Local ablation therapy is considered as a conventional treatment option for patients with early stage hepatocellular carcinoma (HCC). Although radiofrequency (RF) ablation is widely used for HCC, the use of cryoablation has been increasing as newer and safer cryoablation systems have developed. The thermodynamic mechanism of freezing and thawing used in cryoablation is the Joule-Thomson effect. Cryoablation destroys tissue via direct tissue destruction and vascular-related injury. A few recent comparative studies have shown that percutaneous cryoablation for HCCs is comparable to percutaneous RF ablation in terms of long term therapeutic outcomes and complications. Cryoablation has several advantages over RF ablation such as well visualization of iceball, no causation of severe pain, and lack of severe damage to great vessels and gallbladder. It is important to know the advantages and disadvantages of cryoablation compared with RF ablation for improvement of therapeutic efficacy and safety.
Carcinoma, Hepatocellular/diagnostic imaging/*surgery ; Catheter Ablation ; *Cryosurgery ; Humans ; Liver Neoplasms/diagnostic imaging/*surgery ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed ; Ultrasonography

Ultrasound-guided percutaneous radiofrequency (RF) ablation has become one of the most promising local cancer therapies for both resectable and nonresectable hepatic tumors. Although RF ablation is a safe and effective technique for the treatment of liver tumors, the outcome of treatment can be closely related to the location and shape of the tumors. There may be difficulties with RF ablation of tumors that are adjacent to large vessels or extrahepatic heat-vulnerable organs and tumors in the caudate lobe, possibly resulting in major complications or treatment failure. Thus, a number of strategies have been developed to overcome these challenges, which include artificial ascites, needle track ablation, fusion imaging guidance, parallel targeting, bypass targeting, etc. Operators need to use the right strategy in the right situation to avoid the possibility of complications and incomplete thermal tissue destruction; with the right strategy, RF ablation can be performed successfully, even for hepatic tumors in high-risk locations. This article offers technical strategies that can be used to effectively perform RF ablation as well as to minimize possible complications related to the procedure with representative cases and schematic illustrations.
Ascites ; Bile Duct Diseases/etiology ; Carcinoma, Hepatocellular/*surgery/ultrasonography ; Catheter Ablation/adverse effects ; Humans ; Liver Neoplasms/*surgery/ultrasonography ; Neoplasm, Residual/etiology

BACKGROUND/AIMS: To investigate sequential changes in laboratory markers after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) and the relationship of these changes to the severity of the underlying liver disease. METHODS: This retrospective analysis included 65 patients (44 males, 21 females) who underwent RFA of HCC. Hematologic and biochemical markers were assessed at the pre-RFA period and 1 day, 2-3 days, and 1-2 weeks after RFA. We classified the subjects into two groups: Child-Pugh A (n=41) and Child-Pugh B (n=24). The ablative margin volume (AMV) of each patient was measured. We analyzed the changes in laboratory profiles from the baseline, and investigated whether these laboratory changes were correlated with the AMV and the Child-Pugh classification. RESULTS: Most of the laboratory values peaked at 2-3 days after RFA. AMV was significantly correlated with changes in WBC count, hemoglobin level, and serum total bilirubin level (Pearson's correlation coefficient, 0.324-0.453; P<0.05). The alanine aminotransferase (ALT) level varied significantly over time (P=0.023). CONCLUSIONS: Most of the measured laboratory markers changed from baseline, peaking at 2-3 days. The ALT level was the only parameter for which there was a significant difference after RFA between Child-Pugh A and B patients: it increased significantly more in the Child-Pugh A patients.
Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase/blood ; Bilirubin/blood ; Biomarkers/metabolism ; Carcinoma, Hepatocellular/pathology/*surgery/ultrasonography ; Catheter Ablation ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms/pathology/*surgery/ultrasonography ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index

OBJECTIVETo explore the value of ultrasound-guided percutaneous radiofrequency ablation (RFA) in designing the indication, treatment protocol and operational skills for patients with primary hepatocellular carcinoma (HCC) near the liver surface.

