Percutaneous Radiofrequency Ablation Versus Partial Hepatectomy for Small Centrally Located Hepatocellular Carcinoma

Background

It is not known whether percutaneous radiofrequency ablation (PRFA) could get the same treatment efficacy and fewer complications as partial hepatectomy (PH) in patients with small centrally located hepatocellular carcinoma (HCC). The present study was designed to evaluate the efficacy of PH and PRFA in the treatment of small centrally located HCC.

Methods

From January 2002 until December 2007, 196 patients with small centrally located HCC (≤5 cm) were included. Of these 196 patients, 94 received PRFA and 102 patients were treated with PH. Treatment outcomes, including major complications and survival data, were studied.

Results

No treatment-related death occurred in either group. There were no significant differences in survival rates between the two groups. The 1-, 3-, and 5-year disease-free survival rates for the PRFA and PH groups were 57.9 %, 36.4 %, 34.0 %, and 59.8 %, 42.4 %, 40.8 %, respectively (P = 0.50). The 1-, 3-, and 5-year overall survival rates for the two groups were 94.3 %, 74.7 %, and 49.8 %, and 89.2 %, 74.1 %, and 63.1 %, respectively (P = 0.96). PRFA had a lower rate of major complications than PH (8.5 vs 19.6 %), and the hospital stay was also shorter in the PRFA group than in the PH subgroup (4 vs 13 days).

Conclusions

Based on the data obtained, we concluded that PRFA might be equal to PH for the treatment of small centrally located HCC. However, PRFA has the benefits of shorter hospital stay as well as a lower rate of complications.     

Percutaneous Radiofrequency Ablation versus Partial Hepatectomy for Multicentric Small Hepatocellular Carcinomas: A Nonrandomized Comparative Study

Background  

The aim of this study was to compare the results of percutaneous radiofrequency ablation (RFA) with those of partial hepatectomy (PH) in the treatment of multicentric small hepatocellular carcinomas (HCCs). With advances in RFA, it is not known whether the minimally invasive approach with percutaneous RFA could attain comparable survival outcomes but with a lower morbidity in patients with multicentric HCCs.     

经皮射频消融术治疗脊柱转移肿瘤引起的疼痛

目的观察经皮射频消融术治疗脊柱转移肿瘤疼痛的疗效。方法 2006年2月至2010年2月对82例脊柱转移瘤患者123个椎体应用经皮穿刺射频消融术治疗。随访6～18个月,平均13.6个月。对患者术前、术后3d、1周、3个月、6个月、12个月时的疼痛缓解程度应用视觉模拟评分法（visual analog scale,VAS）进行评分及评估分级。结果 VAS评分术前为（8.09±1.18）分,术后3d为（1.80±0.60）分,较术前明显降低,有统计学意义（P〈0.05）;术后各时间点疼痛缓解优良率均大于80%。术后82例患者123个病变椎体病理结果证实为骨转移瘤,术中、术后无严重并发症。结论经皮穿刺射频消融术具有创伤小、操作简单、并发症少等优点,能够有效缓解脊柱转移瘤患者疼痛,改善患者生活质量。     

Sarcoma Lung Metastases Treated with Percutaneous Radiofrequency Ablation: Results from 29 Patients

Purpose  

We aimed to determine safety and efficacy of radiofrequency ablation (RFA) in the treatment of lung metastases arising from sarcoma.     

等离子汽化消融技术治疗颈椎间盘突出症

目的探讨等离子汽化消融治疗颈椎间盘突出症的临床疗效。方法2004年6月~2007年2月应用经皮穿刺等离子汽化消融治疗颈椎间盘突出症患者59例。结果平均随访18(3~28)个月。术前VAS评分平均(5.71±0.48)分,术后随访时平均(1.66±0.71)分,术后1周主观满意优良率86.4%,症状缓解率74.0%;末次随访时主观满意度优良率61.0%,症状缓解率51.0%。未出现脊髓、神经、大血管损伤或伤口感染等并发症。结论等离子治疗椎间盘突出症起效快、创伤小,近期疗效满意,中、远期效果有所减退。     

Intraoperative Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Results in a Large Series

