BACKGROUND Patients with liver cancer complicated by portal hypertension present complex challenges in treatment.AIM To evaluate the efficacy of radiofrequency ablation in combination with sorafenib for improving live...BACKGROUND Patients with liver cancer complicated by portal hypertension present complex challenges in treatment.AIM To evaluate the efficacy of radiofrequency ablation in combination with sorafenib for improving liver function and its impact on the prognosis of patients with this condition.METHODS Data from 100 patients with liver cancer complicated with portal hypertension from May 2014 to March 2019 were analyzed and divided into a study group(n=50)and a control group(n=50)according to the treatment regimen.The research group received radiofrequency ablation(RFA)in combination with sorafenib,and the control group only received RFA.The short-term efficacy of both the research and control groups was observed.Liver function and portal hypertension were compared before and after treatment.Alpha-fetoprotein(AFP),glypican-3(GPC-3),and AFP-L3 levels were compared between the two groups prior to and after treatment.The occurrence of adverse reactions in both groups was observed.The 3-year survival rate was compared between the two groups.Basic data were compared between the survival and non-surviving groups.To identify the independent risk factors for poor prognosis in patients with liver cancer complicated by portal hypertension,multivariate logistic regression analysis was employed.RESULTS When comparing the two groups,the research group's total effective rate(82.00%)was significantly greater than that of the control group(56.00%;P<0.05).Following treatment,alanine aminotransferase and aspartate aminotransferase levels increased,and portal vein pressure decreased in both groups.The degree of improvement for every index was substantially greater in the research group than in the control group(P<0.05).Following treatment,the AFP,GPC-3,and AFP-L3 levels in both groups decreased,with the research group having significantly lower levels than the control group(P<0.05).The incidence of diarrhea,rash,nausea and vomiting,and fatigue in the research group was significantly greater than that in the control group(P<0.05).The 1-,2-,and 3-year survival rates of the research group(94.00%,84.00%,and 72.00%,respectively)were significantly greater than those of the control group(80.00%,64.00%,and 40.00%,respectively;P<0.05).Significant differences were observed between the survival group and the non-surviving group in terms of Child-Pugh grade,history of hepatitis,number of tumors,tumor size,use of sorafenib,stage of liver cancer,histological differentiation,history of splenectomy and other basic data(P<0.05).Logistic regression analysis demonstrated that high Child-Pugh grade,tumor size(6–10 cm),history of hepatitis,no use of sorafenib,liver cancer stage IIIC,and previous splenectomy were independent risk factors for poor prognosis in patients with liver cancer complicated with portal hypertension(P<0.05).CONCLUSION Patients suffering from liver cancer complicated by portal hypertension benefit from the combination of RFA and sorafenib therapy because it effectively restores liver function and increases survival rates.The prognosis of patients suffering from liver cancer complicated by portal hypertension is strongly associated with factors such as high Child-Pugh grade,tumor size(6-10 cm),history of hepatitis,lack of sorafenib use,liver cancer at stage IIIC,and prior splenectomy.展开更多
BACKGROUND Patients with tetralogy of Fallot(TOF)often have arrhythmias,commonly being atrial fibrillation(AF).Radiofrequency ablation is an effective treatment for AF and does not usually cause severe postoperative h...BACKGROUND Patients with tetralogy of Fallot(TOF)often have arrhythmias,commonly being atrial fibrillation(AF).Radiofrequency ablation is an effective treatment for AF and does not usually cause severe postoperative hypoxemia,but the risk of complications may increase in patients with conditions such as TOF.CASE SUMMARY We report a young male patient with a history of TOF repair who developed severe hypoxemia after radiofrequency ablation for AF and was ultimately confirmed to have a new right-to-left shunt.The patient subsequently underwent atrial septal occlusion and eventually recovered.CONCLUSION Radiofrequency ablation may cause iatrogenic atrial septal injury;thus possible complications should be predicted in order to ensure successful treatment and patient safety.展开更多
The role of endoscopic ultrasound(EUS)in the last two decades has shifted from a diagnostic tool to an important therapeutic tool treating mainly pancreatobiliary disorders.In recent years,its applications for treatin...The role of endoscopic ultrasound(EUS)in the last two decades has shifted from a diagnostic tool to an important therapeutic tool treating mainly pancreatobiliary disorders.In recent years,its applications for treating pancreatic diseases have broadened,including the implementation of radiofrequency ablation(RFA),which has been traditionally used for treating solid tumors.In this critical indepth review,we summarized all the papers throughout the literature regarding EUS-RFA for pancreatic neuroendocrine neoplasms,adenocarcinoma,and pancreatic cystic lesions.Overall,for pancreatic neuroendocrine neoplasms we identified 16 papers that reported 96 patients who underwent EUS-RFA,with acceptable adverse events that were rated mild to moderate and a high complete radiological resolution rate of 90%.For pancreatic adenocarcinoma,we identified 8 papers with 121 patients.Adverse events occurred in 13%of patients,mostly rated mild.However,no clear survival benefit was demonstrated.For pancreatic cystic lesions,we identified 4 papers with 38 patients.The adverse events were mostly mild and occurred in 9.1%of patients,and complete or partial radiological resolution of the cysts was reported in 36.8%.Notably,the procedure was technically feasible for most of the patients.Nevertheless,a long road remains before this technique finds its definite place in guidelines due to several controversies.EUS-RFA for pancreatic tumors seems to be safe and effective,especially for pancreatic neuroendocrine neoplasms,but multicenter prospective trials are needed to consider this treatment as a gold standard.展开更多
Background:About 10%-20%of all individuals who develop hepatocellular carcinoma(HCC)do not have cirrhosis.Comparisons are rarely reported regarding the effectiveness of radiofrequency ablation(RFA)and liver resection(...Background:About 10%-20%of all individuals who develop hepatocellular carcinoma(HCC)do not have cirrhosis.Comparisons are rarely reported regarding the effectiveness of radiofrequency ablation(RFA)and liver resection(LR)in survival of HCC without cirrhosis and stratification by tumor size≤5 cm.Methods:We used the Surveillance,Epidemiology,and End Results(SEER)database and identified 1505 patients with a solitary HCC tumor≤5 cm who underwent RFA or LR during 2004-2015.Patients were classified into non-cirrhosis and cirrhosis groups and each group was categorized into three subgroups,according to tumor size(≤30 mm,31-40 mm,41-50 mm).Results:In patients without cirrhosis,LR showed better 5-year HCC cancer-specific survival than RFA in all tumor size subgroups(≤30 mm:82.51%vs.56.42%;31-40 mm:71.31%vs.46.83%;41-50 mm:74.7%vs.37.5%;all P<0.05).Compared with RFA,LR was an independent protective factor for HCC cancer-specific survival in multivariate Cox analysis[≤30 mm:hazard ratio(HR)=0.533,95%confidence interval(CI):0.313-0.908;31-40 mm:HR=0.439,95%CI:0.201-0.957;41-50 mm:HR=0.382;95%CI:0.159-0.916;all P<0.05].In patients with cirrhosis,for both tumor size≤30 mm and 31-40 mm groups,there were no significant survival differences between RFA and LR in multivariate analysis(all P>0.05).However,in those with tumor size 41-50 mm,LR showed significantly better 5-year HCC cancer-specific survival than RFA in both univariate(54.72%vs.23.06%;P<0.001)and multivariate analyses(HR=0.297;95%CI:0.136-0.648;P=0.002).Conclusions:RFA is an inferior treatment option to LR for patients without cirrhosis who have a solitary HCC tumor≤5 cm.展开更多
