorded. In agreement with the literature, pneumothorax was the most frequent complication, even though the incidence in our series was lower than reported in the literature (3.5% vs. 4.3-18%). Other complications of RFA were pleural effusion and subcutaneous emphysema. No massive haemorrhages, haemoptysis, abscesses, pneumonia, infections or tumour seeding were recorded in our series. The most common complication of MWA was pneumothorax (25% vs. 39% reported in the literature). Pleural effusion was a common reaction, but therapeutic drainage was never required. CONCLUSIONS Pneumothorax is the most common complication of both techniques. RFA and MWA are both excellent choices in terms of safety and tolerance.
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Affiliation(s)
- G Carrafiello
- Department of Radiology, Research Centre in Interventional Radiology, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
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Carrafiello G, Ierardi AM, Piacentino F, Lucchina N, Dionigi G, Cuffari S, Fugazzola C. Microwave Ablation with Percutaneous Approach for the Treatment of Pancreatic Adenocarcinoma. Cardiovasc Intervent Radiol 2011; 35:439-42. [DOI: 10.1007/s00270-011-0189-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 05/09/2011] [Indexed: 11/24/2022]
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Radiofrequency ablation: a minimally invasive approach in kidney tumor management. Cancers (Basel) 2010; 2:1895-900. [PMID: 24281207 PMCID: PMC3840440 DOI: 10.3390/cancers2041895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 11/08/2010] [Accepted: 11/11/2010] [Indexed: 11/17/2022] Open
Abstract
The management and diagnosis of renal tumors have changed significantly over the last decade. Due to advances in imaging techniques, more than 50% of kidney tumors are discovered incidentally and many of them represent an early stage lesion. This has stimulated the development of nephron-sparing surgery and of the minimally invasive treatment options including ablative techniques, i.e., radiofrequency ablation (RFA) and cryoablation. The objective of the minimally invasive approach is to preserve the renal function and to lower the perioperative morbidity. RFA involves inducing the coagulative necrosis of tumor tissue. Being probably one of the least invasive procedures in kidney tumor management, RFA may be performed percutaneously under ultrasound (US), computed tomography (CT) or magnetic resonance (MR) guidance. Most of the studies show that the RFA procedure is efficient, safe and has a low complication rate. Due to the still limited data on the oncological outcome of RFA, the indication for this intervention remains limited to selected patients with small organ-confined renal tumors and contraindication to surgery or who have a solitary kidney. The aim of our study is to review the literature on RFA of kidney tumors.
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Carrafiello G, Laganà D, Cotta E, Mangini M, Fontana F, Bandiera F, Fugazzola C. Radiofrequency ablation of intrahepatic cholangiocarcinoma: preliminary experience. Cardiovasc Intervent Radiol 2010; 33:835-9. [PMID: 20411389 DOI: 10.1007/s00270-010-9849-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 03/12/2010] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to evaluate the safety and efficacy of percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) in patients with intrahepatic cholangiocarcinoma (ICCA) in a small, nonrandomized series. From February 2004 to July 2008, six patients (four men and two women; mean age 69.8 years [range 48 to 83]) with ICCA underwent percutaneous US-guided RFA. Preintervetional transarterial embolization was performed in two cases to decrease heat dispersion during RFA in order to increase the area of ablation. The efficacy of RFA was evaluated using contrast-enhanced dynamic computed tomography (CT) 1 month after treatment and then every 3 months thereafter. Nine RFA sessions were performed for six solid hepatic tumors in six patients. The duration of follow-up ranged from 13 to 21 months (mean 17.5). Posttreatment CT showed total necrosis in four of six tumors after one or two RFA sessions. Residual tumor was observed in two patients with larger tumors (5 and 5.8 cm in diameter). All patients tolerated the procedure, and there with no major complications. Only 1 patient developed post-RFA syndrome (pain, fever, malaise, and leukocytosis), which resolved with oral administration of acetaminophen. Percutaneous RFA is a safe and effective treatment for patients with hepatic tumors: It is ideally suited for those who are not eligible for surgery. Long-term follow-up data regarding local and systemic recurrence and survival are still needed.