Background  Intraoperative radiofrequency (RF) ablation with or without surgical resection currently plays one of important roles in modern hepatocellular carcinoma (HCC) therapy. We evaluated long-term follow-up results including prognostic factors of intraoperative RF ablation for HCC that was difficult to treat percutaneously. Methods  A total of 133 patients (male, 22 female, mean age 55.8 years) underwent intraoperative RF ablations for 200 HCCs (follow-up period 3.0–79.7 months, median 22.3 months). Hepatic resection was also performed in 29 patients. Reasons for the intraoperative procedure included no safe electrode path (n = 59), excessive tumor burden (n = 41), nonvisualization of the HCC on ultrasonography (n = 20), and risk of collateral thermal damage to adjacent organs (n = 13). We evaluated the technique effectiveness rate at 1 month computed tomography (CT), cumulative local tumor progression rate, cumulative disease-free and overall survival rates, and complications. We also sought significant prognostic factors for overall survival. Results  The technique effectiveness at 1 month was 94.7% (126/133). The cumulative local tumor progression rates at 1 and 3 years were 4.9% and 8.8%, respectively. The cumulative disease-free and overall survival rates at 1, 3 and 5 years were 51.8%, 21.3%, and 16.0% and 92.3%, 72.6%, and 46.5%, respectively. Major complications occurred in nine patients (6.8%). Procedure-related mortality was 1.5% (2/133). The patients treated for recurrent HCC (P = 0.003) or with high serum alpha-fetoprotein levels (P = 0.009) had poor survival by multivariate analysis. Conclusion  The results of this study showed that intraoperative radiofrequency ablation with or without hepatic resection is a safe and effective treatment for hepatocellular carcinoma in patients who are not candidates for the percutaneous approach.     

Percutaneous Radiofrequency Ablation Versus Repeat Hepatectomy for Recurrent Hepatocellular Carcinoma: A Retrospective Study

Background  Whether percutaneous radiofrequency ablation (PRFA) is as effective as repeat hepatectomy for recurrent small hepatocellular carcinoma (HCC) in the long-term remains unknown. Methods  We included 110 patients into this study. Each patient had fewer than three recurrent HCCs, with the largest tumor less than 5 cm in diameter. Sixty-six patients with 88 tumors were treated by PRFA and 44 patients with 55 tumors were treated by repeat hepatectomy. Results  The 1-, 2-, 3-, 4-, and 5-year overall survival rates after repeat hepatectomy and PRFA were 78.6%, 56.8%, 44.5%, 30.7%, and 27.6%, and 76.6%, 48.6%, 48.6%, 39.9%, and 39.9%, respectively (P = 0.79). The 1-, 2-, 3-, 4-, and 5-year overall survival rates after the initial hepatectomy for the two groups were 95.4%, 79.1%, 65.0%, 50.4%, and 42.9%, and 98.5%, 85.0%, 70.8%, 58.7%, and 55.6%, respectively, (P = 0.18). Subgroup analyses showed that there was no significant difference between the overall survivals of the two groups of patients when the interval of tumor recurrence from the initial hepatectomy was ≤1 year (P = 0.74) or >1 year (P = 0.69), and for recurrent tumor ≤3 cm (P = 0.62) or >3 cm (P = 0.57). Major complications happened significantly more often after repeat hepatectomy than PRFA (30 of 44 versus 2 of 66, P < 0.05). The interval of recurrence from the initial hepatectomy, the diameter of the recurrent tumor and the serum albumin level were significant prognostic factors for overall survival. Conclusion  PRFA was as effective as repeat hepatectomy in the treatment of recurrent small HCC. PRFA had the advantage over repeat hepatectomy in being less invasive.     

二尖瓣置换术同期行心房颤动射频消融术后房性心动过速的射频消融术治疗

目的随访风湿性心脏病患者行二尖瓣置换术同期行心房颤动射频消融术后的心律,探索发生房性心动过速（房速）患者的导管射频消融效果。方法纳入因风湿性心脏病行二尖瓣置换术同期行心房颤动外科消融术后发生房速的11例患者,在心动过速持续状态下采用三维电解剖标测系统,建立左心房或右心房标测图,根据标测结果选择心动过速的关键部位行射频消融术。男4例、女7例,平均年龄（49±8）岁。结果该组患者行外科手术时间为（149±18）min,术后住院时间（9．5±2．9）d,住ICU时间（1．8±0．4）d。在电解剖标测过程中,11例患者共标测出17种心动过速,其中5例患者（6例次,35％）起源于右心房,6例患者（11例次,65％）起源于左心房,其中2例与二尖瓣环有关。消融术中即时成功率为91％（10／11）。平均随访（17±4）个月后,2例左心房房速患者复发。结论该类患者发生的房速来自左心房居多,大多数非二尖瓣瓣环依赖,行导管射频消融术效果满意且安全。     

Endoscopic versus Open Radiofrequency Ablation for Treatment of Small Hepatocellular Carcinoma

Background

Surgical radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is associated with superior oncological outcome in comparison with percutaneous RFA. The present study aimed to retrospectively evaluate the relative perioperative safety and postoperative outcome of the laparoscopic or thoracoscopic approach versus the open approach to RFA for small HCC.

