Percutaneous radiofrequency ablation of hepatocellular carcinoma in cirrhosis: analysis of complications in a single centre over 20 years

Giorgio, Antonio; Merola, Maria Gabriella; Montesarchio, Luca; Merola, Francesca Reduzzi; Gatti, Pietro; Coppola, Carmine; Giorgio, Valentina; Calisti, G

doi:10.1259/bjr.20160804

Cited by 18 publications

(15 citation statements)

References 20 publications

(25 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In RFA, an electrical current is delivered to the tumor tissue through a needle electrode under imaging guidance and causes heat-based thermal cytotoxicity. [4–6] However, complications associated with RFA also occur during thermal injury. Although most of these complications are usually minor and self-limited, major complications may be fatal in cases in which diagnosis and treatment are delayed and inappropriate.…”

Section: Discussionmentioning

confidence: 99%

“…RFA is the most widely used 1st-line treatment in selective patients with HCC and metastatic liver cancer and is usually safe and well tolerated. [4–6] However, previous studies reported the occurrence of major complications associated with RFA, including hemorrhage, liver abscess, hepatic infarction, bile duct injury, gastrointestinal perforation, hemothorax, pneumothorax, tumoral seeding, and hepatic failure. [7–10] The rates of major complications and mortality associated with RFA were 4.1% (range: 3.3–5.1) and 0.15% (range: 0.08–0.23), respectively.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cardiac tamponade after radiofrequency ablation for hepatocellular carcinoma

Chung

Choi

et al. 2018

Medicine

View full text Add to dashboard Cite

Rationale:Radiofrequency ablation (RFA) is a safe and effective local treatment modality with a low complication rate and is commonly used to treat hepatocellular carcinoma (HCC). The clinical outcome of RFA may be closely related to the location, size, and shape of index tumors, and major complications, including hemorrhage, liver abscess, infarction, visceral organ perforation, hemothorax, pneumothorax, tumoral seeding, and hepatic failure. Cardiac tamponade is a rare and serious life-threatening complication associated with RFA. To date, a review of the medical literature reported 5 cases of cardiac tamponade after RFA for HCC. Herein, we report another case of cardiac tamponade after RFA for HCC in a 56-year-old man.Patient concerns:He had suffered from liver cirrhosis due to alcohol abuse. He had chronic obstructive pulmonary disease. Magnetic resonance imaging showed a 3.0-cm exophytic subcapsular HCC in segment IVa of left hepatic lobe. As the patient was at high risk for surgery because of poor lung function, RFA was selected as the treatment of choice. The index tumor was located in the vicinity of the diaphragm and colon. During RFA procedure, thermal injury to the adjacent diaphragm and colon was minimized by introducing artificial ascites. Bleeding or tumoral seeding was prevented by ablating the electrode track during electrode retraction.Diagnosis:Two hours after RFA, the patient presented with dyspnea, chest discomfort, and low blood pressure (80/60 mm Hg), suggesting cardiac tamponade. Immediate follow-up contrast-enhanced computed tomography image depicted the slightly high attenuated hemopericardium. Transthoracic echocardiography (TTE) showed a moderate amount of pericardial effusion with tamponade and a large hematoma.Interventions:Under fluoroscopy and portable echocardiography guidance, a cardiologist immediately inserted a 7-French pigtail catheter into the pericardial space and collected more than 200 cc of bloody pericardial fluid.Outcomes:After pericardiocentesis, the patient's symptoms and hemodynamic status were dramatically improved. Follow-up TTE showed scanty amount of pericardial effusion and the drainage catheter was removed. The patient was discharged.Lessons:When treating HCC in the left lobe (especially segments II and IVa), attention should be paid to cardiac tamponade. The early diagnosis and immediate treatment of cardiac tamponade may increase the chance of cure.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiac tamponade after radiofrequency ablation for hepatocellular carcinoma

Chung

Choi

et al. 2018

Medicine

View full text Add to dashboard Cite

show abstract

“…Patients with cirrhosis and superimposed ICC with a total bilirubin level >2.5 mg/dL were also excluded. 13,16 Before ablation, all patients underwent clinical and biochemical exams (including assays for Ca 19.9 and alphafetoprotein), abdominal conventional US, contrast-enhanced US (CEUS), CECT and/or CEMRI. Enhancement characteristics were classified into four patterns: peripheral irregular rim-like hyperenhancement (type I); diffuse heterogeneous hyperenhancement (type II); diffuse homogeneous hyperenhancement (type III); and diffuse heterogeneous hypoenhancement (type IV).…”

