No abstract available.
Carcinoma, Hepatocellular/radiography/*surgery ; *Catheter Ablation ; Humans ; Liver Neoplasms/radiography/*surgery ; Tomography, X-Ray Computed

BACKGROUND/AIMS: The follow-up strategy after hepatectomy for hepatocellular carcinoma (HCC) usually depends on the experience of physician, resulting in frequent imaging studies, which leads to increased cost. Hence, we investigated the role of monitoring alpha-fetoprotein (AFP) levels after hepatectomy in patients with preoperative high AFP. METHODS: From January 2000 to December 2004, 66 patients who underwent curative hepatectomy due to HCC with preoperative AFP level >400 ng/mL were reviewed. Changes in AFP level after the operation were investigated. The recurrence was suspected in case of two consecutive increase of AFP over cut-off value. Cut-off value was determined by ROC curve. All patients were divided into 2 groups: patients who met the definition (Group S) and those who didn't (Group D). RESULTS: AFP level of 20 ng/ml was proposed as the cut-off value for diagnosis of recurrence by ROC curve. Thirty two patients who didn't have the AFP level decreased below 20 ng/ml after the resection had HCC recurred, whereas 16 out of 34 patients who had AFP decreased had tumor recurrence. The AFP level of patients without recurrence was kept below 20 ng/ml during the follow-up. The AFP level of 44 out of 48 recurred patients increased over 20 ng/ml upon recurrence. By definition, group D were 5 patients. In 4 patients of group D, the AFP level didn't increase above 20 ng/ml upon recurrence. These patients had HCC and they recurred 1 year after the surgery. CONCLUSIONS: In patients with preoperative AFP level >400 ng/ml, the AFP level tended to increase above 20 ng/ml at recurrence mostly within 1 year. Hence, we proposed that these patients could be monitored by only AFP until 1 year after surgery.
Adult ; Aged ; Carcinoma, Hepatocellular/mortality/radiography/*surgery ; Disease-Free Survival ; Female ; Hepatectomy ; Humans ; Liver Neoplasms/mortality/radiography/*surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local/mortality/radiography/*surgery ; ROC Curve ; alpha-Fetoproteins/*analysis

OBJECTIVE: The purpose of this study was to determine the utility of preoperative CT in predicting early recurrence of hepatocellular carcinoma after partial hepatic resection. MATERIALS AND METHODS: Preoperative three-phase helical CT scans in 53 patients with hepatocellular carcinoma were retrospectively reviewed by two radiologists. In 27 patients (group I), HCC had recurred within six months, while 26 (group II) had remained disease free for at least two years. In each group, preoperative CT findings were evaluated in each group for the tumor size and number, the presence or absence of capsule, distinctness of tumor margin, perinodular extension, and the presence or absence of portal vein thrombosis. RESULTS: In group I, a tumor capsule of tumor was seen in five of 27 patients (19%), and in group II, in 16 of 26 (62%) (p = .001). The tumor margin was distinct in eight patients (30%) in group I and in 20 (77%) in group II (p = .001). Multiple tumors, perinodular extension, and portal vein thrombosis were more frequently seen in group I but the differences were not statistically significant (p > .05). Tumor size was similar in each group (p > .05). CONCLUSION: Preoperative CT findings that may help predict the early recurrence of hepatocellular carcinoma after surgical resection are an absence of capsule of tumors and an indistinct margin. Reference to these findings during preop-erative CT can guide clinicians in their choice of treatment.
Carcinoma, Hepatocellular/*radiography/surgery ; Case-Control Studies ; Female ; *Hepatectomy ; Human ; Liver Neoplasms/*radiography/surgery ; Male ; Middle Age ; Neoplasm Recurrence, Local/*radiography/surgery ; Preoperative Care ; Retrospective Studies ; Time Factors ; *Tomography, X-Ray Computed

PURPOSE: The risk of hepatocellular carcinoma (HCC) recurrence must be considered ahead of surgery. This study was undertaken to identify pre-operative risk factors for early intrahepatic recurrence of HCC after curative resection in a large-scale. MATERIALS AND METHODS: We retrospectively reviewed the preoperative three-phase multi-detector CT (MDCT) and laboratory data for 240 HCC patients who underwent curative resection; tumor size, number, gross shape, capsule integrity, distinctiveness of tumor margin, portal vein thrombosis (PVT), alpha-fetoprotein level (AFP), and protein induced by vitamin K absence-II (PIVKA-II) levels were assessed. Surgical pathology was reviewed; tumor differentiation, capsule, necrosis, and micro-vessel invasion were recorded. RESULTS: HCC recurred in 61 patients within six months (early recurrence group), but not in 179 patients (control group). In univariate analysis, large tumor size (p = 0.018), shape (p = 0.028), poor capsule integrity (p = 0.046), elevated AFP (p = 0.015), and PIVKA-II (p = 0.008) were significant preoperative risk factors. Among the pathologic features, PVT (p = 0.023), Glisson's capsule penetration (p = 0.033), microvascular invasion (p < 0.001), and poor differentiation (p = 0.001) showed statistical significance. In multivariate analysis, only the histopathologic parameters of microvascular invasion and poor differentiation achieved statistical significance. CONCLUSION: Preoperative CT and laboratory parameters showed limited value, while the presence of microscopic vascular tumor invasion and poorly differentiated HCC correlated with higher risk of early recurrence after curative resection.
Adult ; Aged ; Carcinoma, Hepatocellular/metabolism/pathology/*radiography/*surgery ; Female ; Humans ; Liver Neoplasms/metabolism/pathology/*radiography/*surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local/metabolism/*pathology/*radiography ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; alpha-Fetoproteins/metabolism