Methods

A retrospective analysis was performed in 55 consecutive patients who underwent open (n = 32) or laparoscopic/thoracoscopic (LTS) RFA (n = 23) for primary unresectable HCC between January 2005 and December 2010. Baseline characteristics, survival/recurrence rates, and complications after treatment were compared between the two groups.

Results

There was a trend showing that LTS RFA was performed for tumors located in the anterior segment (e.g., segments III, V, VIII). The LTS RFA group had a significantly lower intraoperative blood loss, shorter operative time, and shorter postoperative hospital stay, compared with the open RFA group. No major postoperative complications occurred in patients who underwent LTS RFA. No significant differences in overall survival, recurrence-free survival and local recurrence rates were observed between the two groups.

Conclusions

In consideration of operative invasiveness and postoperative recovery, LTS RFA is superior to the open approach in patients with small HCC. Moreover, the surgical outcome did not differ between the two approaches. Laparoscopic/thorascopic RFA can be considered to be a useful procedure for ablation therapy.     

Radio Frequency Ablation for Hepatocellular Carcinoma in Cirrhotic Patients: Prognostic Factors for Survival

Background  Radio frequency ablation (RFA) of hepatocellular carcinoma has proved to be useful in local control of tumor. A few data on survival after treatment are available in literature. The aim of the study was to evaluate factors related to survival and to identify different classes of risk after radio frequency ablation. Methods  Ninety-eight cirrhotic patients with 145 hepatocellular carcinomas were treated with radio frequency ablation from January 1998 to May 2004. In 55 patients, cirrhosis was in Child-Pugh class A, and in 43, in class B. Tumor was single in 60 and multiple in 38; mean tumor number was 1.5 (range 1–3). Tumor size ranged from 1.5 to 6.0 cm, mean 3.8 cm. Mean follow up period was 24.9 months. Radio frequency ablation was performed with expandable type needle with percutaneous approach under real-time ultrasound guidance. For statistical analysis, univariate and multivariate analysis were performed. Results  Complete ablation of the tumor was achieved in 85.5% of lesions. Survival, 1 and 3 years, was 76.7 and 36.6%, respectively. Univariate analysis showed that Cancer of the Liver Italian Program (CLIP) score, tumor growth pattern, α-fetoprotein level, and complete tumor necrosis, were factors significantly related to poor survival. Multivariate analysis identified that factors related to poor survival were α-fetoprotein level >100 ng/ml, Child-Pugh class B, and incomplete tumor necrosis with a hazard ratio of 4.0, 2.7, and 3.8, respectively. After complete ablation, median survival was 38 months in patients with Child-Pugh class A cirrhosis and α-fetoprotein level ≤100 ng/ml, 22 months for patient with Child-Pugh class B cirrhosis and α-fetoprotein ≤100 ng/ml, and 9 months for patient with Child-Pugh class A cirrhosis and α-fetoprotein >100 ng/ml (P < 0.01). Conclusions  Complete necrosis and absence of residual tumor positively affect survival after RFA. In patients with Child-Pugh A cirrhosis and α-fetoprotein level ≤100 radio frequency, ablation have results, 55% after 3 years, that are comparable to those of surgical resection. Patients with Child-Pugh B cirrhosis and/or α-fetoprotein >100 ng/ml showed less satisfactory results, and in these patients, multimodality treatment or other treatments should be considered.     

阵发性心房颤动患者经导管射频消融治疗的护理

目的探讨经导管射频消融治疗阵发性心房颤动患者的护理效果。方法对12例接受介入治疗的阵发性心房颤动患者术前予以心理护理,术中严密观察、密切配合,术后严密监护、有效抗凝等措施。结果12例患者一次射频消融治疗成功。随访4～8个月,10例无复发．2例术后第3、第29天复发,再次治疗好转。结论科学的围术期护理是阵发性心房颤动患者经导管射频消融治疗顺利、预防或减少并发症的重要保障。     

阵发性心房颤动患者经导管射频消融治疗的护理

目的 探讨经导管射频消融治疗阵发性心房颤动患者的护理效果.方法 对12例接受介入治疗的阵发性心房颤动患者术前予以心理护理,术中严密观察、密切配合,术后严密监护、有效抗凝等措施.结果 12例患者一次射频消融治疗成功,随访4～8个月,10例无复发,2例术后第3、第29天复发,再次治疗好转.结论 科学的围术期护理是阵发性心房颤动患者经导管射频消融治疗顺利、预防或减少并发症的重要保障.     

