1
|
Wei Y, Zhang L, Zhang S, Song M, Ji C. Laparoscopic-assisted microwave ablation in treatment of small hepatocellular carcinoma: safety and efficacy in comparison with laparoscopic hepatectomy. BMC Surg 2024; 24:138. [PMID: 38715071 PMCID: PMC11075224 DOI: 10.1186/s12893-024-02432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
Laparoscopic-assisted microwave ablation (LAMWA), as one of the locoregional therapies, has been employed to treat hepatocellular carcinoma (HCC). This study aims to compare the efficacy and safety of LAMWA and laparoscopic hepatectomy in the treatment of small HCC.This study included 140 patients who met the inclusion criteria. Among them, 68 patients received LAMWA and 72 patients underwent laparoscopic hepatectomy. The perioperative condition, liver function recovery, the alpha fetoprotein (AFP) level, morbidities, hospitalization time, overall survival (OS), disease-free survival (DFS) and recurrence rate between the two groups were compared. The rate of complete elimination of tumor tissue was 100% and the AFP level was returned to normal within 3 months after surgery in both groups (P > 0.05). The mean alanine transaminase (ALT) and aspartate transaminase (AST) peak in the LAMWA group was lower than that in the laparoscopic hepatectomy group (259.51 ± 188.75 VS 388.9 ± 173.65, P = 0.000) and (267.34 ± 190.65 VS 393.1 ± 185.67, P = 0.000), respectively. The mean operation time in the LAMWA group was shorter than that in the laparoscopic hepatectomy group (89 ± 31 min VS 259 ± 48 min, P = 0.000). The blood loss in the LAMWA group was less than that in the laparoscopic hepatectomy group (58.4 ± 64.0 ml VS 213.0 ± 108.2 ml, P = 0.000). Compared with the laparoscopic hepatectomy group, patients in the LAMWA group had lower mean hospital stay (4.8 ± 1.2d VS 11.5 ± 2.9d, P = 0.000). The morbidities of the LAMWA group and the hepatectomy group were 14.7%(10/68) and 34.7%(25/72), respectively (P = 0.006). The one-, three-, and five-year OS rates were 88.2%, 69.9%, 45.6% for the LAMWA group and 86.1%, 72.9%, 51.4% for the laparoscopic hepatectomy group (P = 0.693). The corresponding DFS rates for the two groups were 76.3%, 48.1%, 27.9% and 73.2%, 56.7%, 32.0% (P = 0.958). Laparoscopic-assisted microwave ablation is a safe and effective therapeutic option for selected small HCC.
Collapse
Affiliation(s)
- Youping Wei
- Department of imaging, Aviation General Hospital, China Medical University, Beijing, 100012, China
| | - Lihong Zhang
- Department of hepatobiliary surgery, Affiliated Hospital of Yangzhou University, Yangzhou, 225012, China
| | - Shun Zhang
- Department of imaging, Aviation General Hospital, China Medical University, Beijing, 100012, China
| | - Meina Song
- Department of imaging, Aviation General Hospital, China Medical University, Beijing, 100012, China
| | - Changhui Ji
- Department of general surgery, Taixing Peoplès Hospital of Yangzhou University, No. 1, Changzheng Road, Taixing City, 225400, China.
| |
Collapse
|
2
|
Ndhlovu E, Zhang BX, Chen XP, Zhu P. Thermal ablation for hepatic tumors in high-risk locations. Clin Res Hepatol Gastroenterol 2024; 48:102300. [PMID: 38367803 DOI: 10.1016/j.clinre.2024.102300] [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: 10/26/2023] [Revised: 01/21/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
Thermal ablative techniques such as radiofrequency and microwave ablation are minimally invasive and cost-effective approaches that are currently being adopted as alternatives to surgical resection for primary and metastatic liver malignancies. However, they are considered to be relatively contraindicated for tumors in high-risk locations due to technical difficulties and a perceived increased risk of perioperative complications. Several techniques, including artificial ascites, non-touch multibipolar ablation, and laparoscopically assisted ablation, can be used to improve the outcomes of ablation for high-risk tumors. This review aims to provide a comprehensive summary of the techniques currently used to improve thermal ablation outcomes for high-risk liver tumors.
Collapse
Affiliation(s)
- Elijah Ndhlovu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Bi-Xiang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China.
| |
Collapse
|
3
|
Martin RCG, Woeste M, Egger ME, Scoggins CR, McMasters KM, Philips P. Patient Selection and Outcomes of Laparoscopic Microwave Ablation of Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:cancers15071965. [PMID: 37046625 PMCID: PMC10093561 DOI: 10.3390/cancers15071965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/12/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Laparoscopic microwave ablation (MWA) of hepatocellular carcinoma is underutilized and predictors of survival in this setting are not well characterized. Methods: The prognostic value of clinicopathologic variables was evaluated on progression-free survival (PFS) and overall survival (OS) by univariate and multivariate analyses. The aim of this study was to evaluate a preferred laparoscopic MWA approach in HCC patients that are not candidates for percutaneous ablation and further classify clinicopathologic factors that may predict survival outcomes following operative MWA in the setting of primary HCC. Results: 184 patients with HCC (median age 66, (33–86), 70% male) underwent laparoscopic MWA (N = 162, 88% laparoscopic) compared to 12% undergoing open MWA (N = 22). Median PFS was 29.3 months (0.2–170) and OS was 44.2 months (2.8–170). Ablation success was confirmed in 100% of patients. Ablation recurrence occurred in 3% (6/184), and local/hepatic recurrence occurred in 34%, at a median time of 19 months (9–18). Distant progression was noted in 8%. Median follow up was 34.1 months (6.4–170). Procedure-related complications were recorded in six (9%) patients with one 90-day mortality. Further, >1 lesion, AFP levels ≥ 80 ng/mL, and an “invader” on pre-operative radiology were associated with increased risk of progression (>1 lesion HR 2.92, 95% CI 1.06 –7.99, p = 0.04, AFP ≥ 80 ng/mL HR 4.16, 95% CI 1.71–10.15, p = 0.002, Invader HR 3.16, 95% CI 1.91–9.15, p = 0.002 ) and mortality (>1 lesion HR 3.62, 95% CI 1.21–10.81, p = 0.02], AFP ≥ 80 ng/mL HR 2.87, 95% CI 1.12–7.35, p = 0.01, Invader HR 3.32, 95% CI 1.21–9.81, p = 0.02). Conclusions: Preoperative lesion number, AFP ≥ 80 ng/mL, and an aggressive imaging characteristic (Invader) independently predict PFS and OS following laparoscopic operative MWA.