Objective:This study aimed to evaluate the safety and efficacy outcomes of percutaneous radiofrequency ablation(RFA)for localised renal cell carcinoma(RCC)in a tertiary hospital patient who remained unfit for surgical...Objective:This study aimed to evaluate the safety and efficacy outcomes of percutaneous radiofrequency ablation(RFA)for localised renal cell carcinoma(RCC)in a tertiary hospital patient who remained unfit for surgical intervention.Methods:We retrospectively analysed survival outcomes for patients with biopsy proven RCC treated by RFA at Royal Perth Hospital between September 2009 and May 2018.Complication data were gathered for all patients that underwent renal RFA along with 2-and 5-year recurrence-free survival(RFS)rate and compared the outcomes with data from previous studies.Results:A total of 69 patients(73 procedures)were eligible for the study,and those patients had biopsy-proven RCC with a minimum of 2-year follow-up.The complication rate was 8.2%(6/73)and local recurrence rate 9.6%(7/73).Two-year RFS is 95.7% and 5-year RFS is 78.8% on a median 3.82-year follow-up(interquartile range 1.90-5.75 years).Conclusion:RFA performed at our centre was found to be safe and effective with low complication rates and durable RFS in line with expectations from existing research.Our study demonstrated that RFA is an alternative modality of treatment for small renal tumours in patients unfit for surgical approach.展开更多
BACKGROUND Radiofrequency ablation(RFA)is an effective and safe treatment for hepatocellular carcinoma that features a lower incidence of serious complications than surgical resection.Hemocholecyst caused by RFA is a ...BACKGROUND Radiofrequency ablation(RFA)is an effective and safe treatment for hepatocellular carcinoma that features a lower incidence of serious complications than surgical resection.Hemocholecyst caused by RFA is a rare complication of secondary damage to the intrahepatic bile duct that results in hemobilia.CASE SUMMARY Here we report on a case of a hemocholecyst caused by accidental injury during RFA that induced hematemesis and melena.Digital subtraction angiography revealed no gallbladder arterial injuries.After conservative treatment and transcatheter arterial chemoembolization,the patient’s condition stabilized,and she was discharged 1 wk later.CONCLUSION Therefore,when performing interventional procedures such as RFA,clinicians must be vigilant because even minor injuries can lead to serious complications such as hemocholecyst.展开更多
Recently,endoscopic intraductal radiofrequency ablation(ID-RFA)has attracted attention as a local treatment method for malignant biliary obstruction(MBO).IDRFA causes coagulative necrosis of the tumor tissue in the st...Recently,endoscopic intraductal radiofrequency ablation(ID-RFA)has attracted attention as a local treatment method for malignant biliary obstruction(MBO).IDRFA causes coagulative necrosis of the tumor tissue in the stricture and induces exfoliation.Its effects are expected to extend the patency period of biliary stents and prolong the survival period.Evidence for extrahepatic cholangiocarcinoma(eCCA)is gradually accumulating,and some reports show significant therapeutic effects in eCCA patients without distant metastasis.However,it is still far from an established treatment technique,and many unsolved problems remain.Therefore,when performing ID-RFA in clinical practice,it is necessary to understand and grasp the current evidence well and to operate appropriately for the true benefit of the patients.This paper reviews the current status,issues,and prospects of endoscopic ID-RFA for MBO,especially for eCCA.展开更多
Cardiac magnetic resonance(CMR)imaging could enable major advantages when guiding in real-time cardiac electrophysiology procedures offering high-resolu-tion anatomy,arrhythmia substrate,and ablation lesion visualizat...Cardiac magnetic resonance(CMR)imaging could enable major advantages when guiding in real-time cardiac electrophysiology procedures offering high-resolu-tion anatomy,arrhythmia substrate,and ablation lesion visualization in the absence of ionizing radiation.Over the last decade,technologies and platforms for performing electrophysiology procedures in a CMR environment have been developed.However,performing procedures outside the conventional fluoro-scopic laboratory posed technical,practical and safety concerns.The development of magnetic resonance imaging compatible ablation systems,the recording of high-quality electrograms despite significant electromagnetic interference and reliable methods for catheter visualization and lesion assessment are the main limiting factors.The first human reports,in order to establish a procedural workflow,have rationally focused on the relatively simple typical atrial flutter ablation and have shown that CMR-guided cavotricuspid isthmus ablation represents a valid alternative to conventional ablation.Potential expansion to other more complex arrhythmias,especially ventricular tachycardia and atrial fibrillation,would be of essential impact,taking into consideration the widespread use of substrate-based strategies.Importantly,all limitations need to be solved before application of CMR-guided ablation in a broad clinical setting.展开更多
Pancreatic malignancy is still the most lethal gastrointestinal malignancy.It has a very poor prognosis with low survival rate.Surgery is still the main treatment option for pancreatic malignancy.Most patients already...Pancreatic malignancy is still the most lethal gastrointestinal malignancy.It has a very poor prognosis with low survival rate.Surgery is still the main treatment option for pancreatic malignancy.Most patients already have locally advanced and even late stage disease due to non-specific abdominal symptoms.Even though some cases are still suitable for surgical treatment,due to its aggressiveness adjuvant chemotherapy is becoming the standard treatment for controlling the disease.Radiofrequency ablation(RFA)is a thermal therapy that has been used as one of the standard treatments for liver malignancy.It can also be performed intraoperatively.There are several reports on percutaneous RFA treatment for pancreatic malignancy using transabdominal ultrasound and guided by computed tomography scan.However,due to its anatomical location and the risk of high radiation exposure,these methods seem to be very limited.Endoscopic ultrasound(EUS)has been widely used for pancreatic abnormality evaluation due to its ability to detect more accurately,especially small pancreatic lesions,compared to other imaging modalities.By the EUS approach,it is easier to achieve good visualization of tumor ablation and necrosis as the echoendoscope position is closer to the tumor area.Based on studies and a recent meta-analysis,EUS-guided RFA is a promising treatment approach for most pancreatic malignancy cases,but most studies only collected data from a small sample size.Larger studies are needed before clinical recommendations can be made.展开更多