We present a case of a patient with rapid deterioration of esophageal varices caused by portal hypertension accompanied by a large arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma. We used n-butyl cyanoacrylate (NBCA) as an embolic material to achieve pinpoint embolization of the shunt, because the microcatheter tip was 2 cm away from the shunt site. Under hepatic arterial flow control using a balloon catheter, the arterioportal shunt was successfully embolized with NBCA, which caused an improvement in the esophageal varices.
Aged ; Arteriovenous Fistula/etiology/radiography/*therapy ; Carcinoma, Hepatocellular/*surgery ; Catheter Ablation/*adverse effects ; Embolization, Therapeutic/*methods ; Enbucrilate/*therapeutic use ; Esophageal and Gastric Varices/etiology/*therapy ; Hepatic Artery/*abnormalities/radiography ; Humans ; Liver Neoplasms/*surgery ; Male ; Portal Vein/*abnormalities/radiography

Local treatment for hepatocellular carcinoma (HCC) has been widely used in clinical practice due to its minimal invasiveness and high rate of cure. Percutaneous radiofrequency ablation (RFA) is widely used because its treatment effectiveness. However, some serious complications can arise from percutaneous RFA. We present here a rare case of hemorrhagic cardiac tamponade secondary to an anterior cardiac vein (right marginal vein) injury during RFA for treatment of HCC.
Carcinoma, Hepatocellular/radiography/*surgery ; Cardiac Tamponade/*etiology ; *Catheter Ablation ; Fatal Outcome ; Hemorrhage/*etiology ; Humans ; Iatrogenic Disease ; Intraoperative Complications/*etiology ; Liver Neoplasms/radiography/*surgery ; Male ; Middle Aged ; Radiography, Interventional ; Tomography, X-Ray Computed

OBJECTIVE: To assess the technical feasibility and local efficacy of biplane fluoroscopy plus US-guided percutaneous radiofrequency ablation (RFA) for viable hepatocellular carcinoma (HCC) around retained iodized oil after transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS: Our prospective study was approved by our institutional review board and informed consent was obtained from all participating patients. For patients with viable HCC around retained iodized oil after TACE, biplane fluoroscopy plus US-guided RFA was performed. We evaluated the rate of technical success and major complications on a post-RFA CT examination and local tumor progression with a follow-up CT. RESULTS: Among 40 consecutive patients, 19 were excluded due to one of the following reasons: poorly visible HCC on fluoroscopy (n = 13), high risk location (n = 2), RFA performed under monoplane fluoroscopy and US guidance (n = 2), and poorly identifiable new HCCs on US (n = 2). The remaining 21 patients with 21 viable HCCs were included. The size of total tumors ranged from 1.4 to 5.0 cm (mean: 3.2 cm) in the longest diameter. Technical success was achieved for all 21 HCCs, and major complications were observed in none of the patients. During the follow-up period (mean, 20.3 months; range, 6.5-29.9 months), local tumor progression was found in two patients (2/21, 9.5%). Distant intrahepatic metastasis developed in 76.2% (16/21) of patients. CONCLUSION: When retained iodized oil around the tumor after TACE hampers the targeting of the viable tumor for RFA, biplane fluoroscopy plus US-guided RFA may be performed owing to its technical feasibility and effective treatment for viable HCCs.
Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/radiography/*surgery/therapy ; *Catheter Ablation ; *Chemoembolization, Therapeutic ; Complex Mixtures ; *Contrast Media ; Female ; *Fluoroscopy/methods ; Humans ; Iodized Oil/*administration & dosage ; Iohexol/analogs & derivatives/diagnostic use ; Liver Neoplasms/radiography/*surgery/therapy ; Male ; Middle Aged ; *Ultrasonography, Interventional

