Safety and Efficacy of Percutaneous Thermal Ablation of Juxta-Cardiac Hepatic Tumours

Kwan, Jun; Appuhamy, Chinthaka; Lim, Grace; Huang, Ivan Kuang Hsin; Quek, Lawrence Han Hwee; Pua, Uei

doi:10.1007/s00270-018-1938-8

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…This thought could be an obstacle to the treatment of patients. In this study and the literature, percutaneous MWA was shown to be a feasible and effective method, even for these lesions, by evaluating several planes on USG or CT and cooperating with patients 11 , 21 , 22 , 23 , 24 , 25 , 26 .…”

Section: Discussionmentioning

confidence: 72%

Effective and Safe Treatment of Risky Localized Liver Tumors Using Microwave Ablation in Patients with Comorbid Lung Diseases Unfit for Deep Anesthesia

ASIK

2024

MMJ

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Objective: To assess the safety and efficacy of percutaneous microwave ablation (MWA) in treating high-risk localized liver tumors in patients unable to undergo deep anesthesia because of comorbid lung diseases. Methods: Between January 2019 and January 2022, percutaneous MWA procedures were performed for 50 liver tumors. These lesions were situated in close proximity to anatomically essential structures, with a maximum distance to surrounding structures being 10 mm. Because of comorbid lung diseases, patients could not undergo deep anesthesia. Regular follow-ups were performed using blood tests and dynamic contrast-enhanced computed tomography or magnetic resonance imaging. Results: The patient cohort consisted of 30 (68%) men and 14 (32%) women, with a mean age of 64.36±11.65 years (range: 40-80 years). The lesions were challenging to access and were located in proximity to critical structures such as the diaphragm (32, 64%), gallbladder (8, 16%), major vessels (5, 10%), and heart (5, 10%). During the follow-up period, 10 patients (23%) had local tumor recurrence and 14 (32%) had new primary foci in a different location and metastasis [liver (10) and non-liver organs (4)]. No major complications developed, and 21 of 44 patients experienced minor complications, which were treated with local medications during follow-up. Conclusions: Percutaneous MWA results in very low mortality and morbidity, coupled with high complete ablation rates for liver cancer. Most liver tumors can be treated safely and effectively with percutaneous MWA, even in cases of high-risk localization, without the need for deep anesthesia.

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Section: Discussionmentioning

confidence: 72%

Effective and Safe Treatment of Risky Localized Liver Tumors Using Microwave Ablation in Patients with Comorbid Lung Diseases Unfit for Deep Anesthesia

ASIK

2024

MMJ

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“…Early investigations [8,24] reported higher local recurrence rates for subcapsular tumors, which was thought to be due to undertreatment for fear of sustaining thermal damage to adjacent structures or causing liver capsular pain. However, more recent investigations which specifically focused on subcardiac tumors [9,10] reported no statistical difference in complete ablation (83-96%) or local recurrence rates between subcardiac and non-subcardiac tumors, although reported relatively high recurrence rates of 15-22%. Cha et al compared the therapeutic outcomes of conventional US-guided radiofrequency (RF) ablation for subcardiac and non-subcardiac HCC in 73 patients with subcardiac HCC and the same number of patients with non-subcardiac HCC.…”

Section: Discussionmentioning

confidence: 95%

“…Since percutaneous treatment is more challenging in tumors which are located close to the liver capsule, early studies showed significantly higher local tumor recurrence compared to non-subcapsular tumors (65 vs. 19%) [8]. However, more recent studies suggest that whilst RFA for subcardiac locations is technically feasible and not significantly different to non-subcardiac locations [9,10], recurrence rates reported to be relatively high (19.1-20%). Three-dimensional (3D) navigation systems have been implemented to allow for a more sophisticated 3D planning of multiple overlapping ablation zones, precise probe placement and intraoperative assessment of the result by means of image fusion [11,12].…”

Section: Introductionmentioning

confidence: 99%

Stereotactic radiofrequency ablation of subcardiac hepatocellular carcinoma: a case-control study