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Affiliation(s)
- Gianpaolo Carrafiello
- Department of Radiology, University of Insubria c/o Ospedale di Circolo, viale Borri, 21100 Varese, Italy.
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Carrafiello G, Mangini M, De Bernardi I, Fontana F, Dionigi G, Cuffari S, Imperatori A, Laganà D, Fugazzola C. Microwave ablation therapy for treating primary and secondary lung tumours: technical note. Radiol Med 2010; 115:962-74. [PMID: 20352357 DOI: 10.1007/s11547-010-0547-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 10/02/2009] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of our study was to retrospectively evaluate the feasibility, safety and effectiveness of microwave ablation (MWA) in nine patients with unresectable lung tumour. MATERIALS AND METHODS Ten lesions were treated in ten ablation sessions in nine patients. The treatments were performed with a microwave generator with 45 W and 915 MHz connected to a 14.5-gauge antenna for 10 min. Antenna placement was performed with computed tomography (CT) fluoroscopy guidance or XperGuide. All patients underwent CT follow-up at 1, 3 and 6 months from the procedure. RESULTS Technical success was obtained in all cases; mortality at 30 days was 0%. CONCLUSIONS This study shows that in selected patients, MWA is a valid alternative to other ablative techniques. Further studies are required to demonstrate the short- and long-term effects of this technique and to make a comparison with other available ablation systems, especially with radiofrequency.
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Affiliation(s)
- G Carrafiello
- Dipartimento di Radiologia, Università degli Studi dell'Insubria, Ospedale di Circolo Varese, Viale L Borri 57, 21100 Varese, Italy
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Choi DH, Lee HS. A case of gouty arthritis following percutaneous radiofrequency ablation for hepatocellular carcinoma. World J Gastroenterol 2010; 16:778-81. [PMID: 20135729 PMCID: PMC2817069 DOI: 10.3748/wjg.v16.i6.778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
Percutaneous radiofrequency thermal ablation (RFA) is considered an effective technique for providing local control in the majority of Hepatocellular carcinoma (HCC) patients. Although RFA is generally well tolerated, recent studies have reported complications associated with RFA. We describe a case of acute gouty arthritis in a 71-year-old man with chronic renal failure who was treated with RFA for a HCC lesion and who had hepatitis B-associated cirrhosis and mild renal insufficiency. Regular surveillance of the patient detected a 3.5 cm HCC lesion. Because the patient had declined surgery, RFA was chosen for therapy. On the third post-procedural day, the laboratory results showed increases in his uric acid and potassium levels, which were compatible with a tumor lysis syndrome. On the 6th post-procedural day, the patient complained of new right knee pain. Subsequent joint aspiration revealed monosodium urate monohydrate crystals. We made the diagnosis of acute gouty arthritis arising from tumor lysis and liver infarction caused by HCC ablation, which was aggravated by acute renal insufficiency. After adequate hydration and administration of oral colchicines, the patient’s right knee pain subsided and the uric acid serum level returned to normal. This is the first described case of acute gouty arthritis after RFA for a HCC lesion in a patient with underlying chronic renal insufficiency. To avoid hyperuricemia and an acute attack of gout after RFA therapy for HCC, early identification of patients at risk is warranted, such as those with a large tumor, rapid tumor growth, and renal insufficiency, and preventative measures should be considered.
