Microwave ablation versus transcatheter arterial embolization for large hepatic hemangiomas: clinical outcomes

Abstract

Purpose: To evaluate the safety and effect of microwave ablation (MWA) compared with transcatheter arterial embolization (TAE) for the treatment of large hepatic hemangiomas. Materials and methods: A total of 135 patients with symptomatic or/and enlarging hepatic hemangiomas (5-10 cm) from two centers underwent either MWA (n ¼ 82) or TAE (n ¼ 53) as first-line treatment. We compared the two groups in terms of radiologic response, clinical response, operative time, postoperative analgesic requirements, hospital stay and complications. Results: MWA had a significantly higher rate of complete radiologic response (89.0% vs. 37.7%, p<.001) and complete clinical response (88.6% vs. 69.2%, p¼.046), fewer minor complications (43.9% vs. 66.0%, p¼.019), shorter time of using analgesics (p<.001) and shorter hospital stays (p¼.003) than did TAE. The operative time and major complications were comparable between the two groups. Conclusion: Both MWA and TAE are safe and effective in treating patients with large hepatic hemangiomas. MWA had a higher rate of complete response than did TAE, and it was associated with fewer minor complications, faster recovery and shorter hospital stay.

To Systematically Evaluate and Analyze the Efficacy and Safety of Transcatheter Arterial Chemoembolization (TACE) in the Treatment of Primary Liver Cancer

“…Among the 12 RCTs' literatures included in the effective rate analysis, the heterogeneity test was carried out, and it was found that the heterogeneity of the selected studies was small, so meta-analysis with fixed models could be performed. The results of meta-analysis showed that the rhombus plot and vertical line are not intersected in the forest map of 4 included literatures, so there was statistical difference in quality-of-life improvement rate of TACE combined with heat treatment for advanced hepatocellular carcinoma (OR = 2.29,95%CI (1.62,3.23), P < 0.00001, I 2 = 83%, and Z = 3.37) [ 34 – 38 ]. Figure 6 is meta-analysis of the quality-of-life improvement rate between two groups.…”

Ablation for Benign Liver Tumors: Current Concepts and Limitations

“…[15][16][17][18][19][20][21][22][23][24] There are some possible complications of ablation for hemangioma, most of which are classified as Clavien-Dindo grade 1, with hemoglobinuria, fever, and pain being common events (Tables 4 and 5). [15][16][17][18][19][20][21][22][23][25][26][27][28][29] According to Wu et al, 25 the rates of achieving complete ablation and procedure-related complications were similar in 253 patients with hemangiomas of 5-9.9 cm and 38 patients with hemangiomas of ≥10 cm. 25 However, the rates of hemolysis-related and systemic inflammatory response syndrome-related complications were higher in patients with hemangiomas of ≥10 cm than in those with hemangiomas of 5-9.9 cm.…”

“…According to recent studies, either the laparoscopic/surgical or percutaneous approach is predominantly used with US guidance (Tables 2 and 3). [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Complete ablation was reported in >86% of patients with RFA and >84.6% with MWA. The resolution of clinical symptoms was achieved by most patients, complete resolution of clinical symptoms in 50-90.9% by RFA, and 50-100% by MWA.…”

“…According to the study comparing MWA (n=82, 6.9±1.8 cm) and transcatheter arterial embolization (TAE; n=53, 7.1±1.5 cm) for the treatment of large hepatic hemangiomas, 27 the MWA group had a significantly higher rate of complete radiological response defined as no obvious enhancement of lesions on contrast-enhanced CT/magnetic resonance imaging (MRI; 89.0% vs. 37.7%, p<0.001) and complete clinical response defined as disappearance of hemangioma-related symptoms (88.6% vs. 69.2%, p=0.046). MWA was associated with fewer minor complications, defined as events without substantial morbidity or disability that increased the level of care (43.9% vs. 66.0%, p=0.019), shorter time of analgesic use (p<0.001), and shorter hospital stay (p=0.003) than the TAE group.…”

Management ofdrug‐inducedneutropenia, thrombocytopenia, and anaemia after solid organ transplantation: A comprehensive review

“…16 Azathioprine 29%-53% in liver transplant patients 96 Ineffective erythropoiesis due to macrocytosis and megaloblastic changes in bone marrow 16 Dose related 79 Severe in patients with thiopurine methyl transferase deficiency 51 Delayed hematologic suppression may occur 51 Frequent monitoring, dose adjustment or other therapy changes are necessary, 16 especially when coadministered with ACEis. 51 CNIs Tacrolimus: 5%-50% 39 and 1% TMA 44 Cyclosporine: <2% 80 and 3%-14% TMA 3,44 Bone marrow suppression 6,12 CNIs may indirectly cause anaemia via nephrotoxicity. 5 Dose related TMA 44 TMA can occur any time, but usually occurs within the first year 44 In case of TMA consider changing to another CNI or to mTORis.…”