AIM:To evaluate survival and recurrence after radiofrequency ablation(RFA) for the treatment of small hepatocellular carcinoma(HCC) using a meta-analysis.METHODS:Literature on RFA vs surgical resection for the treatme...AIM:To evaluate survival and recurrence after radiofrequency ablation(RFA) for the treatment of small hepatocellular carcinoma(HCC) using a meta-analysis.METHODS:Literature on RFA vs surgical resection for the treatment of small HCC published between January 1990 and December 2008 was retrieved.A metaanalysis was conducted to estimate pooled survival and recurrence ratios.A fixed or random effect model was established to collect the data.RESULTS:The differences in overall survival at 1-year,3-years and at end of follow-up were not statistically significant between the RFA and surgery groups(P > 0.05).There were no differences in 1-year and 3-year recurrences between the RFA and surgery groups(P > 0.05).However,recurrence in the RFA group was lower than that in the surgery group up to the end of follow-up(P = 0.03).Survival was not significantly different.There was a significant difference in recurrences at the end of follow-up after RFA compared with surgical resection.CONCLUSION:RFA did not decrease the number of overall recurrences,and had no effect on survival when compared with surgical resection in a selected group of patients.展开更多
AIM: To analyze the combined treatment of resection and intraoperative radiofrequency ablation (RFA) for multifocal hepatocellular carcinoma in terms of prognosis and surgical outcomes.METHODS: This study was a retros...AIM: To analyze the combined treatment of resection and intraoperative radiofrequency ablation (RFA) for multifocal hepatocellular carcinoma in terms of prognosis and surgical outcomes.METHODS: This study was a retrospective case comparison study using prospectively collected data. The study covered the period from April 2001 to December 2006. The data of 200 patients with histologically confirmed hepatocellular carcinoma were reviewed. Nineteen patients (17 men and 2 women) having received resection in combination with RFA were chosen as subjects of the study (the combination group). Fiftyfour patients (43 men and 11 women) having received resection alone were selected for comparison (the resection group). The two groups matched tumor number and tumor size, and all the patients in the two groups displayed no tumor rupture, major vascular involvement and distant metastasis. Their demographics, preoperative assessment, disease recurrence patterns, overall survival and diseasefree survival were compared.RESULTS: In the combination group, the medianage was 65 years (range, 3477 years), the median tumor number was 3 (range, 29), and the median tumor size was 6 cm (range, 1.214 cm). In the resection group, the median age was 51.5 years (range, 2780 years, P = 0.003), the median tumor number was 3 (range, 29, P = 0.574), and the median tumor size was 6 cm (range, 114 cm, P = 0.782). The two groups were similar in characteristics of tumors and comorbidities, and had comparable results in preoperative liver function tests. All patients had ChildPugh class A status. Bilobar involvement occurred in 14 patients (73.6%) in the combination group and 3 patients (5.5%) in the resection group (P = 0.04). Six patients (32%) in the combination group and 35 patients (65%) in the resection group underwent major hepatectomy. Thirteen patients (68%) in the combination group and 19 patients (35%) in the resection group underwent minor hepatectomy (P = 0.012). The combination group had fewer major resections (32% vs 65%, P = 0.012), less blood loss (400 vs 657 mL, P = 0.007), shorter operation time (270 vs 400 min, P = 0.001), and shorter hospital stay (7 vs 8.5 d, P = 0.042). The two groups displayed no major differences in surgical complications (15.8% vs 31.5%, P = 0.24), disease recurrence (63.2% vs 50%, P = 0.673), hospital mortality (5.3% vs 5.6%, P = 1), and overall survival (53 vs 44.5 mo, P = 0.496).CONCLUSION: Safe and effective for selected patients with multifocal hepatocellular carcinoma, the combination of resection and intraoperative RFA widens the applicability of surgical intervention for the disease.展开更多
We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation a...We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation and measured the total spleen and ablated volumes with contrast-enhanced computed tomography and volumetry. No major complications occurred, thrombocytopenia was resolved, and platelet levels remained stable, which allowed for early treatment of the patient's underlying disease. Previous work has shown that splenic radiofrequency ablation is an attractive alternative treatment for hypersplenism induced by liver cirrhosis. We aimed to contribute to the currently sparse literature evaluating the role of radiofrequency ablation(RFA) in the management of hypersplenism. We conclude that splenic RFA appears to be a viable and promising option for the treatment of hypersplenism.展开更多
AIM: To evaluate the feasibility, efficacy and safety of intraoperative radiofrequency ablation (RFA) combined with 125 iodine seed implantation for unresectable pancreatic cancer. METHODS: Thirty-two patients (21 mal...AIM: To evaluate the feasibility, efficacy and safety of intraoperative radiofrequency ablation (RFA) combined with 125 iodine seed implantation for unresectable pancreatic cancer. METHODS: Thirty-two patients (21 males and 11 females) at the age of 68 years (range 48-90 years) with unresectable locally advanced pancreatic cancer admitted to our hospital from January 2006 to May 2008 were enrolled in this study. The tumor, 4-12 cm in diameter, located in pancreatic head of 23 patients and in pancreatic body and tail of 9 patients, was found to be unresectable during operation. Diagnosis of pancreatic cancer was made through intraoperative biopsy. Patients were treated with FRA combined with 125 iodine seed implantation. In brief, a RFA needle was placed, which was confirmed by intraoperative ultrasound to decrease the potential injury of surrounding vital structures, a 125 iodine seed was implanted near the blood vessels and around the tumor border followed by bypass palliative procedure (cholangio-jejunostomy and/or gastrojejunostomy) in 29 patients.RESULTS: The serum CA 19-9 level was decreased from 512 ± 86 U/mL before operation to 176 ± 64 U/mL, 108 ± 42 U/mL and 114 ± 48 U/mL, respectively, 1, 3 and 6 mo after operation (P < 0.05). The pain score on day 7 after operation, 1 and 3 mo after combined therapy was decreased from 5.86 ± 1.92 before operation to 2.65 ± 1.04, 1.65 ± 0.88 and 2.03 ± 1.16, respectively, after operation (P < 0.05). The rate of complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD) in 32 patients was 21.8% (7/32), 56.3% (18/32), 15.6% (5/32) and 6.3% (2/32), respectively, 6 mo after operation, with a median overall survival time of 17. 5 mo. The median survival time of patients at stage Ⅲ was longer than that of those at stage Ⅳ (19 mo vs 10 mo, P = 0.0026). The median survival time of patients who received and did not receive chemotherapy after operation was 20 mo and 16 mo, respectively (P = 0.0176). Of the 32 patients, 3 (10.6%) experienced postoperative complications including transient biliary leaks in 2 patients and acute pancreatitis in 1 patient. All the patients recovered well after conservative support treatment. CONCLUSION: Intraoperative RFA combined with 125 iodine seed implantation is a feasible and safe procedure for unresectable pancreatic cancer with acceptable minor complications, and can prolong the survival time of patients, especially those at stage Ⅲ.展开更多
Radiofrequency ablation(RFA)of pancreatic neoplasms is restricted to locally advanced,non-resectable but nonmetastatic tumors.RFA of pancreatic tumors is nowadays an ultrasound-guided procedure performed during laparo...Radiofrequency ablation(RFA)of pancreatic neoplasms is restricted to locally advanced,non-resectable but nonmetastatic tumors.RFA of pancreatic tumors is nowadays an ultrasound-guided procedure performed during laparotomy in open surgery.Intraoperative ultrasound covers the mandatory role of staging,evaluation of feasibility,guidance and monitoring of the procedure.Different types of needle can be used.The first aim in the evaluation of RFA as a treatment for locally advanced pancreatic ductal adenocarcinoma,in order of evaluation but not of importance,is to determine the feasibility of the procedure.The second aim is to establish the effect of RFA on tumoral mass in terms of necrosis andcytoreduction.The most important aim,third in order of evaluation,is the potential improvement of quality of life and survival rate.Nowadays,only a few studies assess the feasibility of the procedure.The present paper is an overview of RFA for pancreatic adenocarcinoma.展开更多