METHODSSixty-one HCC patients with 69 lesions, confirmed by clinical examination and pathology, underwent percutaneous radiofrequency ablation. The study included 40 cases of liver function Child-Pugh grade A and 21 cases of grade B. The average size of tumors was (3.8 ± 1.2) cm, tumor diameter ≥ 4 cm accounted for 39.1% (27/69 lesions), and the average age was 58.2 years (range, 35-76 years). Taking comprehensive measures, such as intraperitoneal injection of saline adjacent to the tumor before RFA, increasing the puncture sites on the surface of tumor to avoid overlapping of the central portion of tumor, repeated ablation of the needle track to reduce needle tract metastasis, avoid vertical puncture, and other additional measures, to improve the inactivation of tumors adjacent to the liver surface. Enhanced CT/MRI was performed to evaluate the curative effect at 1, 3, 6 and 24 months after the treatment.

RESULTSThe inactivation rate of tumor was 98.6% (68/69 lesions) and local recurrence rate was 5.8%(4/69) after RFA. The tumor-related marker AFP was 1 000-1 500 ng/ml before and reduced to (98.5 ± 42.5) ng/ml after radiofrequency ablation, among them returned to normal in 13 cases (21.3%). Since the ablation area was rather small, the level of serum alanine aminotransferase was elevated only to (148.5 ± 38.5) U/ml at one week after RFA and returned to normal at (1.8 ± 0.6) week after RFA. No patient experienced severe liver dysfunction. The local HCC recurrent rate after RFA was 5.8%(4/69 lesions) and intrahepatic heterotopic recurrence rate was 24.6% (15/61). The 20-61 months follow-up showed that the 1-, 2- and 3-year survival rate was 83.6%, 57.3% and 44.2%, respectively.

CONCLUSIONSUltrasound-guided percutaneous radiofrequency ablation provides an effective minimally invasive treatment for primary HCC near the liver surface. Taking some additional measures such as intraperitoneal injection of saline, increase of percutaneous puncture sites, and avoiding vertical needle puncture, may reduce complications and improve the therapeutic outcome. RFA is one of effective and minimally invasive treatment and causing less liver damage for primary HCC near the liver surface.

Adult ; Aged ; Biomarkers, Tumor ; blood ; Carcinoma, Hepatocellular ; blood ; pathology ; surgery ; Catheter Ablation ; methods ; Humans ; Liver ; pathology ; Liver Neoplasms ; blood ; pathology ; surgery ; Magnetic Resonance Imaging ; methods ; Middle Aged ; Neoplasm Recurrence, Local ; Survival Rate ; Treatment Outcome ; Tumor Burden ; Ultrasonography, Interventional

We report in a 65-year-old man hepatocellular carcinoma adjacent to a transjugular intrahepatic portosystemic shunt stent-graft which was successfully treated with irreversible electroporation (IRE). IRE is a new non-thermal tissue ablation technique which uses electrical pulses to induce cell necrosis by irreversible membrane poration. IRE proved to be more advantageous in the ablation of perivascular tumor with little injury to the surrounding structures.
Aged ; Carcinoma, Hepatocellular/diagnosis/*surgery ; Electroporation/*methods ; Humans ; Liver Neoplasms/diagnosis/*surgery ; Magnetic Resonance Imaging ; Male ; *Portasystemic Shunt, Transjugular Intrahepatic ; *Stents ; Tomography, X-Ray Computed ; Ultrasonography, Doppler