CT引导下经皮穿刺射频消融术治疗脊柱骨样骨瘤3例报告

目的评价CT引导下经皮穿刺射频消融术治疗脊柱骨样骨瘤的临床效果。方法 3例脊柱骨样骨瘤,分别位于颈椎、腰椎和骶椎,肿瘤边缘紧邻脊髓或神经。局部麻醉后,CT引导下经皮穿刺将射频电极置入骨样骨瘤中心,应用90℃的射频高温持续4 min对瘤巢进行损毁。结果术中及术后无明显并发症发生。术后分别随访2、6、7个月（平均5个月）,疼痛缓解满意,3例VAS评分分别下降了6、8、8分,随访期内疼痛无复发,无神经功能损害。结论 CT引导下经皮穿刺射频消融术治疗脊柱骨样骨瘤微创、安全,患者耐受性好,近期效果确切。     

Contemporary Status of Percutaneous Ablation for the Small Renal Mass

Renal cell carcinoma is the tenth most common malignancy in the USA, with upwards of 61,000 new cases and resulting in more than 14,000 deaths annually. Although partial nephrectomy remains the standard treatment, image-guided nephron-sparing ablative techniques including cryoablation, radiofrequency ablation, and microwave ablation have emerged as treatment options in certain patient populations. Ablative therapies have high technical successes, low tumor recurrence rates, and preserve renal parenchymal volume. The purpose of this article is to provide an update on ablation therapies for small renal masses.     

Open Surgical is Superior to Percutaneous Access for Radiofrequency Ablation of Hepatic Metastases

Purpose  This study was designed to determine the best approach to radiofrequency ablation (RFA) in the liver. Methods  From a total of 41 procedures, 37 patients with 47 tumors were treated with RFA for metastatic disease. Indications included colorectal cancer (n = 28, 68%), neuroendocrine tumors (n = 2, 5%), gynecological primaries (n = 4, 10%), pancreatic/duodenal cancer (n = 2, 5%), and miscellaneous entities (n = 5, 12%). Mean follow-up period was 18 (median, 18) months. All ways of approach to RFA were applied: percutaneous was chosen in 17 (41.5%), laparoscopic and hand-assisted laparoscopic in 5 (12.2%), and open surgical in 19 cases (46.3%), and in 10 cases, RFA was combined with hepatic resection. The average maximum tumor size was 2.3 (range, 0.8–6) cm, and the mean number of nodules treated per patient in a single session was 1.3 (range, 1–3). Results  Overall survival was 59.5% at 2 years, recurrence-free 2-year survival was 12.6%, local tumor recurrence rate was 34%, and overall recurrence was 75.6%. Local tumor recurrence and disease-free survival were significantly improved in the open surgically treated patients compared with the percutaneous treatment group (15.8% [n = 3] vs. 58.8% [n = 10] and 11.5 vs. 7.9 months, p < 0.01 [χ² test] and p < 0.05 [log-rank test], respectively). Conclusions  Open surgical approach is superior to percutaneous access for RFA in metastatic hepatic disease.     

Use of Percutaneous Radiofrequency Ablation in Pulmonary Metastases from Renal Cell Carcinoma

Background  

Surgical resection of pulmonary metastases from renal cell carcinoma (RCC) has been demonstrated in recent studies to produce good long-term survival outcomes. Radiofrequency ablation (RFA) may offer an alternative treatment option for this group of patients, especially for those who are unable to have surgery.     

超声在经皮射频消融治疗肾脏肿瘤中的应用

目的：探讨超声在经皮射频消融治疗。肾脏肿瘤中的应用价值。方法：对25例肿瘤位于肾脏背外侧、。肾中下极的患者,行超声引导下经皮射频消融术。结果：25例手术均获成功,手术时间30-50min,平均37min,无。肾周出血、肾周积液、邻近脏器损伤等并发症。术后病理肾细胞癌18例,肾脏错构瘤5例,2例病理无法判断。1例术后复查证实肿瘤残留,再次行经皮射频治疗。结论：超声在经皮射频消融术治疗肾脏肿瘤中,起到关键性的作用,熟练的操作可以提高肾脏肿瘤完全灭活的成功率。