Collapse
|
4
|
Kwak MH, Lee MW, Ko SE, Rhim H, Kang TW, Song KD, Kim JM, Choi GS. Laparoscopic radiofrequency ablation versus percutaneous radiofrequency ablation for subphrenic hepatocellular carcinoma. Ultrasonography 2022; 41:543-552. [PMID: 35430787 PMCID: PMC9262669 DOI: 10.14366/usg.21241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/09/2022] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Radiofrequency ablation is a curative treatment option for very early-stage or earlystage hepatocellular carcinoma (HCC). However, percutaneous radiofrequency ablation (PRFA) for subphrenic tumors is technically challenging. Laparoscopic radiofrequency ablation (LRFA) has been used to overcome this disadvantage. This study compared the treatment outcomes between LRFA and PRFA for subphrenic HCC. METHODS This retrospective study screened patients who underwent PRFA or LRFA for subphrenic HCC between 2013 and 2018. Therapeutic outcomes, including local tumor progression (LTP), intrahepatic distant recurrence (IDR), extrahepatic metastasis (EM), disease-free survival (DFS), and overall survival (OS), were compared between the two groups. RESULTS Thirty patients in the PRFA group and 23 patients in the LRFA group were included. LTP was observed in six patients in the PRFA group (20%), but in no patients in the LRFA group. The cumulative LTP rates at 1, 3, and 5 years were 3.7%, 23.4%, and 23.4%, respectively, in the PRFA group and 0.0% in the LRFA group (P=0.015). The IDR, EM, and DFS rates were not significantly different between the two groups (P=0.304, P=0.175, and P=0.075, respectively). The OS rates at 1, 3, and 5 years were 96.6%, 85.7%, and 71.6%, respectively, in the PRFA group and 100%, 95.7%, and 95.7%, respectively, in the LRFA group (P=0.049). CONCLUSION LRFA demonstrated better therapeutic outcomes than did PRFA for subphrenic tumors in terms of LTP and OS. Therefore, LRFA can be considered as the first-line treatment option for subphrenic HCC.
Collapse
Affiliation(s)
- Min Hwan Kwak
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Seong Eun Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Sustained Complete Response after Biological Downstaging in Patients with Hepatocellular Carcinoma: XXL-Like Prioritization for Liver Transplantation or "Wait and See" Strategy? Cancers (Basel) 2021; 13:cancers13102406. [PMID: 34067521 PMCID: PMC8156031 DOI: 10.3390/cancers13102406] [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: 02/26/2021] [Revised: 04/22/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The XXL trial has recently shown that biological downstaging is an effective strategy to also allow liver transplantation into patients with more advanced hepatocellular carcinoma without alternative curative options. Some potential limits of the XXL downstaging protocol are (a) the rather high downstaging failure rate (i.e., 32%), and (b) the additional prioritization of transplantation for patients with a potential good prognosis without transplant, i.e., those obtaining a complete response to downstaging. In this study, we showed that, using aggressive surgical downstaging, it is possible to considerably decrease the downstaging failure rate. Moreover, we showed that it is possible to avoid an immediate prioritization of transplantation for patients with a sustained complete response to downstaging by applying a “wait and see” policy. This policy seems to spare a relevant number of organs without worsening patient outcome. Abstract The XXL trial represents the first prospective validation of “biological downstaging” in liver transplantation (LT) for hepatocellular carcinoma. The aim of this study was to compare the Padua downstaging protocol to the XXL protocol in terms of downstaging failure rates and patient outcome. A total of 191 patients undergoing aggressive surgical downstaging and potentially eligible for LT from 2012 to 2018 at our center were retrospectively selected according to XXL trial criteria. Unlike the XXL trial, patients with a complete response to downstaging did not receive any prioritization for LT. Downstaging failure was defined as stable progressive disease or post-treatment mortality. The statistical method of “matching-adjusted indirect comparison” was used to match the study group to the XXL population. Downstaging failure rate was considerably lower in the study group than in the XXL trial (12% vs. 32%, d value = |0.683|). The survival curves of our LT group (n = 68) overlapped with those of the LT-XXL group (p = 0.846). Survival curves of non-LT candidates with a sustained complete response (n = 64) were similar to those of transplanted patients (p = 0.281). Our study represents a validation of the current Padua and Italian policies of denying rapid prioritization to patients with complete response to downstaging. Such a policy seems to spare organs without worsening patient outcome.
