Major complications after radiofrequency ablation for liver tumors:Analysis of 255 patients

AIM:To investigate the major complications after radiofrequency ablation(RFA) for the treatment of liver tumors and analyze possible risk factors that precipitate these complications.METHODS:From March 2001 to April 2008,255 patients with liver tumors(205 male,50 female;age range,18-89 years;mean age,56.0 years) who received RFA were enrolled in this study.Of these patients,212 had hepatocellular carcinoma,39 had metastatic liver tumors and four had cholangiocellular carcinoma.One hundred and forty eight patients had a single tumor,and 107 had multiple tumors.Maximum diameter of the tumors ranged 1.3-20 cm(mean,5.1 cm).All patients were treated with a cooled-tip perfusion electrode attached to a radiofrequency generator(Radionics,Burlington,MA,USA).RFA was performed via the percutaneous approach(n = 257),laparoscopy(n = 7),or open surgical treatment(n = 86).The major complications related to RFA were recorded.The resultant data were analyzed to determine risk factors associated these complications.RESULTS:Among the 255 patients,425 liver tumors were treated and 350 RFA sessions were performed.Thirty-seven(10%) major complications were observed which included 13 cases of liver failure,10 cases of hydrothorax requiring drainage,three casesof tumor seeding,one case of upper gastrointestinal bleeding,one case ofintrahepatic abscess,one case of bile duct injury,one case of cardiac arrest,and five cases of hyperglycemia.Seven patients had more than two complications.Liver failure was the most severe complication and was associated with the highest mortality.Eleven patients died due to worsening liver decompensation.Child-Pugh classification(P = 0.001) and choice of approach(P = 0.045) were related to post-treatment liver failure,whereas patient age,tumor size and number were not significant factors precipitating this complication.CONCLUSION:RFA can be accepted as a relatively safe procedure for the treatment of liver tumors.However,attention should be paid to possible complications even though the incidences of these complications are rare.Careful patient selection and the best approach choice(percutaneous,laparoscopy,or laparotomy) will help to minimize the incidence and morbidity rate of complications which occur after RFA.

Feasibility and safety of autologous bone marrow mononuclear cell transplantation in patients with advanced chronic liver disease

AIM： To evaluate the safety and feasibility of bone marrow cell （BMC） transplantation in patients with chronic liver disease on the waiting list for liver transplantation. METHODS： Ten patients （eight males） with chronic liver disease were enrolled to receive infusion of autologous bone marrow-derived cells. Seven patients were classified as Child-Pugh B and three as Child-Pugh C. Baseline assessment included complete clinical and laboratory evaluation and abdominal MRI. Approximately 50 mL of bone marrow aspirate was prepared by centrifugation in a ficoll-hypaque gradient. At least of 100 millions of mononuclear-enriched BMCs were infused into the hepatic artery using the routine technique for arterial chemoembolization for liver tumors. Patients were followed up for adverse events up to 4 mo. RESULTS： The median age of the patients was 52 years （range 24-70 years）. All patients were discharged 48 h after BMC infusion. Two patients complained ofmild pain at the bone marrow needle puncture site. No other complications or specific side effects related to the procedure were observed. Bilirubin levels were lower at 1 （2.19 ± 0.9） and 4 mo （2.10 ± 1.0） after cell transplantation that baseline levels （238 ± 1.2）. Albumin levels 4 mo after BMC infusion （3.73 ± 0.5） were higher than baseline levels （3.47 ± 0.5）. International normalized ratio （INR） decreased from 1.48 （SD = 0.23） to 1.43 （SD = 0.23） one month after cell transplantation. CONCLUSION： BMC infusion into hepatic artery of patients with advanced chronic liver disease is safe and feasible. In addition, a decrease in mean serum bilirubin and INR levels and an increase in albumin levels are observed. Our data warrant further studies in order to evaluate the effect of BMC transplantation in patients with advanced chronic liver disease.

Hyperlactatemia in patients with non-acetaminophen-related acute liver failure

AIM： To characterize hyperlactatemia in patients with non-acetaminophen acute liver failure （ALF） in an attempt to clarify the mechanisms implicated and the role as a prognosis factor. METHODS： In the setting of liver transplantation, 63 consecutive patients with non-acetaminophen acute liver failure were studied in relation to tissue oxygenation, hemodynamic and metabolic parameters. Before and after transplantation, the number of infected patients and outcome were registered. RESULTS： Acute ALF showed higher levels of lactate than subacute ALF （5.4 ± 1 mmol/L versus 2.2 ± 0.6 mmol/L, P= 0.01）. Oxygenation parameters were within the normal range. Lactate levels showed good correlation with respiratory quotient （r=0.759, P〈 0.005）, mean glucose administration （r= 0.664, P= 0.01） and encephalopathy （r= 0.698, P= 0.02）, but not with splanchnic arteriovenous difference in PCO2, pH and the presence of infection （P=0.1）. Portal vein lactate was higher （P〈0.05） than arterial and mixed venous lactate, suggesting its production of hyperlactatemia in the intestine and spleen. The presence of infection was an independent predictor of survival. CONCLUSION： Hyperlactatemia is not a prognosis factor due to byproduct of the overall acceleration in glycolysis.