Patterns of complications following intraoperative radiofrequency ablation for liver metastases

Désolneux, G.; Vara, Jeremy; Razafindratsira, Tsiriniaina; Isambert, M.; Brouste, Véronique; McKelvie-Sebileau, Pippa; Évrard, Serge

doi:10.1111/hpb.12274

Cited by 10 publications

(8 citation statements)

References 28 publications

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“…Potential septic surgery is also known to cause higher post-operative complications. 13,28,30 As often in extensive surgeries, PVO was correlated with higher post-operative complications. In the literature, PVO seems to improve liver volume and function, 33 but is associated with more post-operative complications (blood loss) and may stimulate the growth of the remaining metastases.…”

Section: Discussionmentioning

confidence: 94%

“…After 10 years and many studies, results are still heterogeneous, including patients with different and incomparable chemotherapies, without essential and exhaustive histological analysis. 10,12–17 Our study is interesting as the patients received only one line of chemotherapy, giving us pertinent and homogeneous results on the impact of chemotherapy on liver. The study by Rubbia-Brandt et al 9 did not show any impact of sex, contrary to our results.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 In general, reports in literature on the impact of chemotherapy on non-tumoural liver and on post-operative morbidity and mortality are heterogeneous with contradictory conclusions. 10–13…”

Section: Introductionmentioning

confidence: 99%

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Hepatotoxicities Induced by Neoadjuvant Chemotherapy in Colorectal Cancer Liver Metastases: Distinguishing the True From the False

Desjardin

Bonhomme

Bail

et al. 2019

Clin Med Insights Oncol

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Background:Pre-operative chemotherapy for colorectal liver metastasis (CRLM) is thought to be the cause of hepatotoxicity of non-tumoural parenchyma. Studies on hepatotoxicity are contradictory. We investigated the impact of a single-line pre-operative chemotherapy on non-tumoural liver analysed by an expert hepatico-pancreatico-biliary pathologist, and the consequences on surgical outcomes.Patients and methods:Patients operated for CRLM, after a pure first-line pre-operative chemotherapy, were retrospectively included. Two comparative histopathological analyses were performed for vascular toxicity and steatohepatitis.Results:Between 2003 and 2015, 147 patients were included. Chemotherapy was based on oxaliplatin (40.1%), irinotecan (55.8%), or both (4.1%). The expert pathologist described 38.8% of vascular lesions including dilation, nodular regeneration, and peliosis. In multivariate analysis, vascular lesions correlated to male sex (P = .01), pre-operative platelets <150 g/L (P = .04), and aspartate aminotransferase to platelet ratio index (APRI) score >0.36 (P = .02). Steatohepatitis was observed in 15 patients (10.2%), more frequently after irinotecan (14.8% vs 3.4%, P = .01; odds ratio [OR] = 7.3; 95% confidence interval [CI] = [1.5-34.7]), and for patients with body mass index (BMI) >25 kg/m2 (P = .004; OR = 10.0; 95% CI = [2.1-47.5]). A total of 29 patients (19.7%) developed major complications with 2 risk factors: portal vein obstruction (PVO) and septic surgery. Reproducibility assessment of steatohepatitis and dilated lesions by 2 pathologists showed moderate agreement (Kappa score 0.53 and 0.54, respectively).Conclusions:There is a probable association between non-alcoholic steatohepatitis (NASH) and irinotecan. Oxaliplatin seems to lead to higher vascular lesions. Except in the presence of pre-existent comorbidities, liver toxicities should not restrain the use of pre-operative chemotherapy prior to parenchymal-sparing surgery.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Hepatotoxicities Induced by Neoadjuvant Chemotherapy in Colorectal Cancer Liver Metastases: Distinguishing the True From the False

Desjardin

Bonhomme

Bail

et al. 2019

Clin Med Insights Oncol

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“…4,6 Other reports concerning CRLM patients indicated that local control and oncological safety of ablative techniques were similar to liver resection. [34][35][36][37] Some reports indicate that combined resection and ablation achieves results comparable to conventional liver resection with respect to short-term postoperative outcomes and oncological outcomes. [38][39][40][41][42] However, oncological safety of combined resection and ablation is still under debate as multicenter randomized studies are lacking and contrasting results have been published before.…”

Section: Discussionmentioning

confidence: 99%

Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study

Elfrink

Nieuwenhuizen

Tol

et al. 2021

HPB

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Background: Combining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation. Methods: In this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery. Results: Of 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy. Conclusion: Significant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy.

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“…RFA is a safe, economical, efficient transdermal technology in the treatment of patients with primary and secondary tumors, as well as unresectable tumors in the spinal canal and those that are insensitive to chemotherapy and radiotherapy (30,31). It can prevent or delay tumor progression and the risk of fracture, thus preventing or delaying paraplegia, reducing the pain caused by the tumor, and improving the daily activities and life quality of patients.…”

Section: Discussionmentioning

confidence: 99%

Image-guided minimally invasive percutaneous treatment of spinal metastasis

Yang

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. In order to provide effective options for minimally invasive treatment of spinal metastases, the present study retrospectively evaluated the efficacy and safety of image-guided minimally invasive percutaneous treatment of spinal metastases. Image-guided percutaneous vertebral body enhancement, radiofrequency ablation (RFA) and tumor debulking combined with other methods to strengthen the vertebrae were applied dependent on the indications. Percutaneous vertebroplasty (PVP) was used when vertebral body destruction was simple. In addition, RFA was used in cases where pure spinal epidural soft tissue mass or accessories (spinous process, vertebral plate and vertebral pedicle) were destroyed, but vertebral integrity and stability existed. Tumor debulking (also known as limited RFA) combined with vertebral augmentation were used in cases presenting destruction of the epidural soft tissue mass and accessories, and pathological vertebral fractures. A comprehensive assessment was performed through a standardized questionnaire and indicators including biomechanical stability of the spine, quality of life, neurological status and tumor progression status were assessed during the 6 weeks-6 months follow-up following surgery. After the most suitable treatment was used, the biomechanical stability of the spine was increased, the pain caused by spinal metastases within 6 weeks was significantly reduced, while the daily activities and quality of life were improved. The mean progression-free survival of tumors was 330±54 days, and no associated complications occurred. Therefore, the use of a combination of image-guided PVP, RFA and other methods is safe and effective for the treatment of spinal metastases.

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Patterns of complications following intraoperative radiofrequency ablation for liver metastases

Abstract: Mortality and morbidity after IRFA, with or without resection, are low. Nevertheless, long interventions and concurrent bowel operations increase the risk for septic complications.

Cited by 10 publications

References 28 publications

Hepatotoxicities Induced by Neoadjuvant Chemotherapy in Colorectal Cancer Liver Metastases: Distinguishing the True From the False

Hepatotoxicities Induced by Neoadjuvant Chemotherapy in Colorectal Cancer Liver Metastases: Distinguishing the True From the False

Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study

Image-guided minimally invasive percutaneous treatment of spinal metastasis

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