Collapse
|
6
|
Zhang Z, Li JZ, Li HM. Hepatic Hemangioma Treatment Using Microwave Coagulation Therapy—a Systematic Review. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
7
|
Vitale A, Trevisani F, Farinati F, Cillo U. Treatment of Hepatocellular Carcinoma in the Precision Medicine Era: From Treatment Stage Migration to Therapeutic Hierarchy. Hepatology 2020; 72:2206-2218. [PMID: 32064645 DOI: 10.1002/hep.31187] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/28/2020] [Indexed: 01/27/2023]
Abstract
Treatment allocation is extremely complex in patients with hepatocellular carcinoma (HCC) because this neoplasm arises, in most cases, in patients with cirrhosis and additional comorbidities. The "stage hierarchy" approach, which involves linking each stage (or substage) of the disease to a specific treatment, has become the main proposed treatment strategy for the clinical management of HCC, particularly in the West. The Barcelona Clinic Liver Cancer (BCLC) scheme serves as the main example of the application of this strategy. In an attempt to increase the plasticity of the "stage hierarchy" approach as well as its adaptability to the requirements of real-world clinical practice, the latest versions of European and American guidelines have introduced certain relevant elements of flexibility, which were not intrinsic to the original BCLC scheme. These elements are as follows: the "treatment stage migration" strategy, which allows moving to another treatment (generally the one that is associated with the subsequent stage) if the approach linked with the current stage proves to be unfeasible, and the "treatment stage alternative" approach, which proposes further therapeutic options for each BCLC-defined stage. In regard to most of the solid cancers, another potential strategy is to consider the treatment decision to be hierarchically dictated by the efficacy of each therapy with complete or partial independence from the tumor stage. This concept of "therapeutic hierarchy" has been historically endorsed by the Asia-Pacific treatment algorithm as well as by the recent Italian multisociety guidelines. The present review provides a critical analysis of the different conceptual approaches to HCC management, highlighting their advantages and disadvantages and focusing on the remarkable differences between the stage-guided and the hierarchical strategies.
Collapse
Affiliation(s)
- Alessandro Vitale
- Department of Surgical, Oncological, and Gastroenterological Sciences, Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, Semeiotics Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Fabio Farinati
- Department of Surgical, Oncological, and Gastroenterological Sciences, Gastroenterology Division, Padua University Hospital, Padua, Italy
| | - Umberto Cillo
- Department of Surgical, Oncological, and Gastroenterological Sciences, Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| |
Collapse
|
8
|
"Primum Non Nocere" in Interventional Oncology for Liver Cancer: How to Reduce the Risk for Complications? Life (Basel) 2020; 10:life10090180. [PMID: 32899925 PMCID: PMC7555139 DOI: 10.3390/life10090180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022] Open
Abstract
Interventional oncology represents a relatively new clinical discipline based upon minimally invasive therapies applicable to almost every human organ and disease. Over the last several decades, rapidly evolving research developments have introduced a newer generation of treatment devices, reagents, and image-guidance systems to expand the armamentarium of interventional oncology across a wide spectrum of disease sites, offering potential cure, control, or palliative care for many types of cancer patients. Due to the widespread use of locoregional procedures, a comprehensive review of the methodologic and technical considerations to optimize patient selection with the aim of performing a safe procedure is mandatory. This article summarizes the expert discussion and report from the Mediterranean Interventional Oncology Live Congress (MIOLive 2020) held in Rome, Italy, integrating evidence-reported literature and experience-based perceptions as a means for providing guidance on prudent ways to reduce complications. The aim of the paper is to provide an updated guiding tool not only to residents and fellows but also to colleagues approaching locoregional treatments.
Collapse
|
9
|
Early experience with laparoscopic treatment of liver tumors using a separable cluster electrode with a no-touch technique. Wideochir Inne Tech Maloinwazyjne 2020; 16:76-82. [PMID: 33786119 PMCID: PMC7991943 DOI: 10.5114/wiitm.2020.95065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/21/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction Radiofrequency ablation (RFA) is one of the best curative treatments for hepatocellular carcinoma in selected patients, and this procedure can be applied either percutaneously or laparoscopically. Laparoscopic RFA has the benefit of direct visual control of the RFA procedure. Cluster electrodes (Octopus RF electrodes) can create a common ablation zone. Aim Using these two methods (laparoscopic approach and no touch technique), this present study evaluated the technical and clinical outcomes of early experience with laparoscopic RFA and a no-touch technique. Material and methods Between November 2015 and November 2018, 21 patients underwent laparoscopic RFA for hepatocellular carcinoma with a no-touch technique using cluster electrodes. Laparoscopic RFA is recommended for patients with a contraindication for surgical resection, patients wants and a relative contraindication for conventional percutaneous RFA, such as lesions adjacent to the gastrointestinal tract, gallbladder, bile duct, or heart. Results In the 21 tumors, 2 were treated with a single electrode, 12 with 2 electrodes, and 7 tumors with 3 electrodes. The mean time of ablation per lesion was 20.43 ±8.77 min. There was no mortality, local tumor progression, delayed destructive biliary damage, or liver abscess at the follow-up computed tomography. No technical failures occurred. Conclusions Laparoscopic RFA can access lesions for which percutaneous RFA is contraindicated or risky. Cluster electrodes can create sufficient ablation zones without contact and can achieve a sufficient margin with a low complication rate and no tumor dissemination. Therefore, laparoscopic RFA with a no-touch technique might be a safe and feasible treatment for HCC tumor in selected patients.
Collapse
|
10
|
Worakitsitisatorn A, Lu DS, Lee MW, Asvadi NH, Moshksar A, Yuen AD, McWilliams J, Raman SS. Percutaneous thermal ablation of subcapsular hepatocellular carcinomas: influence of tumor-surface contact and protrusion on therapeutic efficacy and safety. Eur Radiol 2019; 30:1813-1821. [PMID: 31822975 DOI: 10.1007/s00330-019-06497-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/10/2019] [Accepted: 10/02/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate therapeutic efficacy and complication of percutaneous thermal ablation of subcapsular hepatocellular carcinomas (HCCs), and how these may be influenced by the degree of tumor to liver surface contact and tumor protrusion from liver surface. MATERIALS AND METHODS Our retrospective study was approved by the Institutional Review Board. Between January 2006 and December 2013, 290 patients (82 women, 208 men; mean age, 64.5 years; range, 33-89 years) with 474 subcapsular (within 1 cm to the liver surface) HCCs (mean size, 23.7 mm; range, 6-71 mm) underwent percutaneous thermal ablation. The HCCs were divided into surface contact group (n = 243) and non-surface contact group (n = 231). The former was further subdivided into exophytic and non-exophytic HCCs. Technical success, primary technique efficacy, local tumor progression (LTP), and secondary technique efficacy rates were analyzed and compared by the chi-square test or Fisher exact test. Prognostic factors for LTP and secondary technique efficacy were assessed using the Cox regression model. Major complications were also assessed. RESULTS With median follow-up of 15 months (range, 1-87 months), technical success and primary technique efficacy were 98.7% and 95.7% % in the non-surface contact group; 96.4% and 94.0% in the non-exophytic group; and 100% and 94.7% in the exophytic group (p > 0.05). Tumor size > 3 cm was a significant predictor for LTP, but not for secondary efficacy. Overall major complication rate was 3.8% (24/624) and was not different among the three groups. CONCLUSION Subcapsular HCCs can be effectively treated with thermal ablation techniques. Degree of tumor-surface contact including moderate protrusion does not appear to limit feasibility or procedure effectiveness. KEY POINTS • Subcapsular HCCs can be effectively treated with thermal therapy when proper image-guided technique and assistive techniques are applied. • Degree of tumor surface contact including moderate protrusion does not appear to limit feasibility or procedure effectiveness. • Major complications after percutaneous thermal ablation of subcapsular HCCs such as tumor seeding can be minimized by avoiding breach of the tumor capsule exposed to the peritoneal surface and use of tract ablation.