Objective: Most recurrent intrahepatic cholangiocarcinoma (RICC) lost the opportunity of radical resection while most nonsurgical management failed to prolong patients' survival. The efficacy and safety of radiofr...Objective: Most recurrent intrahepatic cholangiocarcinoma (RICC) lost the opportunity of radical resection while most nonsurgical management failed to prolong patients' survival. The efficacy and safety of radiofrequency ablation (RFA) as a local treatment for recurrent hepatocellular carcinoma have been confirmed by many clinical studies. The purpose of this study was to evaluate the efficacy, long-term survival and complications of RFA for RICC. Methods: A total of 12 patients with 19 RICCs after radical resection were included in this study. The tumors were 1.9-6.8 cm at the maximum diameter (median, 3.2±1.6 cm). All patients were treated with ultrasound guided RFA. There were two RFA approaches including percutaneous and open. Results: A total of 18 RFA treatment sessions were performed. Ablation was successful (evaluated by 1-month CT after the initial RFA procedure) in 18 (94.7%) of 19 tumors. By a median follow-up period of 29.9 months after RFA, 5 patients received repeated RFA because of intrahepatic lesion recurrence. The median local recurrence-free survival period and median event-free survival period after RFA were 21.0 months and 13.0 months, respectively. The median overall survival was 30 months, and the 1- and 3-year survival rates were 87.5% and 37.5%, respectively. The complication rate was 5.6% (1/18 sessions). The only one major complication was pleural effusion requiring thoracentesis. Conclusion: This study showed RFA may effectively and safely manage RICC with 3-year survival of 37.5%. It provides a treatment option for these RICC patients who lost chance for surgery.展开更多
A 51-year-old Chinese male with a 20-year history of hepatitis B was diagnosed with hepatocellular carcinoma in the right anterior portion of the liver, sized 3.5 cm × 3.2 cm, and was treated with radiofrequency ...A 51-year-old Chinese male with a 20-year history of hepatitis B was diagnosed with hepatocellular carcinoma in the right anterior portion of the liver, sized 3.5 cm × 3.2 cm, and was treated with radiofrequency ablation (RFA) on December 18, 2001. The patient did not receive antiviral therapy for hepatitis B virus after RFA. The treated lesion reduced gradually and reached its minimum size of 1.7 cm × 1.5 cm seven years later on November 18, 2008. However computed tomography findings revealed that a recurrence lesion of 6.0 cm × 4.8 cm which was histologically confirmed overlapped the previous treated lesion at the 8th year on December 3, 2009. Although recurrence at 8 years after curative RFA is a rare event, such a possibility must be kept in mind. To find and treat the recurrence lesion promptly, long-term and close monitoring is warranted after RFA. Meanwhile, the recurrence-prevention therapy is as important as close monitoring for those patients with a history of hepatitis B.展开更多
BACKGROUND Surgical resection and radiofrequency ablation(RFA)represent two possible strategy in treatment of hepatocellular carcinoma(HCC)in Milan criteria.AIM To evaluate short-and long-term outcome in elderly patie...BACKGROUND Surgical resection and radiofrequency ablation(RFA)represent two possible strategy in treatment of hepatocellular carcinoma(HCC)in Milan criteria.AIM To evaluate short-and long-term outcome in elderly patients(>70 years)with HCC in Milan criteria,which underwent liver resection(LR)or RFA.METHODS The study included 594 patients with HCC in Milan criteria(429 in LR group and 165 in RFA group)managed in 10 European centers.Statistical analysis was performed using the Kaplan-Meier method before and after propensity score matching(PSM)and Cox regression.RESULTS After PSM,we compared 136 patients in the LR group with 136 patients in the RFA group.Overall survival at 1,3,and 5 years was 91%,80%,and 76%in the LR group and 97%,67%,and 41%in the RFA group respectively(P=0.001).Diseasefree survival at 1,3,and 5 years was 84%,60%and 44%for the LR group,and 63%,36%,and 25%for the RFA group(P=0.001).Postoperative Clavien-Dindo IIIIV complications were lower in the RFA group(1%vs 11%,P=0.001)in association with a shorter length of stay(2 d vs 7 d,P=0.001).In multivariate analysis,Model for End-stage Liver Disease(MELD)score(>10)[odds ratio(OR)=1.89],increased value of international normalized ratio(>1.3)(OR=1.60),treatment with radiofrequency(OR=1.46),and multiple nodules(OR=1.19)were independent predictors of a poor overall survival while a high MELD score(>10)(OR=1.51)and radiofrequency(OR=1.37)were independent factors associated with a higher recurrence rate.CONCLUSION Despite a longer length of stay and a higher rate of severe postoperative complications,surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients(>70 years)with HCC in Milan criteria.展开更多
Background:A ruptured hepatocellular carcinoma(HCC)is often fatal.In addition to surgery and transarterial embo?lization,radiofrequency ablation(RFA)might be another option for treating a ruptured HCC.Unfortunately,co...Background:A ruptured hepatocellular carcinoma(HCC)is often fatal.In addition to surgery and transarterial embo?lization,radiofrequency ablation(RFA)might be another option for treating a ruptured HCC.Unfortunately,conven?tional RFA has a limited ablation zone;as such,it is rarely used to treat ruptured tumors.Case presentation:This case was a 60?year?old man who had a large,ruptured HCC in which hydrochloric acid(HCl)?enhanced RFA successfully controlled the bleeding and made the tumor completely necrotic.Conclusion:Considering the effectiveness of HCl?enhanced RFA in achieving hemostasis and tumor ablation,it might be a new option for treating large,ruptured HCCs.展开更多
Background: Gold standard for colorectal liver metastases(CRLM) remains hepatic resection(HR). However, patients with severe comorbidities, unresectable or deep-situated resectable CRLM are candidates for ablation. Th...Background: Gold standard for colorectal liver metastases(CRLM) remains hepatic resection(HR). However, patients with severe comorbidities, unresectable or deep-situated resectable CRLM are candidates for ablation. The aim of the study was to compare recurrence rate and survival benefit of the microwave ablation(MWA), radiofrequency ablation(RFA) and HR by conducting the first network meta-analysis. Data sources: Systematic search of the literature was conducted in the electronic databases. Both updated traditional and network meta-analyses were conducted and the results were compared between them. Results: HR cohort demonstrated significantly less local recurrence rate and better 3-and 5-year diseasefree(DFS) and overall survival(OS) compared to MWA and RFA cohorts. HR cohort included significantly younger patients and with significantly lower preoperative carcinoembryonic antigen(CEA) by 10.28 ng/m L compared to RFA cohort. Subgroup analysis of local recurrence and OS of solitary and ≤3 cm CRLMs did not demonstrate any discrepancies when compared with the whole sample. Conclusions: For resectable CRLM the treatment of choice still remains HR. MWA and RFA can be used as a single or adjunct treatment in patients with unresectable CRLM and/or prohibitive comorbidities.展开更多