OBJECTIVE: To determine whether pretreatment evaluation with contrast-enhanced ultrasonography (CEUS) is effective for percutaneous radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) with poor conspicuity on conventional ultrasonography (US). MATERIALS AND METHODS: This retrospective study was approved by the institutional review board and informed consent was waived. From June 2008 to July 2011, 82 patients having HCCs (1.2 +/- 0.4 cm) with poor conspicuity on planning US for RFA were evaluated with CEUS prior to percutaneous RFA. We analyzed our database, radiologic reports, and US images in order to determine whether the location of HCC candidates on planning US coincide with that on CEUS. To avoid incomplete ablation, percutaneous RFA was performed only when HCC nodules were identified on CEUS. The rate of technical success was assessed. The cumulative rate of local tumor progression was estimated with the use of the Kaplan-Meier method (mean follow-up: 24.0 +/- 13.0 months). RESULTS: Among 82 patients, 73 (89%) HCCs were identified on CEUS, whereas 9 (11%) were not. Of 73 identifiable HCCs on CEUS, the location of HCC on planning US corresponded with that on CEUS in 64 (87.7%), whereas the location did not correspond in 9 (12.3%) HCCs. Technical success was achieved for all 73 identifiable HCCs on CEUS in a single (n = 72) or two (n = 1) RFA sessions. Cumulative rates of local tumor progression were estimated as 1.9% and 15.4% at 1 and 3 years, respectively. CONCLUSION: Pretreatment evaluation with CEUS is effective for percutaneous RFA of HCCs with poor conspicuity on conventional US.
Carcinoma, Hepatocellular/surgery/*ultrasonography ; Catheter Ablation/*methods ; Contrast Media/*diagnostic use ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms/surgery/*ultrasonography ; Male ; Middle Aged ; Neoplasm Staging ; Preoperative Period ; Retrospective Studies

OBJECTIVE: To assess the technical feasibility and local efficacy of percutaneous radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) for an intermediate-sized (3-5 cm in diameter) hepatocellular carcinoma (HCC) under the dual guidance of biplane fluoroscopy and ultrasonography (US). MATERIALS AND METHODS: Patients with intermediate-sized HCCs were treated with percutaneous RFA combined with TACE. RFA was performed under the dual guidance of biplane fluoroscopy and US within 14 days after TACE. We evaluated the rate of major complications on immediate post-RFA CT images. Primary technique effectiveness rate was determined on one month follow-up CT images. The cumulative rate of local tumor progression was estimated with the use of Kaplan-Meier method. RESULTS: Twenty-one consecutive patients with 21 HCCs (mean size: 3.6 cm; range: 3-4.5 cm) were included. After TACE (mean: 6.7 d; range: 1-14 d), 20 (95.2%) of 21 HCCs were visible on fluoroscopy and were ablated under dual guidance of biplane fluoroscopy and US. The other HCC that was poorly visible by fluoroscopy was ablated under US guidance alone. Major complications were observed in only one patient (pneumothorax). Primary technique effectiveness was achieved for all 21 HCCs in a single RFA session. Cumulative rates of local tumor progression were estimated as 9.5% and 19.0% at one and three years, respectively. CONCLUSION: RFA combined with TACE under dual guidance of biplane fluoroscopy and US is technically feasible and effective for intermediate-sized HCC treatment.
Aged ; Antibiotics, Antineoplastic/administration & dosage ; Antineoplastic Agents/administration & dosage ; Carcinoma, Hepatocellular/*drug therapy/radiography/*surgery/ultrasonography ; Catheter Ablation/*methods ; Chemoembolization, Therapeutic/*methods ; Combined Modality Therapy ; Disease Progression ; Doxorubicin/administration & dosage ; Ethiodized Oil/administration & dosage ; Feasibility Studies ; Female ; Fluoroscopy ; Humans ; Liver Neoplasms/*drug therapy/radiography/*surgery/ultrasonography ; Male ; Postoperative Complications ; *Radiography, Interventional ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; *Ultrasonography, Interventional

OBJECTIVETo analyze the major complications of percutaneous cooled-tip microwave ablation for the treatment of primary liver cancer and the possible risk factors of severe complications in a series of 693 patients.