Collapse
Affiliation(s)
- Akeanong Worakitsitisatorn
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.,Department of Diagnostic and Interventional Radiology, Chulabhorn Hospital, 54 KamphaengPhet 6, Talat Bang Khen, Lak Si, Bangkok, 10210, Thailand
| | - David S Lu
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Min Woo Lee
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.,Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Nazanin H Asvadi
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Amin Moshksar
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Alexander D Yuen
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Justin McWilliams
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Steven S Raman
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| |
Collapse
|
11
|
Cillo U, Bertacco A, Fasolo E, Carandina R, Vitale A, Zanus G, Gringeri E, D'Amico F, Bassi D, Neri D, Dadduzio V, Farinati F, Aliberti C. Videolaparoscopic microwave ablation in patients with HCC at a European high-volume center: Results of 815 procedures. J Surg Oncol 2019; 120:956-965. [PMID: 31373009 DOI: 10.1002/jso.25651] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/21/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Videolaparoscopic (VL) microwave ablation (MWA) is not included in most of the international guidelines as a therapeutic option for hepatocellular carcinoma (HCC). Aim of this study was to assess the safety of VL MWA in patients with HCC for whom resection or percutaneous ablation is unsuitable. METHODS A retrospective analysis was performed on a prospective database of patients with HCC treated with VL MWA at our institution from 2009 to 2016. Patient demographics, operational characteristics, and complications were recorded. Statistical analysis was performed to identify safety profile, overall survival and recurrence rate. RESULTS A total of 815 VL MWA were performed in 674 patients with a mean age of 64 years. Patients had a mean Model for End-stage Liver Disease score of 10 (±3); 32.8% were Child B, 44.1% Barcelona Clinic Liver Cancer B-C. Perioperative mortality was 0.4%. Overall morbidity was 30.8%, with Dindo-Clavien complications ≥3 in 2%. The median length of stay was 2 days. In 43.1% VL MWA was the first-line therapy. Overall 1-, 3-, and 5-year survival rates were 81.9%, 54.9%, and 35.9%. CONCLUSIONS The present is the largest series of VL ablation and the bigger number of patients with HCC treated with MW reported nowadays. It confirms the safety of a minimally invasive procedure for patients with HCC when resection or percutaneous ablation is not feasible.
Collapse
Affiliation(s)
- Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Alessandra Bertacco
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Elisa Fasolo
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | | | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Giacomo Zanus
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Enrico Gringeri
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Francesco D'Amico
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Domenico Bassi
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Daniele Neri
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Vincenzo Dadduzio
- Department of Clinical and Experimental Oncology, Medical Oncology Unit 1, Istituto Oncologico Veneto-IRCCS, Padua, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, Padua University, Padua, Italy
| | | |
Collapse
|
12
|
Takaoka Y, Morimoto N, Miura K, Nomoto H, Murayama K, Hirosawa T, Watanabe S, Fujieda T, Ttsukui M, Kawata H, Niki T, Isoda N, Iijima M, Yamamoto H. A successful treatment for hepatocellular carcinoma with Osler–Rendu–Weber disease using radiofrequency ablation under laparoscopy. Clin J Gastroenterol 2018; 11:501-506. [DOI: 10.1007/s12328-018-0877-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/07/2018] [Indexed: 11/25/2022]
|
13
|
Nault JC, Sutter O, Nahon P, Ganne-Carrié N, Séror O. Percutaneous treatment of hepatocellular carcinoma: State of the art and innovations. J Hepatol 2018; 68:783-797. [PMID: 29031662 DOI: 10.1016/j.jhep.2017.10.004] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/01/2017] [Accepted: 10/06/2017] [Indexed: 02/06/2023]
Abstract
Percutaneous treatment of hepatocellular carcinoma (HCC) encompasses a vast range of techniques, including monopolar radiofrequency ablation (RFA), multibipolar RFA, microwave ablation, cryoablation and irreversible electroporation. RFA is considered one of the main curative treatments for HCC of less than 5 cm developing on cirrhotic liver, together with surgical resection and liver transplantation. However, controversies exist concerning the respective roles of ablation and liver resection for HCC of less than 3 to 5 cm on cirrhotic liver. In line with the therapeutic algorithm of early HCC, percutaneous ablation could also be used as a bridge to liver transplantation or in a sequence of upfront percutaneous treatment, followed by transplantation if the patient relapses. Moreover, several innovations in ablation methods may help to efficiently treat early HCC, initially considered as "non-ablatable", and might, in some cases, extend ablation criteria beyond early HCC, enabling treatment of more patients with a curative approach.