BACKGROUND Extrahepatic metastasis(EHM)of hepatocellular carcinoma(HCC)is associated with poor outcomes.However,the clinical features and risk factors of EHM of HCC after radiofrequency ablation(RFA)remain unclear.AIM...BACKGROUND Extrahepatic metastasis(EHM)of hepatocellular carcinoma(HCC)is associated with poor outcomes.However,the clinical features and risk factors of EHM of HCC after radiofrequency ablation(RFA)remain unclear.AIM To elucidate the characteristics and risk factors of EHM after RFA for HCC.METHODS From January 2008 to December 2017,we retrospectively enrolled 661 patients who underwent RFA as first-line treatment for HCC at 2 tertiary hospitals.The inclusion criteria were age≥18 years,a diagnosis of HCC,and treatment-naivety.Abdominal computed tomography(CT)or magnetic resonance imaging(MRI)and alpha-fetoprotein measurements were routinely performed at 1 mo after RFA and followed-up at intervals of 3-6 mo.Univariate analyses were performed using the chi-squared test or Student’s t-test,and univariate and multivariate analyses were performed via logistic regression,as appropriate.RESULTS EHM was diagnosed in 44 patients(6.7%)during a median follow-up period of 1204 days.The 10-year cumulative rate of HCC recurrence and EHM was 92.7%and 33.7%,respectively.Initial recurrence was most often intrahepatic,and the rate of extrahepatic recurrence at initial recurrence was only 1.2%.The median time to the diagnosis of EHM was 2.68 years,and 68.2%of patients developed EHM within 2 years of the first recurrence,regardless of recurrence-free survival and 75.0%of patients developed EHM within 5 years after first recurrence.EHM was mostly diagnosed via abdominal CT/MRI in 33(75.0%)and 38 of 44 patients(86.4%)with EHM had either positive abdominal CT scan results or serum AFP level elevation.In multivariate analysis,recurrence-free survival<2 years,ablation zone/tumor size<2,and alpha-fetoprotein level>400 IU/mL were associated with a high EHM risk.CONCLUSION EHM occurs following multiple intrahepatic recurrences after RFA and combined contrast-enhanced abdominal CT and serum AFP were useful for surveillance.Patients especially with high-risk factors require close follow-up for EHM.展开更多
文摘BACKGROUND Patients with liver cancer complicated by portal hypertension present complex challenges in treatment.AIM To evaluate the efficacy of radiofrequency ablation in combination with sorafenib for improving liver function and its impact on the prognosis of patients with this condition.METHODS Data from 100 patients with liver cancer complicated with portal hypertension from May 2014 to March 2019 were analyzed and divided into a study group(n=50)and a control group(n=50)according to the treatment regimen.The research group received radiofrequency ablation(RFA)in combination with sorafenib,and the control group only received RFA.The short-term efficacy of both the research and control groups was observed.Liver function and portal hypertension were compared before and after treatment.Alpha-fetoprotein(AFP),glypican-3(GPC-3),and AFP-L3 levels were compared between the two groups prior to and after treatment.The occurrence of adverse reactions in both groups was observed.The 3-year survival rate was compared between the two groups.Basic data were compared between the survival and non-surviving groups.To identify the independent risk factors for poor prognosis in patients with liver cancer complicated by portal hypertension,multivariate logistic regression analysis was employed.RESULTS When comparing the two groups,the research group's total effective rate(82.00%)was significantly greater than that of the control group(56.00%;P<0.05).Following treatment,alanine aminotransferase and aspartate aminotransferase levels increased,and portal vein pressure decreased in both groups.The degree of improvement for every index was substantially greater in the research group than in the control group(P<0.05).Following treatment,the AFP,GPC-3,and AFP-L3 levels in both groups decreased,with the research group having significantly lower levels than the control group(P<0.05).The incidence of diarrhea,rash,nausea and vomiting,and fatigue in the research group was significantly greater than that in the control group(P<0.05).The 1-,2-,and 3-year survival rates of the research group(94.00%,84.00%,and 72.00%,respectively)were significantly greater than those of the control group(80.00%,64.00%,and 40.00%,respectively;P<0.05).Significant differences were observed between the survival group and the non-surviving group in terms of Child-Pugh grade,history of hepatitis,number of tumors,tumor size,use of sorafenib,stage of liver cancer,histological differentiation,history of splenectomy and other basic data(P<0.05).Logistic regression analysis demonstrated that high Child-Pugh grade,tumor size(6–10 cm),history of hepatitis,no use of sorafenib,liver cancer stage IIIC,and previous splenectomy were independent risk factors for poor prognosis in patients with liver cancer complicated with portal hypertension(P<0.05).CONCLUSION Patients suffering from liver cancer complicated by portal hypertension benefit from the combination of RFA and sorafenib therapy because it effectively restores liver function and increases survival rates.The prognosis of patients suffering from liver cancer complicated by portal hypertension is strongly associated with factors such as high Child-Pugh grade,tumor size(6-10 cm),history of hepatitis,lack of sorafenib use,liver cancer at stage IIIC,and prior splenectomy.
文摘BACKGROUND Patients with tetralogy of Fallot(TOF)often have arrhythmias,commonly being atrial fibrillation(AF).Radiofrequency ablation is an effective treatment for AF and does not usually cause severe postoperative hypoxemia,but the risk of complications may increase in patients with conditions such as TOF.CASE SUMMARY We report a young male patient with a history of TOF repair who developed severe hypoxemia after radiofrequency ablation for AF and was ultimately confirmed to have a new right-to-left shunt.The patient subsequently underwent atrial septal occlusion and eventually recovered.CONCLUSION Radiofrequency ablation may cause iatrogenic atrial septal injury;thus possible complications should be predicted in order to ensure successful treatment and patient safety.
文摘The role of endoscopic ultrasound(EUS)in the last two decades has shifted from a diagnostic tool to an important therapeutic tool treating mainly pancreatobiliary disorders.In recent years,its applications for treating pancreatic diseases have broadened,including the implementation of radiofrequency ablation(RFA),which has been traditionally used for treating solid tumors.In this critical indepth review,we summarized all the papers throughout the literature regarding EUS-RFA for pancreatic neuroendocrine neoplasms,adenocarcinoma,and pancreatic cystic lesions.Overall,for pancreatic neuroendocrine neoplasms we identified 16 papers that reported 96 patients who underwent EUS-RFA,with acceptable adverse events that were rated mild to moderate and a high complete radiological resolution rate of 90%.For pancreatic adenocarcinoma,we identified 8 papers with 121 patients.Adverse events occurred in 13%of patients,mostly rated mild.However,no clear survival benefit was demonstrated.For pancreatic cystic lesions,we identified 4 papers with 38 patients.The adverse events were mostly mild and occurred in 9.1%of patients,and complete or partial radiological resolution of the cysts was reported in 36.8%.Notably,the procedure was technically feasible for most of the patients.Nevertheless,a long road remains before this technique finds its definite place in guidelines due to several controversies.EUS-RFA for pancreatic tumors seems to be safe and effective,especially for pancreatic neuroendocrine neoplasms,but multicenter prospective trials are needed to consider this treatment as a gold standard.
基金the National Natural Science Foundation of China(82173353)Top talent scientific research project of“six one projects”(LGY2018028).