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Salagierski M, Salagierski MS, Salagierska-Barwińska A. Radiofrequency ablation in kidney tumour management: A method of real-time monitoring. ACTA ACUST UNITED AC 2010; 44:84-90. [DOI: 10.3109/00365590903555385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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37
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Carrafiello G, Mangini M, Fontana F, Recaldini C, Piacentino F, Pellegrino C, Laganà D, Cuffari S, Marconi A, Fugazzola C. Single-antenna microwave ablation under contrast-enhanced ultrasound guidance for treatment of small renal cell carcinoma: preliminary experience. Cardiovasc Intervent Radiol 2009; 33:367-74. [PMID: 19915901 DOI: 10.1007/s00270-009-9745-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 10/12/2009] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to determine the safety, effectiveness, and feasibility of microwave ablation (MWA) of small renal cell carcinomas (RCCs) in selected patients. Institutional review board and informed consent were obtained. From December 2007 to January 2009, 12 patients (8 male, 4 female) were enrolled in a treatment group, in which percutaneous MWA of small RCCs was performed under contrast-enhanced ultrasound guidance. The tumors were 1.7-2.9 cm in diameter (mean diameter, 2.0 cm).Therapeutic effects were assessed at follow-up with computed tomography. All patients were followed up for 3-14 months (mean, 6 months) to observe the therapeutic effects and complications (according to SIR classification). Assessment was carried out with CT imaging. No severe complications or unexpected side effects were observed after the MWA procedures. In all cases technical success was achieved. Clinical effectiveness was 100%; none of the patients showed recurrence on imaging. In conclusion, our preliminary results support the use of MWA for the treatment of small renal tumors. This technology can be applied in select patients who are not candidates for surgery, as an alternative to other ablative techniques.
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Affiliation(s)
- Gianpaolo Carrafiello
- Department of Radiology, University of Insubria, Viale Borri 57, Varese 21100, Italy.
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38
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Carrafiello G, Laganà D, Pellegrino C, Fontana F, Mangini M, Nicotera P, Petullà M, Bracchi E, Genovese E, Cuffari S, Fugazzola C. Percutaneous imaging-guided ablation therapies in the treatment of symptomatic bone metastases: preliminary experience. Radiol Med 2009; 114:608-25. [DOI: 10.1007/s11547-009-0395-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 10/06/2008] [Indexed: 01/29/2023]
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Abstract
Studies have demonstrated that chemotherapy alone is usually unsuccessful as exclusive therapy for osteosarcoma (Cancer 95:2202-2201, 2002). Information will be presented for situations where non-surgical alternatives could be considered as useful, if not necessary, adjuncts to chemotherapy. In the thorax these include treatment of pleural effusions, chest wall lesions, central lung or mediastinal osteosarcoma, as well as recurrences in patients with limited pulmonary reserve. Other situations include too many metastases to easily resect, axial osteosarcomas, bone metastases, liver and brain metastases. Non-surgical local control measures include radiation with chemotherapy for radiosensitization, bone-seeking radioisotopes (e.g., 153Sm-EDTMP, 223Ra), bisphosphonates, heat (radiofrequency ablation), freezing and thawing (cryoablation), and intracavitary or regional (aerosol) therapy. Because of the predictable and common pattern of pulmonary metastases in osteosarcoma, aerosol therapy also offers an attractive regional treatment strategy. Principles and use of aerosol cytokines (e.g., GM-CSF, IL-2), and aerosol chemotherapy with gemcitabin will be discussed. Individual cases illustrating strategy and techniques will be presented.
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Affiliation(s)
- Pete Anderson
- Children's Cancer Hospital, University of Texas MD Anderson Cancer Center, Unit 87, Pediatrics, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA.