Collapse
Affiliation(s)
- Jean-Charles Nault
- Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France.
| | - Olivier Sutter
- Department of Radiology, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
| | - Pierre Nahon
- Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Nathalie Ganne-Carrié
- Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Olivier Séror
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France; Department of Radiology, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France.
| |
Collapse
|
14
|
Vitale A, Peck-Radosavljevic M, Giannini EG, Vibert E, Sieghart W, Van Poucke S, Pawlik TM. Personalized treatment of patients with very early hepatocellular carcinoma. J Hepatol 2017; 66:412-423. [PMID: 27677712 DOI: 10.1016/j.jhep.2016.09.012] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/01/2016] [Accepted: 09/16/2016] [Indexed: 12/04/2022]
Abstract
Hepatocellular carcinoma (HCC), in its very early stage, is heterogeneous both in terms of liver function (i.e., presence or absence of portal hypertension, model for end-stage liver disease score, Child-Pugh score 5 or 6, bilirubin level) and tumor characteristics (i.e., location, alpha-fetoprotein values, pathological features such as microvascular invasion, tumor grade and satellitosis). Existing evidence in comparing different curative options for patients with very early HCC is poor due to small sample sizes and lack of solid subgroup analyses. Large observational studies are available, with the potential to identify effective interventions in different subgroup of patients and to discover which treatments work "in a real world setting". These studies suggest some important treatment selection strategies in very early HCC patients. According to extent of liver resection, and liver function, percutaneous ablation or liver resection are the recommended first line therapies in these patients. Laparoscopic surgery (resection or ablation) is the preferable strategy when the tumor is in the surface of the liver or close to extra-hepatic organs. Due to scarce donor resources and competition with patients at high transplant benefit (HCC patients unsuitable for non-transplant radical therapies and non-HCC patients with decompensated cirrhosis), transplantation is recommended only as second line therapy in patients with very early stage HCC in case of tumor recurrence or liver failure after ablation or liver resection.
Collapse
Affiliation(s)
- Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
| | - Markus Peck-Radosavljevic
- Department of Internal Medicine III, Division of Gastroenterology/Hepatology, Liver Cancer (HCC)-Study Group, Medical University, Vienna, Austria; Department of Gastroenterology, Hepatology, Endocrinology and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, University of Genoa, Genoa, Italy
| | - Eric Vibert
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - Wolfgang Sieghart
- Department of Internal Medicine III, Division of Gastroenterology/Hepatology, Liver Cancer (HCC)-Study Group, Medical University, Vienna, Austria
| | - Sven Van Poucke
- Department of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Timothy M Pawlik
- Department of Surgery, Wexner Medical Center at The Ohio State University, OH, USA
| |
Collapse
|
15
|
Dong HH, Mei B, Liu FL, Zhang ZW, Zhang BX, Huang ZY, Chen XP, Zhang WG. Laparoscopic versus traditional open splenectomy for hepatocellular carcinoma with hypersplenism. ACTA ACUST UNITED AC 2016; 36:519-522. [PMID: 27465326 DOI: 10.1007/s11596-016-1618-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/20/2016] [Indexed: 12/16/2022]
Abstract
This study aimed to examine the efficacy of the laparoscopic vs. traditional open splenectomy for hepatocellular carcinoma (HCC) with hypersplenism. Between 2002 and 2013, 51 Chinese HCC patients with hypersplenism underwent either simultaneous laparoscopic splenectomy plus anticancer therapies (Lap-S&A) (n=25) or traditional open splenectomy plus anti-cancer therapies (TOS&A) (n=26). The outcomes were reviewed during and after the operation. Anti-cancer therapies for HCC included laparoscopic hepatectomy (LH) and laparoscopic microwave ablation (LMA). The results showed that there was no significant difference in the operating time between the two groups, but the blood loss and blood transfusion were less, pain intensity after surgery was weaker, the time to first bowel movement, time to the first flatus and postoperative hospital stay were shorter, and the postoperative complication rate and the readmission rate were lower in the Lap-S&A group than in the TO-S&A group. Two patients in the Lap-S&A group and one patient in the TO-S&A group died 30 days after surgery. However, no significant difference in the mortality rate was noted between the two groups. It was concluded that simultaneous Lap-S&A holds the advantages of more extensive indications, lower complication incidence and less operative expenditure than conventional open approach and it is a feasible and safe approach for HCC with hypersplenism.
Collapse
Affiliation(s)
- Han-Hua Dong
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Bin Mei
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fei-Long Liu
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhi-Wei Zhang
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Bi-Xiang Zhang
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhi-Yong Huang
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Ping Chen
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wan-Guang Zhang
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| |
Collapse
|
16
|
Gao J, Ji JS, Ding XM, Ke S, Xin ZH, Ning CM, Guo SG, Li XL, Dong YH, Sun WB. Laparoscopic Radiofrequency Ablation for Large Subcapsular Hepatic Hemangiomas: Technical and Clinical Outcomes. PLoS One 2016; 11:e0149755. [PMID: 26901132 PMCID: PMC4765839 DOI: 10.1371/journal.pone.0149755] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/04/2016] [Indexed: 01/12/2023] Open
Abstract
Objectives The aim of this study was to evaluate the technical and clinical outcomes of using laparoscopic radiofrequency (RF) ablation for treating large subcapsular hepatic hemangiomas. Methods We retrospectively reviewed our sequential experience of treating 124 large subcapsular hepatic hemangiomas in 121 patients with laparoscopic RF ablation. Results The mean diameter of the 124 hemangiomas was 9.1 ± 3.2 cm (5.0–16.0 cm). RF ablation was performed successfully in all patients. There were 55 complications related to the ablation in 26 patients, including 5 of 69 (7.3%) patients with hemangioma <10 cm and 21 of 52 (40.4%) patients with hemangiomas ≥10 cm (P < 0.001). No injuries to abdominal viscera occurred in all the 121 patients. According to the Dindo–Clavien classification, all the complications were minor in 26 patients (Grade I). Out of 124 hepatic hemangiomas, 118 (95.2%) were completely ablated, including 70 of 72 (97.2%) lesions < 10 cm and 48 of 52 (92.3%) lesions ≥ 10 cm (P = 0.236). Conclusion Laparoscopic RF ablation therapy is a safe, feasible and effective procedure for large subcapsular hepatic hemangiomas, even in the hepatic hemangiomas ≥ 10 cm. Its use avoids thermal injury to the abdominal viscera.