文摘Background:About 10%-20%of all individuals who develop hepatocellular carcinoma(HCC)do not have cirrhosis.Comparisons are rarely reported regarding the effectiveness of radiofrequency ablation(RFA)and liver resection(LR)in survival of HCC without cirrhosis and stratification by tumor size≤5 cm.Methods:We used the Surveillance,Epidemiology,and End Results(SEER)database and identified 1505 patients with a solitary HCC tumor≤5 cm who underwent RFA or LR during 2004-2015.Patients were classified into non-cirrhosis and cirrhosis groups and each group was categorized into three subgroups,according to tumor size(≤30 mm,31-40 mm,41-50 mm).Results:In patients without cirrhosis,LR showed better 5-year HCC cancer-specific survival than RFA in all tumor size subgroups(≤30 mm:82.51%vs.56.42%;31-40 mm:71.31%vs.46.83%;41-50 mm:74.7%vs.37.5%;all P<0.05).Compared with RFA,LR was an independent protective factor for HCC cancer-specific survival in multivariate Cox analysis[≤30 mm:hazard ratio(HR)=0.533,95%confidence interval(CI):0.313-0.908;31-40 mm:HR=0.439,95%CI:0.201-0.957;41-50 mm:HR=0.382;95%CI:0.159-0.916;all P<0.05].In patients with cirrhosis,for both tumor size≤30 mm and 31-40 mm groups,there were no significant survival differences between RFA and LR in multivariate analysis(all P>0.05).However,in those with tumor size 41-50 mm,LR showed significantly better 5-year HCC cancer-specific survival than RFA in both univariate(54.72%vs.23.06%;P<0.001)and multivariate analyses(HR=0.297;95%CI:0.136-0.648;P=0.002).Conclusions:RFA is an inferior treatment option to LR for patients without cirrhosis who have a solitary HCC tumor≤5 cm.
文摘Objective:This study aimed to evaluate the safety and efficacy outcomes of percutaneous radiofrequency ablation(RFA)for localised renal cell carcinoma(RCC)in a tertiary hospital patient who remained unfit for surgical intervention.Methods:We retrospectively analysed survival outcomes for patients with biopsy proven RCC treated by RFA at Royal Perth Hospital between September 2009 and May 2018.Complication data were gathered for all patients that underwent renal RFA along with 2-and 5-year recurrence-free survival(RFS)rate and compared the outcomes with data from previous studies.Results:A total of 69 patients(73 procedures)were eligible for the study,and those patients had biopsy-proven RCC with a minimum of 2-year follow-up.The complication rate was 8.2%(6/73)and local recurrence rate 9.6%(7/73).Two-year RFS is 95.7% and 5-year RFS is 78.8% on a median 3.82-year follow-up(interquartile range 1.90-5.75 years).Conclusion:RFA performed at our centre was found to be safe and effective with low complication rates and durable RFS in line with expectations from existing research.Our study demonstrated that RFA is an alternative modality of treatment for small renal tumours in patients unfit for surgical approach.
文摘BACKGROUND Radiofrequency ablation(RFA)is an effective and safe treatment for hepatocellular carcinoma that features a lower incidence of serious complications than surgical resection.Hemocholecyst caused by RFA is a rare complication of secondary damage to the intrahepatic bile duct that results in hemobilia.CASE SUMMARY Here we report on a case of a hemocholecyst caused by accidental injury during RFA that induced hematemesis and melena.Digital subtraction angiography revealed no gallbladder arterial injuries.After conservative treatment and transcatheter arterial chemoembolization,the patient’s condition stabilized,and she was discharged 1 wk later.CONCLUSION Therefore,when performing interventional procedures such as RFA,clinicians must be vigilant because even minor injuries can lead to serious complications such as hemocholecyst.
文摘Recently,endoscopic intraductal radiofrequency ablation(ID-RFA)has attracted attention as a local treatment method for malignant biliary obstruction(MBO).IDRFA causes coagulative necrosis of the tumor tissue in the stricture and induces exfoliation.Its effects are expected to extend the patency period of biliary stents and prolong the survival period.Evidence for extrahepatic cholangiocarcinoma(eCCA)is gradually accumulating,and some reports show significant therapeutic effects in eCCA patients without distant metastasis.However,it is still far from an established treatment technique,and many unsolved problems remain.Therefore,when performing ID-RFA in clinical practice,it is necessary to understand and grasp the current evidence well and to operate appropriately for the true benefit of the patients.This paper reviews the current status,issues,and prospects of endoscopic ID-RFA for MBO,especially for eCCA.
文摘Cardiac magnetic resonance(CMR)imaging could enable major advantages when guiding in real-time cardiac electrophysiology procedures offering high-resolu-tion anatomy,arrhythmia substrate,and ablation lesion visualization in the absence of ionizing radiation.Over the last decade,technologies and platforms for performing electrophysiology procedures in a CMR environment have been developed.However,performing procedures outside the conventional fluoro-scopic laboratory posed technical,practical and safety concerns.The development of magnetic resonance imaging compatible ablation systems,the recording of high-quality electrograms despite significant electromagnetic interference and reliable methods for catheter visualization and lesion assessment are the main limiting factors.The first human reports,in order to establish a procedural workflow,have rationally focused on the relatively simple typical atrial flutter ablation and have shown that CMR-guided cavotricuspid isthmus ablation represents a valid alternative to conventional ablation.Potential expansion to other more complex arrhythmias,especially ventricular tachycardia and atrial fibrillation,would be of essential impact,taking into consideration the widespread use of substrate-based strategies.Importantly,all limitations need to be solved before application of CMR-guided ablation in a broad clinical setting.
文摘Pancreatic malignancy is still the most lethal gastrointestinal malignancy.It has a very poor prognosis with low survival rate.Surgery is still the main treatment option for pancreatic malignancy.Most patients already have locally advanced and even late stage disease due to non-specific abdominal symptoms.Even though some cases are still suitable for surgical treatment,due to its aggressiveness adjuvant chemotherapy is becoming the standard treatment for controlling the disease.Radiofrequency ablation(RFA)is a thermal therapy that has been used as one of the standard treatments for liver malignancy.It can also be performed intraoperatively.There are several reports on percutaneous RFA treatment for pancreatic malignancy using transabdominal ultrasound and guided by computed tomography scan.However,due to its anatomical location and the risk of high radiation exposure,these methods seem to be very limited.Endoscopic ultrasound(EUS)has been widely used for pancreatic abnormality evaluation due to its ability to detect more accurately,especially small pancreatic lesions,compared to other imaging modalities.By the EUS approach,it is easier to achieve good visualization of tumor ablation and necrosis as the echoendoscope position is closer to the tumor area.Based on studies and a recent meta-analysis,EUS-guided RFA is a promising treatment approach for most pancreatic malignancy cases,but most studies only collected data from a small sample size.Larger studies are needed before clinical recommendations can be made.
文摘AIM:To evaluate survival and recurrence after radiofrequency ablation(RFA) for the treatment of small hepatocellular carcinoma(HCC) using a meta-analysis.METHODS:Literature on RFA vs surgical resection for the treatment of small HCC published between January 1990 and December 2008 was retrieved.A metaanalysis was conducted to estimate pooled survival and recurrence ratios.A fixed or random effect model was established to collect the data.RESULTS:The differences in overall survival at 1-year,3-years and at end of follow-up were not statistically significant between the RFA and surgery groups(P > 0.05).There were no differences in 1-year and 3-year recurrences between the RFA and surgery groups(P > 0.05).However,recurrence in the RFA group was lower than that in the surgery group up to the end of follow-up(P = 0.03).Survival was not significantly different.There was a significant difference in recurrences at the end of follow-up after RFA compared with surgical resection.CONCLUSION:RFA did not decrease the number of overall recurrences,and had no effect on survival when compared with surgical resection in a selected group of patients.