Section: Methodsmentioning

confidence: 99%

Intrahepatic Cholangiocarcinoma and Thermal Ablation: Long-term Results of An Italian Retrospective Multicenter Study

Giorgio¹,

Gatti²,

Montesarchio³

et al. 2019

Journal of Clinical and Translational Hepatology

Self Cite

View full text Add to dashboard Cite

Background and Aims: Despite resection being considered the treatment of choice for intrahepatic cholangiocarcinoma (ICC), percutaneous thermal ablation can be an alternative treatment for patients unfit for surgery. Our aim was to compare long-term results of percutaneous sonographically-guided radiofrequency ablation (RFA) with highpowered microwave ablation (MWSA) in treatment of ICC. Methods: Results of 71 ICC patients with 98 nodules treated with RFA (36 patients) or MWSA (35 patients) between January 2008 and June 2018 in 5 Interventional Ultrasound centers of Southern Italy were retrospectively reviewed. Cumulative overall survival curves were calculated with the Kaplan-Meyer method and differences with the log-rank test. Eleven possible factors affecting survival were analyzed. Results: Overall survival of the entire series was 88%, 65%, 45% and 34% at 12, 36, 60 and 80 months, respectively. Patients treated with MWSA survived longer than patients treated with RFA (p < 0.005). The MWSA group with ICC nodules #3 cm or nodules up to 4 cm survived longer than the RFA group (p < 0.0005). In patients with nodules >4 cm, no significant difference was found. Disease-free survival and progression-free survival were better in the MWSA group compared to the RFA group (p < 0.005). Diameter of nodules and MWSA were independent factors predicting a better survival. No major complications were observed. Conclusions: MWSA is superior to RFA in treating ICC unfit for surgery, achieving better long-term survival in small (#3 cm) ICC nodules as well as nodules up to 4 cm of neoplastic tumors and should replace RFA. Citation of this article: GiorgioA, Gatti P, Montesarchio L, Santoro B, Dell'Olio A, Crucinio N, et al. Intrahepatic cholangiocarcinoma and thermal ablation: long-term results of an Italian retrospective multicenter study.

show abstract

“…Similar rates have been observed in more recent studies [46,47] . A pre-RFA value of bilirubin > 2.5 mg/dL may predict liver decompensation after treatment [48] .…”

Section: Radio Frequency Ablationmentioning

confidence: 99%

Thermal ablation of large unresectable hepatocellular carcinoma in cirrhotic patients

Costanzo¹,

Tortora²,

Opramolla³

et al. 2018

View full text Add to dashboard Cite

Hepatocellular carcinoma (HCC) is one of the most common and lethal malignancies worldwide. Surgery is the mainstay of treatment, but less than 20%-30% of patients are good candidates. Actually, thermal ablation is considered the best treatment with curative intent for cirrhotic patients with unresectable HCC ≤ 3 cm. Unfortunately, radio frequency efficacy in obtaining the complete ablation of HCC nodules diminishes with increasing tumor size and local tumor progression is more frequent in larger nodules. To overcome these problems, higher-powered generators, different devices and techniques have been attempted. Furthermore, microwave ablation has been introduced with the promise of a large ablative capacity. The aim of this review is to describe the role of thermal ablation for the treatment of large unresectable HCC.

show abstract

Percutaneous radiofrequency ablation of hepatocellular carcinoma in cirrhosis: analysis of complications in a single centre over 20 years

Cited by 18 publications

References 20 publications

Cardiac tamponade after radiofrequency ablation for hepatocellular carcinoma

Cardiac tamponade after radiofrequency ablation for hepatocellular carcinoma

Intrahepatic Cholangiocarcinoma and Thermal Ablation: Long-term Results of An Italian Retrospective Multicenter Study

Thermal ablation of large unresectable hepatocellular carcinoma in cirrhotic patients

Contact Info

Product

Resources

About