Schullian

Johnston

Putzer

et al. 2019

International Journal of Hyperthermia

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Purpose: The purpose of this study is to evaluate the safety and efficacy of stereotactic radiofrequency ablation (SRFA) for the treatment of subcardiac hepatocellular carcinoma (HCC). Material and methods: From 2003 to 2018, 79 consecutive patients underwent 104 multi-probe SRFA sessions for the treatment of 114 subcardiac HCC with a median size of 2.5 cm (0.5-9.5 cm). The results were compared with a randomly selected control group of 79 patients with 242 HCC with a median size of 2.0 cm (0.5-12 cm) following SRFA in other (non-subcardiac) locations with propensity score matching. Results: The 95.6% of the tumors were successfully treated by the first ablation session (primary technical efficacy rate) and 99.1% after the second session (secondary technical efficacy rate). Local tumor recurrence developed in 8 nodules (7.0%). Major complication and perioperative mortality rates were 7.7% (8/104) and 1% (1/104), respectively. The overall survival (OS) rates from the date of the first SRFA with single subcardiac HCCs were 92%, 77% and 65% at 1, 3 and 5 years, respectively, with a median OS of 90.6 months. The disease-free survival (DFS) after SRFA was 75, 34 and 34%, at 1, 3 and 5 years, respectively, with a median DFS of 19.1 months. There was no statistically significant difference with the control group in terms of local tumor control, safety, OS and DFS. Conclusion: SRFA of subcardiac tumors is as safe and efficacious as when treating tumors remote from the heart.

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“…Additionally, multiple reports exist of pericardial tamponade complicating RFA of HCC lesions that abut or involve the pericardium [19]. Safety and efficacy of thermal ablation (RFA, MWA) for JC tumors were recently demonstrated to be comparable to non-JC tumors [20]. That study characterized lesions < 10 mm from the cardiac border as JC.…”

Section: Discussionmentioning

confidence: 99%

Eye Opener to EtOH Ablation for Juxta-Cardiac Hepatocellular Carcinoma

Soule

Lamsal

Lall

et al. 2018

Gastrointest Tumors

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Background: Hepatocellular carcinoma (HCC) is notoriously refractory to systemic chemotherapy, mandating an interventional approach. Mortality may be avoided by neutralizing rapidly growing tumors that approach the heart and major vessels. When the risk/benefit ratio of surgery is unacceptable, percutaneous ablation can achieve remarkable results. High volumes of flowing blood adjacent to the treatment area may impact the ability to reliably achieve an adequate ablation margin for modalities that rely on extreme temperatures to destroy malignant cells. Ethanol ablation is safe, efficacious, and unaffected by this “thermal sink” effect. This report describes a juxta-cardiac (JC) HCC in segment 4a measuring 35 × 26 mm, which exhibited rapid growth until it was abutting the pericardium and 7.5 mm from the chamber of the right ventricle (RV). Methods: One 21-gauge needle was inserted using direct CT fluoroscopy into the center of the hepatic mass. In order to confirm the position of the needle, 0.5 mL of diluted Visipaque was injected. Then, under CT fluoroscopy guidance, a mixture of 1 mL of Ethiodol and 10 mL of 98% dehydrated alcohol was slowly injected into the mass. Results: Repeat CT scan 1 month post-ablation demonstrated decreased arterial enhancement and dense Ethiodol throughout the tumor consistent with ablation. Tumor size decreased to 30 × 23 mm with a distance of 12.4 mm from the chamber of the RV. Conclusion: Pericardial involvement or large vessels near the treatment area may limit the use of thermal ablation techniques for JC HCC. Percutaneous, intratumoral ethanol injection provides safe and effective alternative that is not subject to the “thermal sink” effect.

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Safety and Efficacy of Percutaneous Thermal Ablation of Juxta-Cardiac Hepatic Tumours

Abstract: Percutaneous thermal ablation of JC tumours has similar rates of local tumour control and safety profile when compared to tumours in a NJC location. Tumours in a JC location should not be considered a contraindication for thermal ablation.

Cited by 8 publications

References 24 publications

Effective and Safe Treatment of Risky Localized Liver Tumors Using Microwave Ablation in Patients with Comorbid Lung Diseases Unfit for Deep Anesthesia

Effective and Safe Treatment of Risky Localized Liver Tumors Using Microwave Ablation in Patients with Comorbid Lung Diseases Unfit for Deep Anesthesia

Stereotactic radiofrequency ablation of subcardiac hepatocellular carcinoma: a case-control study

Eye Opener to EtOH Ablation for Juxta-Cardiac Hepatocellular Carcinoma

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