文摘AIM: To analyze the combined treatment of resection and intraoperative radiofrequency ablation (RFA) for multifocal hepatocellular carcinoma in terms of prognosis and surgical outcomes.METHODS: This study was a retrospective case comparison study using prospectively collected data. The study covered the period from April 2001 to December 2006. The data of 200 patients with histologically confirmed hepatocellular carcinoma were reviewed. Nineteen patients (17 men and 2 women) having received resection in combination with RFA were chosen as subjects of the study (the combination group). Fiftyfour patients (43 men and 11 women) having received resection alone were selected for comparison (the resection group). The two groups matched tumor number and tumor size, and all the patients in the two groups displayed no tumor rupture, major vascular involvement and distant metastasis. Their demographics, preoperative assessment, disease recurrence patterns, overall survival and diseasefree survival were compared.RESULTS: In the combination group, the medianage was 65 years (range, 3477 years), the median tumor number was 3 (range, 29), and the median tumor size was 6 cm (range, 1.214 cm). In the resection group, the median age was 51.5 years (range, 2780 years, P = 0.003), the median tumor number was 3 (range, 29, P = 0.574), and the median tumor size was 6 cm (range, 114 cm, P = 0.782). The two groups were similar in characteristics of tumors and comorbidities, and had comparable results in preoperative liver function tests. All patients had ChildPugh class A status. Bilobar involvement occurred in 14 patients (73.6%) in the combination group and 3 patients (5.5%) in the resection group (P = 0.04). Six patients (32%) in the combination group and 35 patients (65%) in the resection group underwent major hepatectomy. Thirteen patients (68%) in the combination group and 19 patients (35%) in the resection group underwent minor hepatectomy (P = 0.012). The combination group had fewer major resections (32% vs 65%, P = 0.012), less blood loss (400 vs 657 mL, P = 0.007), shorter operation time (270 vs 400 min, P = 0.001), and shorter hospital stay (7 vs 8.5 d, P = 0.042). The two groups displayed no major differences in surgical complications (15.8% vs 31.5%, P = 0.24), disease recurrence (63.2% vs 50%, P = 0.673), hospital mortality (5.3% vs 5.6%, P = 1), and overall survival (53 vs 44.5 mo, P = 0.496).CONCLUSION: Safe and effective for selected patients with multifocal hepatocellular carcinoma, the combination of resection and intraoperative RFA widens the applicability of surgical intervention for the disease.
基金Instituto do Cancer do Estado de Sao Paulo,University of Sao Paulo Medical School,Sao Paulo,SP,Brazil
文摘We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation and measured the total spleen and ablated volumes with contrast-enhanced computed tomography and volumetry. No major complications occurred, thrombocytopenia was resolved, and platelet levels remained stable, which allowed for early treatment of the patient's underlying disease. Previous work has shown that splenic radiofrequency ablation is an attractive alternative treatment for hypersplenism induced by liver cirrhosis. We aimed to contribute to the currently sparse literature evaluating the role of radiofrequency ablation(RFA) in the management of hypersplenism. We conclude that splenic RFA appears to be a viable and promising option for the treatment of hypersplenism.
文摘AIM: To evaluate the feasibility, efficacy and safety of intraoperative radiofrequency ablation (RFA) combined with 125 iodine seed implantation for unresectable pancreatic cancer. METHODS: Thirty-two patients (21 males and 11 females) at the age of 68 years (range 48-90 years) with unresectable locally advanced pancreatic cancer admitted to our hospital from January 2006 to May 2008 were enrolled in this study. The tumor, 4-12 cm in diameter, located in pancreatic head of 23 patients and in pancreatic body and tail of 9 patients, was found to be unresectable during operation. Diagnosis of pancreatic cancer was made through intraoperative biopsy. Patients were treated with FRA combined with 125 iodine seed implantation. In brief, a RFA needle was placed, which was confirmed by intraoperative ultrasound to decrease the potential injury of surrounding vital structures, a 125 iodine seed was implanted near the blood vessels and around the tumor border followed by bypass palliative procedure (cholangio-jejunostomy and/or gastrojejunostomy) in 29 patients.RESULTS: The serum CA 19-9 level was decreased from 512 ± 86 U/mL before operation to 176 ± 64 U/mL, 108 ± 42 U/mL and 114 ± 48 U/mL, respectively, 1, 3 and 6 mo after operation (P < 0.05). The pain score on day 7 after operation, 1 and 3 mo after combined therapy was decreased from 5.86 ± 1.92 before operation to 2.65 ± 1.04, 1.65 ± 0.88 and 2.03 ± 1.16, respectively, after operation (P < 0.05). The rate of complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD) in 32 patients was 21.8% (7/32), 56.3% (18/32), 15.6% (5/32) and 6.3% (2/32), respectively, 6 mo after operation, with a median overall survival time of 17. 5 mo. The median survival time of patients at stage Ⅲ was longer than that of those at stage Ⅳ (19 mo vs 10 mo, P = 0.0026). The median survival time of patients who received and did not receive chemotherapy after operation was 20 mo and 16 mo, respectively (P = 0.0176). Of the 32 patients, 3 (10.6%) experienced postoperative complications including transient biliary leaks in 2 patients and acute pancreatitis in 1 patient. All the patients recovered well after conservative support treatment. CONCLUSION: Intraoperative RFA combined with 125 iodine seed implantation is a feasible and safe procedure for unresectable pancreatic cancer with acceptable minor complications, and can prolong the survival time of patients, especially those at stage Ⅲ.
文摘Radiofrequency ablation(RFA)of pancreatic neoplasms is restricted to locally advanced,non-resectable but nonmetastatic tumors.RFA of pancreatic tumors is nowadays an ultrasound-guided procedure performed during laparotomy in open surgery.Intraoperative ultrasound covers the mandatory role of staging,evaluation of feasibility,guidance and monitoring of the procedure.Different types of needle can be used.The first aim in the evaluation of RFA as a treatment for locally advanced pancreatic ductal adenocarcinoma,in order of evaluation but not of importance,is to determine the feasibility of the procedure.The second aim is to establish the effect of RFA on tumoral mass in terms of necrosis andcytoreduction.The most important aim,third in order of evaluation,is the potential improvement of quality of life and survival rate.Nowadays,only a few studies assess the feasibility of the procedure.The present paper is an overview of RFA for pancreatic adenocarcinoma.
基金supported by the National "863" High‐Tech Res & Dev Program of China (No. 2007AA02Z4B8)the National Science Foundation for Young Scholars of China (No. 81101745)
文摘Objective: Most recurrent intrahepatic cholangiocarcinoma (RICC) lost the opportunity of radical resection while most nonsurgical management failed to prolong patients' survival. The efficacy and safety of radiofrequency ablation (RFA) as a local treatment for recurrent hepatocellular carcinoma have been confirmed by many clinical studies. The purpose of this study was to evaluate the efficacy, long-term survival and complications of RFA for RICC. Methods: A total of 12 patients with 19 RICCs after radical resection were included in this study. The tumors were 1.9-6.8 cm at the maximum diameter (median, 3.2±1.6 cm). All patients were treated with ultrasound guided RFA. There were two RFA approaches including percutaneous and open. Results: A total of 18 RFA treatment sessions were performed. Ablation was successful (evaluated by 1-month CT after the initial RFA procedure) in 18 (94.7%) of 19 tumors. By a median follow-up period of 29.9 months after RFA, 5 patients received repeated RFA because of intrahepatic lesion recurrence. The median local recurrence-free survival period and median event-free survival period after RFA were 21.0 months and 13.0 months, respectively. The median overall survival was 30 months, and the 1- and 3-year survival rates were 87.5% and 37.5%, respectively. The complication rate was 5.6% (1/18 sessions). The only one major complication was pleural effusion requiring thoracentesis. Conclusion: This study showed RFA may effectively and safely manage RICC with 3-year survival of 37.5%. It provides a treatment option for these RICC patients who lost chance for surgery.