METHODSThe clinicopathological data of 693 patients with primary liver cancer who underwent ultrasound-guided percutaneous cooled-tip microwave (MW) ablation in our hospital over the past 5 years were retrospectively analyzed, and the risk factors of severe complications were explored.

RESULTSIn a total of 693 patients with 898 primary liver tumors were treated and 1111 MW ablation sessions were performed. The mean diameter of tumors was (2.5 ± 1.2) cm and the range was 0.4 - 10.0 cm. Three deaths occurred in the peri-ablation period, including one case died of multiorgan failure, one case died of pulmonary embolism and one case died of hepatorenal syndrome. Major complications occurred in 27 (3.9%) patients, including 12 pleural effusion requiring thoracentesis (1.7%), 10 tumor seeding (1.4%), 3 liver abscess and empyema (0.4%), 1 hemorrhage requiring arterial embolization (0.1%), and 1 bile duct injury (0.1%). The Chi-square test results showed that the diameter of tumors, number of MW ablation sessions and histological type of tumor were significantly associated with the major complications rate (P < 0.05). The multiple variables 1ogistic regression analysis showed that only type of tumors was associated with the major complication rate (P < 0.05).

CONCLUSIONSResults of this study confirm that cooled-tip MW ablation is a relatively low-risk and effective minimally invasive procedure for the treatment of primary liver cancer. Proper direction for the treatment of cholangiocarcinoma (ICC) patients as well as fewer ablated tumor numbers during one hospital stay may help minimize the major complication rate in patients with primary liver cancer treated by ultrasound-guided percutaneous cooled-tip microwave ablation.

Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms ; diagnostic imaging ; surgery ; Bile Ducts, Intrahepatic ; Carcinoma, Hepatocellular ; diagnostic imaging ; surgery ; Catheter Ablation ; adverse effects ; methods ; Cholangiocarcinoma ; diagnostic imaging ; surgery ; Female ; Follow-Up Studies ; Humans ; Liver Abscess ; drug therapy ; etiology ; Liver Neoplasms ; diagnostic imaging ; surgery ; Male ; Microwaves ; therapeutic use ; Middle Aged ; Neoplasm Seeding ; Pleural Effusion ; etiology ; surgery ; Retrospective Studies ; Ultrasonography, Interventional

OBJECTIVETo assess the value of an infusion-based separation technique to assist in ultrasound (US)-guided percutaneous radiofrequency ablation (RFA) of liver cancers abutting the liver edge.

METHODSTwenty-four cases of malignant liver tumors abutting the hepatic edge were treated with US-guided puncture accompanied by the assistant infusion technique. The US-guided puncture was made with a 22-G needle through the hepatic tissue and into the abdominal cavity near the target tumor. Infusion of a saline solution was used to separate the liver from any surrounding structures so that percutaneous RFA could be safely performed. Complications, including gastrointestinal injury, hemorrhage and death, were recorded. Technical efficacy and safety were evaluated.

RESULTSAmong the 24 patients, the target tumors were adjacent to the right kidney (n=6), colon (n=6), stomach (n=5), pericardium (n=4), and gall bladder (n=3). Twenty-three patients received a successful radical percutaneous RFA with assistant infusion. The assistant infusion volumes ranged from 80-390 ml and created spaces ranging from 0.8-2.5 cm between the liver and surrounding structures. Five of the cases with tumors adjacent to the stomach or colon received the largest volume infusions. The infusion failed to create a separation space in only one case, due to the presence of an adhesion; as a result, this patient was treated with palliative RFA. The mean hospital stay for all 24 patients was four days after surgery. No severe complications or deaths occurred. At 1-month follow-up, computed tomography images showed that 22 cases had complete ablation, yielding a technical success rate of 95.7% (22/23). No needle track implantation was observed.

CONCLUSIONAssistant infusion for percutaneous radiofrequency ablation creates a protective space between the liver and surrounding structures in patients with liver tumors abutting the liver edge. This safe and effective assistant technique broadens the range of patients available for percutaneous RFA treatment.