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Anderson P, Kornguth D, Ahrar K, Hughes D, Phan P, Huh W, Cornelius K, Mahajan A. Recurrent, refractory, metastatic and/or unresectable pediatric sarcomas: treatment options for young people ‘off the roadmap’. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/17455111.2.5.605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Although sarcoma surgery is very important for cancer control, it is not always possible or practical to offer in some situations, including sarcoma recurrences, metastatic disease and/or unacceptable loss of function. We review some pragmatic approaches and examples of how to balance indications, risks and alternatives to control cancer in young people with sarcomas that are no longer using ‘front-line’ therapy. Radiotherapy combined with chemotherapy and outpatient ‘continuation’ chemotherapy regimens using drugs that cause less alopecia can improve function and quality of life. Some effective strategies to help cope when cure is not possible may include tumor ablation techniques performed in interventional radiology and percutaneous nerve blocks. Family centered care and effective problem solving of difficult issues can be greatly facilitated by consultation with a multidisciplinary team experienced in the management of very difficult cases. Treatment of young people with recurrent, relapsed and/or metastatic sarcoma still remains an art very much in the realm of compassion not protocol and persistent advocacy is required for the young person for whom cure may not be possible. A reduction of suffering and assistance in writing more chapters of a rich life narrative is the goal.
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Affiliation(s)
- Pete Anderson
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
| | - David Kornguth
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
- Department of Radiation Oncology
| | - Kamran Ahrar
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
- Department of Diagnostic Radiology
| | - Dennis Hughes
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
| | - Phil Phan
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
- Department of Anesthesia & Cancer Pain Service
| | - Winston Huh
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
| | - Kathleen Cornelius
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
| | - Anita Mahajan
- University of Texas, Department of Pediatrics, Unit 87, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA
- Department of Radiation Oncology
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Pezzilli R, Ricci C, Serra C, Casadei R, Monari F, D’Ambra M, Corinaldesi R, Minni F. Current medical treatment of pancreatic neuroendocrine tumors. Cancers (Basel) 2007; 2:1419-31. [PMID: 24281165 PMCID: PMC3837314 DOI: 10.3390/cancers2031419] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 06/28/2010] [Accepted: 06/30/2010] [Indexed: 02/07/2023] Open
Abstract
Pancreatic neuroendocrine tumors (NETs) consist of a wide group of neoplasms, with different biological behaviors in terms of aggressiveness and hormone production. In the last two decades, significant progress has been observed in our understanding of their biology, diagnosis and treatment. Surgery remains to be the only curative approach, but unfortunately the diagnosis is often delayed due to the slow growth of these tumors and the difficulty in identifying the symptoms related to the tumor-released hormones. In addition to surgery, other approaches to control the disease are biological therapy consisting of somatostatin analogs and interferon (IFN), systemic chemotherapy, radioligand therapy and local therapy with chemoembolization. Several newer cytotoxic agents, including irinotecan, gemcitabine, taxanes, oxaliplatin, capecitabine and PS-341 have been studied in metastatic patients. Considering the high vascularity of these tumors, antiangiogenic agents like endostatin and thalidomide have also been evaluated in advanced NETs. Although these agents seem to have potential activity in NETs and may increase progression free survival, none of these currently available medical therapeutic options are curative. While more efficient novel strategies are to be developed, the rationale use of the current therapeutic options may improve quality of life, control the symptoms related to the hypersecretion of hormones and/or peptides, control tumor proliferation and prolong survival in patients suffering from NETs.
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Affiliation(s)
- Raffaele Pezzilli
- Department of Internal Medicine and Gastroenterology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mail: (C.S.); (R.C.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-051-636-4148
| | - Claudio Ricci
- Department of Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mails: (C.R.); (R.C.); (F.M.); (M.D’A.); (F.M.)
| | - Carla Serra
- Department of Internal Medicine and Gastroenterology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mail: (C.S.); (R.C.)
| | - Riccardo Casadei
- Department of Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mails: (C.R.); (R.C.); (F.M.); (M.D’A.); (F.M.)
| | - Francesco Monari
- Department of Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mails: (C.R.); (R.C.); (F.M.); (M.D’A.); (F.M.)
| | - Marielda D’Ambra
- Department of Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mails: (C.R.); (R.C.); (F.M.); (M.D’A.); (F.M.)
| | - Roberto Corinaldesi
- Department of Internal Medicine and Gastroenterology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mail: (C.S.); (R.C.)
| | - Francesco Minni
- Department of Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mails: (C.R.); (R.C.); (F.M.); (M.D’A.); (F.M.)
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