文摘A 51-year-old Chinese male with a 20-year history of hepatitis B was diagnosed with hepatocellular carcinoma in the right anterior portion of the liver, sized 3.5 cm × 3.2 cm, and was treated with radiofrequency ablation (RFA) on December 18, 2001. The patient did not receive antiviral therapy for hepatitis B virus after RFA. The treated lesion reduced gradually and reached its minimum size of 1.7 cm × 1.5 cm seven years later on November 18, 2008. However computed tomography findings revealed that a recurrence lesion of 6.0 cm × 4.8 cm which was histologically confirmed overlapped the previous treated lesion at the 8th year on December 3, 2009. Although recurrence at 8 years after curative RFA is a rare event, such a possibility must be kept in mind. To find and treat the recurrence lesion promptly, long-term and close monitoring is warranted after RFA. Meanwhile, the recurrence-prevention therapy is as important as close monitoring for those patients with a history of hepatitis B.
文摘BACKGROUND Surgical resection and radiofrequency ablation(RFA)represent two possible strategy in treatment of hepatocellular carcinoma(HCC)in Milan criteria.AIM To evaluate short-and long-term outcome in elderly patients(>70 years)with HCC in Milan criteria,which underwent liver resection(LR)or RFA.METHODS The study included 594 patients with HCC in Milan criteria(429 in LR group and 165 in RFA group)managed in 10 European centers.Statistical analysis was performed using the Kaplan-Meier method before and after propensity score matching(PSM)and Cox regression.RESULTS After PSM,we compared 136 patients in the LR group with 136 patients in the RFA group.Overall survival at 1,3,and 5 years was 91%,80%,and 76%in the LR group and 97%,67%,and 41%in the RFA group respectively(P=0.001).Diseasefree survival at 1,3,and 5 years was 84%,60%and 44%for the LR group,and 63%,36%,and 25%for the RFA group(P=0.001).Postoperative Clavien-Dindo IIIIV complications were lower in the RFA group(1%vs 11%,P=0.001)in association with a shorter length of stay(2 d vs 7 d,P=0.001).In multivariate analysis,Model for End-stage Liver Disease(MELD)score(>10)[odds ratio(OR)=1.89],increased value of international normalized ratio(>1.3)(OR=1.60),treatment with radiofrequency(OR=1.46),and multiple nodules(OR=1.19)were independent predictors of a poor overall survival while a high MELD score(>10)(OR=1.51)and radiofrequency(OR=1.37)were independent factors associated with a higher recurrence rate.CONCLUSION Despite a longer length of stay and a higher rate of severe postoperative complications,surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients(>70 years)with HCC in Milan criteria.
基金supported by grants from the National Natural Science Foundation of China (No. 81371652)the Science and Technology Planning Project of Guangdong Province (No. 2012B031800120)
文摘Background:A ruptured hepatocellular carcinoma(HCC)is often fatal.In addition to surgery and transarterial embo?lization,radiofrequency ablation(RFA)might be another option for treating a ruptured HCC.Unfortunately,conven?tional RFA has a limited ablation zone;as such,it is rarely used to treat ruptured tumors.Case presentation:This case was a 60?year?old man who had a large,ruptured HCC in which hydrochloric acid(HCl)?enhanced RFA successfully controlled the bleeding and made the tumor completely necrotic.Conclusion:Considering the effectiveness of HCl?enhanced RFA in achieving hemostasis and tumor ablation,it might be a new option for treating large,ruptured HCCs.
文摘Background: Gold standard for colorectal liver metastases(CRLM) remains hepatic resection(HR). However, patients with severe comorbidities, unresectable or deep-situated resectable CRLM are candidates for ablation. The aim of the study was to compare recurrence rate and survival benefit of the microwave ablation(MWA), radiofrequency ablation(RFA) and HR by conducting the first network meta-analysis. Data sources: Systematic search of the literature was conducted in the electronic databases. Both updated traditional and network meta-analyses were conducted and the results were compared between them. Results: HR cohort demonstrated significantly less local recurrence rate and better 3-and 5-year diseasefree(DFS) and overall survival(OS) compared to MWA and RFA cohorts. HR cohort included significantly younger patients and with significantly lower preoperative carcinoembryonic antigen(CEA) by 10.28 ng/m L compared to RFA cohort. Subgroup analysis of local recurrence and OS of solitary and ≤3 cm CRLMs did not demonstrate any discrepancies when compared with the whole sample. Conclusions: For resectable CRLM the treatment of choice still remains HR. MWA and RFA can be used as a single or adjunct treatment in patients with unresectable CRLM and/or prohibitive comorbidities.
基金Supported by the Research Supporting Program of The Korean Association for the Study of the Liver and the Korean Liver Foundation,No.KASLKLF2019-06.
文摘BACKGROUND Extrahepatic metastasis(EHM)of hepatocellular carcinoma(HCC)is associated with poor outcomes.However,the clinical features and risk factors of EHM of HCC after radiofrequency ablation(RFA)remain unclear.AIM To elucidate the characteristics and risk factors of EHM after RFA for HCC.METHODS From January 2008 to December 2017,we retrospectively enrolled 661 patients who underwent RFA as first-line treatment for HCC at 2 tertiary hospitals.The inclusion criteria were age≥18 years,a diagnosis of HCC,and treatment-naivety.Abdominal computed tomography(CT)or magnetic resonance imaging(MRI)and alpha-fetoprotein measurements were routinely performed at 1 mo after RFA and followed-up at intervals of 3-6 mo.Univariate analyses were performed using the chi-squared test or Student’s t-test,and univariate and multivariate analyses were performed via logistic regression,as appropriate.RESULTS EHM was diagnosed in 44 patients(6.7%)during a median follow-up period of 1204 days.The 10-year cumulative rate of HCC recurrence and EHM was 92.7%and 33.7%,respectively.Initial recurrence was most often intrahepatic,and the rate of extrahepatic recurrence at initial recurrence was only 1.2%.The median time to the diagnosis of EHM was 2.68 years,and 68.2%of patients developed EHM within 2 years of the first recurrence,regardless of recurrence-free survival and 75.0%of patients developed EHM within 5 years after first recurrence.EHM was mostly diagnosed via abdominal CT/MRI in 33(75.0%)and 38 of 44 patients(86.4%)with EHM had either positive abdominal CT scan results or serum AFP level elevation.In multivariate analysis,recurrence-free survival<2 years,ablation zone/tumor size<2,and alpha-fetoprotein level>400 IU/mL were associated with a high EHM risk.CONCLUSION EHM occurs following multiple intrahepatic recurrences after RFA and combined contrast-enhanced abdominal CT and serum AFP were useful for surveillance.Patients especially with high-risk factors require close follow-up for EHM.
