Percutaneous Microwave Coagulation for the Treatment of Small Solitary Focal Nodular Hyperplasia of Liver

Background: Whether percutaneous microwave coagulation (PMC) is safe and effective for the treatment of symptomatic focal nodular hyperplasia (FNH) of the liver remains unknown. Methods: Between January 2006 and September 2015, sixteen patients with solitary symptomatic FNHs in the liver (the largest diameter less than 5 cm) were treated by PMC. The safty and effectiveness were analyzed. Results: There were 4 males and 12 females. All these patients suffered from upper abdominal pain. The FNHs ranged in size from 3.2 cm to 5.0 cm (3.9 cm ± 0.12 cm). All the PMC procedures were performed successfully. All 16 patients had symptomatic improvement after the treatment with no procedure-related morbidity or mortality. Among 16 patients, 15 (93.8%) patients with FNHs were assessed to be ablated completely by CT examination performed within four weeks after PMC treatment. One patient failed to follow up regularly, but showed up 2 years and 7 months later for suffering upper abdominal pain again with original FNH enlargement, and the patient received surgical resection of the FNH and achieved asymptomatic aftermath. Conclusion: PMC is safe and effectiveness for symptomatic liver FNHs. PMC should be considered to be an alternative modality for those solitary FNHs with less than 5 cm in diameter.

Metal Stenting with or without Endobiliary Radiofrequency Ablation for Unresectable Extrahepatic Cholangiocarcinoma

Background: Retrospective comparison of stent patency and survival of patients with unresectable extrahepatic cholangiocarcinoma (CCA) treated by placement of self-expanding metal stents (SEMS) with or without endobiliary radiofrequency ablation (ERFA). Methods: Between January 2010 and September 2014, 76 patients with biliary obstruction caused by unresectable extrahepatic CCA (27 patients with Bismuth type I hilar CCA and 49 patients with distal CCA) were recruited into this study. Patients either received ERFA with SEMS (n = 34) or SEMS only (n = 42). Stent patency and survival of both groups were compared and predictors for overall survival were analyzed. Results: Demographic data were not different between the two groups. Complication rates of both groups were similar. Thirty-day stent patency was obtained in all patients and the median stent patency in the ERFA + SEMS group (9.5 months, 4.5 - 14.0 months) was significantly longer than that in the SEMS group (8.4 months, 4.9 - 11 months) (P = 0.024). The overall survival curve in the ERFA + SEMS group was significantly better than that of the SEMS group (P = 0.036). Multivariate Cox proportional hazards regression analyses showed that ERFA, tumor AJCC stage, extrahepatic CCA type, serum albumin and adjuvant chemotherapy were significant prognostic factors for overall patient survival. Conclusions: ERFA is effective for unresectable extrahepatic CCA and may improve metal stent patency and patient survival for unresectable extrahepatic CCA with biliary obstruction. Prospective randomized trials will be needed to confirm these findings.