Collapse
Affiliation(s)
- Jun Gao
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, No. 5 Jingyuan Street, Beijing 100043, China
| | - Jian-Song Ji
- Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Zhejiang, 32300, China
| | - Xue-Mei Ding
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, No. 5 Jingyuan Street, Beijing 100043, China
| | - Shan Ke
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, No. 5 Jingyuan Street, Beijing 100043, China
| | - Zong-Hai Xin
- Department of General Surgery, Zhanhua People's Hospital, Shandong 256800, China
| | - Chun-Min Ning
- Department of General Surgery, Chaoyang Central Hospital, Liaoning 122000, China
| | - Shi-Gang Guo
- Department of General Surgery, Chaoyang Central Hospital, Liaoning 122000, China
| | - Xiao-Long Li
- Department of General Surgery, Affiliated Hospital of Chifeng University, Neimenggu 024000, China
| | - Yong-Hong Dong
- Department of General Surgery, Shanxi Provincial People's Hospital, Shanxi 032200, China
| | - Wen-Bing Sun
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, No. 5 Jingyuan Street, Beijing 100043, China
- * E-mail:
| |
Collapse
|
17
|
Santambrogio R, Bruno S, Kluger MD, Costa M, Salceda J, Belli A, Laurent A, Barabino M, Opocher E, Azoulay D, Cherqui D. Laparoscopic ablation therapies or hepatic resection in cirrhotic patients with small hepatocellular carcinoma. Dig Liver Dis 2016; 48:189-96. [PMID: 26675381 DOI: 10.1016/j.dld.2015.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 11/12/2015] [Accepted: 11/16/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Barcelona Clinic Liver Cancer staging system recommends radiofrequency ablation as treatment of choice for patients with "small" (up to 2 cm in size) hepatocellular carcinoma. AIMS Aim of the study was to assess whether laparoscopic ablation therapies or hepatic resection could be proposed as alternative option if percutaneous approach is not feasible. METHODS Overall survival and tumour recurrence rate were compared in a retrospective cohort of 176 consecutive patients with small hepatocellular carcinoma on cirrhosis treated by laparoscopic ablation therapies or surgery. To balance the covariates between the two groups, a propensity case-matched analysis was developed to generate a matched sample, which included 76 patients in each arm. RESULTS Local tumour progression (p=0.005), intra-segmental recurrence (p=0.0001), and 5-year recurrence rates (80% vs. 60%; p=0.0014) were significantly higher in the ablation therapies group. The 5-year survival rate were 48% after ablation therapies and 69% after hepatic resection (p=0.0006). Multivariate analysis showed that MELD score, alpha-fetoprotein value, procedure category and intraoperative restaging were associated with survival, while the surgery was the only independent predictor of intra-hepatic recurrence. CONCLUSIONS The present study suggests that, if percutaneous ablation is not feasible, hepatic resection may be considered as a sound option in the treatment of small hepatocellular carcinoma.
Collapse
Affiliation(s)
- Roberto Santambrogio
- Surgical Unit 2, Hepatobiliary-Pancreatic and Digestive, San Paolo Hospital, University of Milan, Italy.
| | - Savino Bruno
- Humanitas University Medicine and Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Michael D Kluger
- Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; Division of Gastrointestinal and Endocrine Surgery, Columbia College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, USA
| | - Mara Costa
- Surgical Unit 2, Hepatobiliary-Pancreatic and Digestive, San Paolo Hospital, University of Milan, Italy; Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Juan Salceda
- Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Andrea Belli
- Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; Department of Oncological Abdominal Surgery, National Tumour Institute "G. Pascale", Naples, Italy
| | - Alexis Laurent
- Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Matteo Barabino
- Surgical Unit 2, Hepatobiliary-Pancreatic and Digestive, San Paolo Hospital, University of Milan, Italy
| | - Enrico Opocher
- Surgical Unit 2, Hepatobiliary-Pancreatic and Digestive, San Paolo Hospital, University of Milan, Italy
| | - Daniel Azoulay
- Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Daniel Cherqui
- Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; Hepato-Biliary Centre, AP-HP Hospital Paul Brousse, Villejuif, France
| |
Collapse
|
18
|
Facciorusso A, Di Maso M, Muscatiello N. Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: A systematic review and meta-analysis. Int J Hyperthermia 2016; 32:339-44. [PMID: 26794414 DOI: 10.3109/02656736.2015.1127434] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Radiofrequency ablation (RFA) and microwave ablation (MWA) are the two main percutaneous techniques for the treatment of unresectable hepatocellular carcinoma (HCC). However, to date, studies comparing the two therapies have provided discordant results. The aim of this meta-analysis is to evaluate the efficacy and safety of the two treatments for HCC patients. MATERIALS AND METHODS A computerised bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. The rates of complete response (CR), local recurrence (LRR), 3-year survival (SR) and major complications were compared between the two treatment groups by using the Mantel-Haenszel test in cases of low heterogeneity or the DerSimonian and Laird test in cases of high heterogeneity. Sources of heterogeneity were investigated using subgroup analyses. In order to confirm our finding, sensitivity analysis was performed restricting the analysis to high-quality studies. RESULTS One randomised controlled trial (RCT) and six retrospective studies with 774 patients were included in the meta-analysis. A non-significant trend of higher CR rates in the patients treated with MWA was found (odds ratio (OR) = 1.12, 95% confidence interval (CI) 0.67-1.88, p = 0.67]. Overall LRR was similar between the two treatment groups (OR 1.01, 95% CI 0.53-1.87, p = 0.98) but MWA outperformed RFA in cases of larger nodules (OR 0.46, 95% CI 0.24-0.89, p = 0.02). 3-year SR was higher after RFA without statistically significant difference (OR 0.95, 95% CI 0.58-1.57, p = 0.85). Major complications were more frequent, although not significantly, in MWA patients (OR 1.63, 95% CI 0.88-3.03, p = 0.12). CONCLUSIONS Our results indicate a similar efficacy between the two percutaneous techniques with an apparent superiority of MWA in larger neoplasms.