The early assessment of the therapeutic response after percutaneous radiofrequency (RF) ablation is important, in order to correctly decide whether further treatment is necessary. The residual unablated tumor is usually depicted on contrast-enhanced multiphase helical computed tomography (CT) as a focal enhancing structure during the arterial and portal venous phases. Contrast-enhanced color Doppler and power Doppler ultrasonography (US) have also been used to detect residual tumors. Contrast-enhanced gray-scale US, using a harmonic technology which has recently been introduced, allows for the detection of residual tumors after ablation, without any of the blooming or motion artifacts usually seen on contrast-enhanced color or power Doppler US. Based on our experience and reports in the literature, we consider that contrast-enhanced gray-scale harmonic US constitutes a reliable alternative to contrast-enhanced multiphase CT for the early evaluation of the therapeutic response to RF ablation for liver cancer. This technique was also useful in targeting any residual unablated tumors encountered during additional ablation.
Adult ; Aged ; Carcinoma, Hepatocellular/radiography/*surgery/*ultrasonography ; *Catheter Ablation ; Contrast Media ; Female ; Humans ; Liver Neoplasms/radiography/*surgery/*ultrasonography ; Male ; Middle Aged ; Polysaccharides/diagnostic use ; Suspensions/diagnostic use ; Tomography, Spiral Computed ; Ultrasonography, Doppler/methods

BACKGROUND/AIMS: Radiofrequency ablation (RFA) is emerging as a new therapeutic method in the management of hepatocellular carcinoma (HCC). We report the results of 64 patients with a follow-up interval of 3 to 19 months. METHOD: Sixty-four patients with 82 nodules underwent ultrasound guided RFA. The mean tumor diameter was 2.5+/-1.0 cm. Laparoscopic ultrasound guided RFA was performed in 38 cases, and percutaneous ultrasound guided RFA in 26 cases. The therapeutic efficacy was evaluated by means of three-phase dynamic abdominal computed tomography (CT) performed within at least one week after ablating. The recurrence was evaluated after treatment by means of abdominal CT and alpha fetoprotein every 3 months. We calculated cumulative recurrence rates, survival rates of patients, and found out complication of RFA. RESULTS: Cumulative recurrence rates in 3, 6, 12 months after RFA was 8.8%, 15.8%, 25.9%. 12 cases were recurred during follow-up. Among them, intrahepatic recurrences were noted in 11 cases, local recurrences in 3 cases. Cumulative survival curves indicated that survival rate was 95% at the third month, 94% at the sixth month, 81% at the twelfth month. After RFA, the alpha fetoprotein level was decreased significantly after 1 month (p<0.05), and serum transaminase levels were transiently elevated (p<0.01) but returned to normal within one week. Complications of RFA were not serious, and resolved spontaneously. CONCLUSION: RFA can be considered a useful new treatment for HCC. Laparoscopic RFA is a useful procedure for the treatment of HCC regardless of its location.
Adult ; Aged ; Carcinoma, Hepatocellular/radiography/*surgery/ultrasonography ; *Catheter Ablation/adverse effects ; English Abstract ; Female ; Human ; *Laparoscopy ; Liver Neoplasms/radiography/*surgery/ultrasonography ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Tomography, X-Ray Computed ; *Ultrasonography, Interventional

OBJECTIVE: The objective of this study was evaluate the diagnostic efficacy of three-phase helical dynamic CT in the detection of hepatocellular carcinomas in patients with advanced liver cirrhosis. MATERIALS AND METFODS: Three-phase helical dynamic CT in 77 patients with advanced liver cirrhosis was evaluated prospectively before orthotopic liver transplantation. The histopathologically confirmed hepatocellular carcinomas in the explanted livers were compared with pretransplantation CT results by one-to-one correlation. RESULTS: Histopathologic examination of the explanted livers revealed 72 hepatocellular carcinomas in 41 patients. The size of the hepatocellular carcinomas was 0.5-14.0 cm (mean, 1.6 cm). The use of helical dynamic CT enabled the detection of 38 of 72 hepatocellular carcinomas (sensitivity, 53%). Fifteen of 35 (43%) hepatocellular carcinomas smaller than 2 cm and 23 of 37 (62%), hepatocellular carcinomas ranging from 2.0 cm to 14.0 cm were detected. Patient sensitivity and specificity in the detection of hepatocellular carcinoma were 81% (33/41) and 94% (34/36), respectively. CONCLUSIONS: Three-phase helical dynamic CT is insensitive for detection of hepatocellular carcinomas in patients with advanced liver cirrhosis, especially for hepatocellular carcinomas smaller than 2 cm.
Adolescent ; Adult ; Biopsy ; Carcinoma, Hepatocellular/complications/pathology/*radiography/surgery ; Female ; Human ; Liver/*pathology ; Liver Cirrhosis/*complications ; Liver Neoplasms/complications/pathology/*radiography/surgery ; Male ; Middle Aged ; Prospective Studies ; Sensitivity and Specificity ; *Tomography, Spiral Computed