Adult ; Aged ; Carcinoma, Hepatocellular ; surgery ; Catheter Ablation ; methods ; Female ; Humans ; Isotonic Solutions ; administration & dosage ; Liver Neoplasms ; surgery ; Male ; Middle Aged ; Treatment Outcome ; Ultrasonography, Interventional

OBJECTIVETo retrospectively investigate the feasibility of radiofrequency ablation (RFA) in treating advanced hepatocellular carcinoma (HCC) using standard ultrasound-guided percutaneous RFA.

METHODSA total of 655 patients with unresectable advanced HCC underwent ultrasound-guided percutaneous RFA therapy at our institution between July 2000 to September 2001. Ninety-two of those patients, representing 136 tumors, were selected for analysis based on the following criteria: presence of UICC/AJCC-TNM (6th edition) stage III and IV advanced HCC, (III: n=82 patients, with 126 tumors; IV: n=10 patients, with 10 tumors); extensive portal vein or inferior vena cava tumor thrombus; extrahepatic metastasis after surgical resection; and complete follow-up data. Follow-up consisted of enhanced computed tomography (CT) performed at one month post-RFA treatment, then every three months. Contrast-enhanced ultrasound (CEUS) was performed in 51 (55.4%) patients before RFA. The standard treatment using optimal strategies were applied in (72.8%) 67 patients. The established strategies included: (1) select RFA indications based on CEUS results; (2) design radical protocols based on invasive range showed by CEUS; (3) multiple overlapping ablations based on mathematical protocols; (4) two or three bipolar RFA electrodes with three-dimensional localization; (5) color ultrasound-guided percutaneous ablation of tumor feeding artery (PAA)/transcatheter arterial chemoembolization (TACE) + RFA for HCC with rich supply. The other 25 patients (27.2 %) were treated with conventional RFA protocols. The ablation procedure was considered a success if no abnormal enhancement or wash-out was detected in the treated area on the CT scan at one month. All patients had received liver protection treatments following RFA. Chi-squared test or Fisher's exact test were used to compare the early complete tumor necrosis rates and the local recurrence rates. Survival was estimated by Kaplan-Meier analysis and log-rank test. P less than 0.05 was considered statistically significant.

RESULTSThe RFA-treated tumors ranged in size from 1.5 to 7.0 cm (average: 4.5 cm). Fifty-nine patients had solitary tumor, and the remaining 33 had multiple tumors (2 to 4 tumors). Patients were classified by Child-Pugh score as A (n=58), B (n=32) and C (n=2). Early complete tumor necrosis rate after initial RFA was 90.4% (123/136 tumors). Serious complications developed in two patients (2.2%). No treatment-related death occurred. Follow-up ranged from 3-134 months. Local recurrence rate was 16.9% (23/136 tumors). The 1-, 3- and 5-year overall survival rates were 83.3%, 48.3% and 21.9%, respectively, and the median survival time was 35 months. Stratification analysis indicated the early complete tumor necrosis rate was higher in groups of patients with Child-Pugh A score (98.3%) , CEUS administration (98.0%), and standard treatment (97.0%). The local recurrence rate was lower in groups of patients with tumors less than or equal to 3.0 cm (5.9%), CEUS administration (11.8%), and standard treatment (16.4%). The 5-year survival was significantly higher in patients with Child-Pugh A, tumors less than or equal to 3.0 cm, CEUS administration, and standard treatment (all, P less than 0.05).

CONCLUSIONRFA treatment of patients with advanced HCC, tumors less than 7.0 cm, and without thrombosis in the main vessels was efficacious. The RFA treatment strategy and subsequent liver protection therapy in RFA may improve survival.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; pathology ; surgery ; Catheter Ablation ; methods ; Female ; Humans ; Liver Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Ultrasonography, Interventional