Collapse
Affiliation(s)
- Antonio Facciorusso
- a Department of Medical Sciences , Section of Gastroenterology, University of Foggia , Italy
| | - Marianna Di Maso
- a Department of Medical Sciences , Section of Gastroenterology, University of Foggia , Italy
| | - Nicola Muscatiello
- a Department of Medical Sciences , Section of Gastroenterology, University of Foggia , Italy
| |
Collapse
|
19
|
Tuci F, Vitale A, D'Amico F, Gringeri E, Neri D, Zanus G, Bassi D, Polacco M, Boetto R, Lodo E, Germani G, Burra P, Angeli P, Cillo U. Survival benefit of transplantation for recurrence of hepatocellular carcinoma after liver resection. Transplant Proc 2015; 46:2287-9. [PMID: 25242770 DOI: 10.1016/j.transproceed.2014.07.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Liver transplantation (LT) for hepatocellular carcinoma (HCC) can be used for tumor recurrence after liver resection (LR) both for initially transplant-eligible patients as conventional salvage therapy (ST) and for non-transplant-eligible patients (beyond Milan criteria) with a goal of downstaging (DW). The aim of this study was to compare the intention-to-treat (ITT) survival rates of patients who are listed for LT, according to these two strategies. METHODS We analyzed a prospective database of 399 consecutive patients who underwent hepatic resection for HCC from 2002 to 2011 to identify patients included in the waiting list for tumor recurrence. Intention-to-treat (ITT) survivals were compared with those of patients resected for HCC within and beyond Milan criteria in the same period and not included in the LT waiting list. RESULTS The study group consisted of 42 patients, 28 in the ST group (within Milan) and 14 in the DW group (beyond Milan). The 5-year ITT survival rate was similar between the 2 groups, being 64% for ST and 60% for DW (P=.84). Twenty-five patients (15 ST and 10 DW) underwent LT, 13 (10 ST and 3 DW) were still awaiting LT, 4 (3 ST and 1 DW) dropped out of the waiting list because of tumor progression, and 7 (5 ST [33%] and 2 DW [20%]) had tumor recurrence. The 5-year ITT survival of ST patients was similar to that of 252 in-Milan HCC patients resected only (P=.3), whereas 5-year ITT survival of DW patients was significantly higher (P<.01) than that of 105 beyond-Milan HCC patients resected only. CONCLUSIONS LR seems to be a safe and effective therapy both as alternative to transplantation and as downstaging strategy for intermediate-advanced HCC. The survival benefit of salvage LT, however, seems to be higher in the 2nd than in the 1st group.
Collapse
Affiliation(s)
- F Tuci
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy
| | - A Vitale
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy.
| | - F D'Amico
- Unità di Emergenze Trapiantologiche, Azienda, Università di Padova, Padua, Italy
| | - E Gringeri
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy
| | - D Neri
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy
| | - G Zanus
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy
| | - D Bassi
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy
| | - M Polacco
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy
| | - R Boetto
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy
| | - E Lodo
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy
| | - G Germani
- Unità di Trapianto Multiviscerale, Azienda, Università di Padova, Padua, Italy
| | - P Burra
- Unità di Trapianto Multiviscerale, Azienda, Università di Padova, Padua, Italy
| | - P Angeli
- Unità di Emergenze Trapiantologiche, Azienda, Università di Padova, Padua, Italy
| | - U Cillo
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda, Università di Padova, Padua, Italy
| |
Collapse
|
20
|
de la Serna S, Vilana R, Sánchez-Cabús S, Calatayud D, Ferrer J, Molina V, Fondevila C, Bruix J, Fuster J, García-Valdecasas JC. Results of laparoscopic radiofrequency ablation for HCC. Could the location of the tumour influence a complete response to treatment? A single European centre experience. HPB (Oxford) 2015; 17:387-93. [PMID: 25545319 PMCID: PMC4402048 DOI: 10.1111/hpb.12379] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/21/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In selected patients, radiofrequency ablation (RFA) is a well-established treatment for hepatocellular carcinoma (HCC). However, subcapsular or lesions close to adjacent viscera preclude a percutaneous approach. In this setting laparoscopic-RFA (LRFA) is a potential alternative. The aim of this study was to analyse the safety and feasibility of LRFA in patients with HCC. PATIENTS AND METHODS Retrospective study of patients with HCC meeting strict inclusion criteria who underwent LRFA at a single Institution from December 2000 to March 2013. RESULTS Forty-one patients underwent 42 LRFA of 51 nodules. The median size of the nodule was 2.5 (range 1.2-4.7) cm. Thirty-one tumours were subcapsular and 17 located near the gallbladder. Major complications occurred in 17 patients. The initial complete response (ICR) rate was 94% and was lower among tumours located adjacent to the gallbladder. At the end of the follow-up period, the sustained complete response (SCR) rate was 70% and was lower in tumours adjacent to the gallbladder while increased for subcapsular tumours. The 1-, 3- and 5-year overall survival rate was 92.6%, 64.5% and 43%, respectively. CONCLUSION LRFA of HCC is safe, feasible and achieves excellent results in selected patients. LRFA should be the first-line technique for subcapsular lesions as it minimizes the risk of tumoural seeding and improves ICR. Proximity to gallbladder interferes in treatment efficacy (lower rate of ICR and lower rate of SCR).
