Efficacy and long‐term outcome of laparoscopic microwave coagulation or radiofrequency ablation therapy for surface‐type hepatocellular carcinoma

Background: Microwave or radiofrequency ablation therapy has been widely perfomed for hepatocellular carcinoma (HCC). Whereas ablation therapy is effective treatment, it cannot be perfomed easily, as is evident in several reports of severe complications. We treated surface‐type HCC under laparoscopy in avoidance of complications from March 1996. In the present study, we examined the efficacy and long‐term outcome of laparoscopic ablation therapy. Patients and Methods: The patients were 47 cases (58 lesions) of HCC treated by laparoscopic ablation therapy under general anesthesia in our Center from March 1996 until March 2003. Results: The surface‐type HCC to which the therapy was applicable accounted for approximately 15% of all cases. The overall 5‐year survival rate was 62%. Hepatic reserve and rate of intrahepatic recurrences in the remnant liver after curative treatment were the limiting factors on the survival rate. There was no serious complication in the treatment. It was well tolerated and brought about good quality of life. Conclusion: Laparoscopic ablation therapy was considered to be an easy and effective approach, and its utility was also recognized in the avoidance of the problems of percutaneous treatment, such as bleeding or damage to the adjacent organs.     

Upper cavo‐pulmonary anastomosis by transcatheter technique

Objectives: The aim of this animal study was to establish a shunt connection between superior vena cava (SVC) and right pulmonary artery (RPA) by transvascular intervention solely. Background: After initial shunt creation, the establishment of the upper cavo‐pulmonary anastomosis (UCPA) is the second out of three open chest operations young infants with univentricular anatomy are subjected to. To avoid the risks of reoperation with cardiovascular bypass, we sought to replace this surgical step by an interventional technique. Methods: After cannulation of jugular and femoral veins in four piglets (mean body weight of 12.5 kg) an UCPA was created by radiofrequency perforation from the SVC across the right atrium into the RPA and subsequent implantation of covered stents. The perforation was guided by biplane fluoroscopy and the perforation wire premounted with a coaxial catheter was advanced into the distal pulmonary artery and exchanged for a stiffer wire. A long sheath was brought into the RPA and an 80 mm long expanded poly‐tetra‐fluoro‐ethylene (ePTFE)‐covered Cheatham Platinum stent was then implanted connecting the SVC with the RPA. Results: Immediate angiography showed antegrade flow from SVC to RPA. Angiographic re‐evaluation after a median period of 4 weeks showed partial in‐stent stenosis but patent lumina. Additionally, veno‐venous collaterals from the SVC to the right atrium had developed. Histology of the explanted stents revealed parietal thrombi and mild to moderate pseudo intima proliferation inside the lumina. Conclusions: The transvascular creation of an upper unidirectional cavo‐pulmonary anastomosis in piglets is technically feasible using standard catheterization equipment. © 2012 Wiley Periodicals, Inc.     

Sex‐specific efficacy and safety of cryoballoon versus radiofrequency ablation for atrial fibrillation: A systematic review and meta‐analysis

Background: Atrial fibrillation (AF) is a growing healthcare burden, for which pulmonary vein isolation (PVI) using cryoballoon (CB) or radiofrequency (RF) represent attractive therapies. Women are at higher risk of recurrence after AF ablation and present a specific complications profile. Therefore, a systematic catheter‐specific assessment of pulmonary vein isolation is urgently needed in women. Objective: Systematically assessing the sex‐specific efficacy/safety of CB vs RF ablation. Methods: We performed a structured database search of the scientific literature for randomized controlled trials (RCTs) and observational prospective studies (OPS) comparing CB and RF ablation efficacy at 1 year. We investigated the reporting of sex‐specific analyses and assessed the comparative sex‐specific efficacy, safety and procedural characteristics of CB vs RF using random‐effect meta‐regression accounting for the proportion of enrolled women. Results: Twenty‐three studies were included (18 OPS and 5 RCTs) for a total of 13 509 patients. Sex‐specific outcomes by ablation device were reported in two and sex‐specific regression in four studies, none of which took the ablation device into account. Meta‐regression accounting for the proportion of enrolled women showed no significant difference in outcomes between RF or CB. Conclusion: The sex‐specific reporting in trials comparing CB to RF is extremely low. A quantitative meta‐regression using the percentage of enrolled women as sex‐specific indicator did not show any difference between CB and RF but acknowledging the low percentage of enrolled women and the lack of sex‐specific data, further research including patient‐level data is urgently needed to draw more definitive conclusions.     

Percutaneous radiofrequency ablation as first‐line treatment for small hepatocellular carcinoma: Results and prognostic factors on long‐term follow up

Background and Aims: We evaluated the prognosis and associated factors in patients with small hepatocellular carcinoma (HCC; up to 3 nodules, each up to 3cm in diameter) treated with percutaneous radiofrequency ablation (RFA) as first‐line treatment. Methods: Eighty‐eight consecutive patients who underwent percutaneous RFA as first‐line treatment were enrolled, among whom 70 who had hypervascular HCC nodules which were treated by a combination of transcatheter arterial chemoembolization and RFA. RFA was repeated until an ablative margin was obtained. Results: The rate of local tumor progression at 1 and 3 years was 4.8% and 4.8%, respectively. The rate of overall survival at 3 and 5 years was 83.0% and 70.0%, and the rate of disease‐free survival at 3 and 5 years was 34.0% and 24.0%, respectively. On multivariate analysis, age (< 70 years; hazard ratio [HR] = 2.341, 95% confidence interval [CI] = 1.101–4.977, P = 0.027) and indocyanine green retention rate at 15 min (< 15%; HR = 3.621, 95% CI = 1.086–12.079, P = 0.036) were statistically significant determinants of overall survival, while tumor number (solitary, HR = 2.465, 95% CI = 1.170–5.191, P = 0.018) was identified for disease‐free survival. Overall survival of patients with early recurrence after RFA was significantly worse than that of patients with late recurrence. Tumor size was the only independent risk factor of early recurrence after RFA of HCC (tumor size > 2 cm; risk ratio [RR] = 4.629, 95% CI = 1.241–17.241, P = 0.023). Conclusion: Percutaneous RFA under the protocol reported here has the potential to provide local tumor control for small HCC. In addition to host factors, time interval from RFA to recurrence was an important determinant of prognosis.