Collapse
Affiliation(s)
- Sofía de la Serna
- HBP Surgery and Liver Transplantation Unit, University of BarcelonaBarcelona, Spain
| | - Ramón Vilana
- Barcelona Clinic Liver Cancer (BCLC), University of BarcelonaBarcelona, Spain
- Department of Radiology, Institut de Malalties Digestives i Metabòliques, IDIBAPS, University of BarcelonaBarcelona, Spain
| | | | - David Calatayud
- HBP Surgery and Liver Transplantation Unit, University of BarcelonaBarcelona, Spain
| | - Joana Ferrer
- HBP Surgery and Liver Transplantation Unit, University of BarcelonaBarcelona, Spain
- Barcelona Clinic Liver Cancer (BCLC), University of BarcelonaBarcelona, Spain
| | - Victor Molina
- HBP Surgery and Liver Transplantation Unit, University of BarcelonaBarcelona, Spain
| | | | - Jordi Bruix
- Barcelona Clinic Liver Cancer (BCLC), University of BarcelonaBarcelona, Spain
- Liver Unit, Hospital Clínic i Provincial, CIBERehd, University of BarcelonaBarcelona, Spain
| | - Josep Fuster
- HBP Surgery and Liver Transplantation Unit, University of BarcelonaBarcelona, Spain
- Barcelona Clinic Liver Cancer (BCLC), University of BarcelonaBarcelona, Spain
| | | |
Collapse
|
21
|
Hansen PD, Cassera MA, Wolf RF. Ablative technologies for hepatocellular, cholangiocarcinoma, and metastatic colorectal cancer of the liver. Surg Oncol Clin N Am 2014; 24:97-119. [PMID: 25444471 DOI: 10.1016/j.soc.2014.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A wide array of ablation technologies, in addition to the progressive sophistication of imaging technologies and percutaneous, laparoscopic, and open surgical techniques, have allowed us to expand treatment options for patients with liver tumors. In this article, technical considerations of chemical and thermal ablations and their application in hepatic oncology are reviewed.
Collapse
Affiliation(s)
- Paul D Hansen
- Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, Providence Portland Medical Center, 4805 NE Glisan St, Suite 6N60, Portland, OR 97213, USA.
| | - Maria A Cassera
- Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, Providence Portland Medical Center, 4805 NE Glisan St, Suite 6N60, Portland, OR 97213, USA
| | - Ronald F Wolf
- Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, Providence Portland Medical Center, 4805 NE Glisan St, Suite 6N60, Portland, OR 97213, USA
| |
Collapse
|
22
|
Cillo U, Noaro G, Vitale A, Neri D, D’Amico F, Gringeri E, Farinati F, Vincenzi V, Vigo M, Zanus G. Laparoscopic microwave ablation in patients with hepatocellular carcinoma: a prospective cohort study. HPB (Oxford) 2014; 16:979-86. [PMID: 24750429 PMCID: PMC4487748 DOI: 10.1111/hpb.12264] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/06/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES There are no prospective studies of laparoscopic microwave (MW) ablation in patients with hepatocellular carcinoma (HCC). The aim of this study was to demonstrate the safety and efficacy of laparoscopic MW ablation. METHODS A prospective study group of consecutive HCC patients considered ineligible for liver resection and/or percutaneous ablation was conducted from December 2009 to December 2010. Short-term (3-month) outcomes included a centralized revision of radiological response, mortality and morbidity. Mid-term (24-month) outcomes included time to recurrence in the study group compared with that in a cohort of consecutive patients treated with laparoscopic radiofrequency (RF) ablation using propensity score analysis. RESULTS A total of 42 patients were enrolled. Their median age was 64 years; 67% were positive for hepatitis C virus; 33% were of Child-Pugh class B status; the median tumour diameter was 2.5 cm, and 48% of patients had multinodular HCC. In 47 of 50 (94%) nodules treated with MW ablation, a complete radiological response was observed at 3 months. There was no perioperative mortality. The overall morbidity rate was 24%. The 2-year survival rate was 79% and the 2-year recurrence rate was 55%. Using propensity score analysis (in 28 MW ablation patients and 28 RF ablation controls), 2-year recurrence rates were 55% in the MW ablation group and 77% in the control group (P = 0.03). CONCLUSIONS Laparoscopic MW ablation is a safe and effective therapeutic option for selected HCC patients who are ineligible for liver resection and/or percutaneous ablation.
Collapse
Affiliation(s)
- Umberto Cillo
- Hepatobiliary Surgery and Liver Transplant Unit, University of Padua Hospital TrustPadua, Italy
| | - Giulia Noaro
- Hepatobiliary Surgery and Liver Transplant Unit, University of Padua Hospital TrustPadua, Italy
| | - Alessandro Vitale
- Hepatobiliary Surgery and Liver Transplant Unit, University of Padua Hospital TrustPadua, Italy,Correspondence, Alessandro Vitale, Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda Ospedaliera Universitaria di Padova, Via Giustiniani 2, 35128 Padua, Italy. Tel: + 39 049 821 8624. Fax: + 39 049 821 1816. E-mail:
| | - Daniele Neri
- Hepatobiliary Surgery and Liver Transplant Unit, University of Padua Hospital TrustPadua, Italy
| | - Francesco D’Amico
- Hepatobiliary Surgery and Liver Transplant Unit, University of Padua Hospital TrustPadua, Italy
| | - Enrico Gringeri
- Hepatobiliary Surgery and Liver Transplant Unit, University of Padua Hospital TrustPadua, Italy
| | - Fabio Farinati
- Division of Gastroenterology, University of Padua Hospital TrustPadua, Italy
| | - Valter Vincenzi
- Department of General Medicine, San Martino HospitalBelluno, Italy
| | - Mario Vigo
- Department of Diagnostic Imaging, Abano Terme General HospitalPadua, Italy
| | - Giacomo Zanus
- Hepatobiliary Surgery and Liver Transplant Unit, University of Padua Hospital TrustPadua, Italy
| | | |
Collapse
|
23
|
Murakami K, Naka S, Shiomi H, Akabori H, Kurumi Y, Morikawa S, Tani T. Initial experiences with MR Image-guided laparoscopic microwave coagulation therapy for hepatic tumors. Surg Today 2014; 45:1173-8. [DOI: 10.1007/s00595-014-1042-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/15/2014] [Indexed: 02/06/2023]
|