Scattered and rapid intrahepatic recurrences after radio frequency ablation for hepatocellular carcinoma

AIM： To evaluate a series of patients with hepatocellular carcinoma （HCC） treated with several different protocols and devices. METHODS： We treated 138 patients [chronic hepatitis/ liver cirrhosis （Child-Pugh A/B/C）, 3/135 （107/25/3）] with two different devices and protocols： cool-tip needle [initial ablation at 60 W （standard method） （n = 37） or at 40 W （modified method） （n = 28）] or; ablation with a LeVeen needle using a standard single-step, full expansion （single-step） method （n = 39） or a multi-step, incremental expansion （multi-step） method. RESULTS： Eleven patients experienced rapid and scattered recurrences 1 to 7 mo after the ablation. Nine patients were treated by the cool-tip original protocol （60 W） （9/37 = 24%） and the other two by the LeVeen single-step method （2/39 = 5%）. The location of the recurrence was surrounding and limited to the site of ablation segment in three cases, and spread over one Iobule or both Iobules in the other eight cases. There was no recurrence in the patients treated with the modified cool-tip modified method （40 W） or the LeVeen multi-step method. CONCLUSION： There is a risk of rapid and scattered recurrence after RFA, especially when the standard cool- tip procedure is used. Because such recurrence would worsen the prognosis, we recommend that modified protocols for the cool-tip and LeVeen needle methods should be used in clinical practice.

Impact of endoscopic ultrasound-guided radiofrequency ablation in managing pancreatic malignancy

Pancreatic malignancy is still the most lethal gastrointestinal malignancy.It has a very poor prognosis with low survival rate.Surgery is still the main treatment option for pancreatic malignancy.Most patients already have locally advanced and even late stage disease due to non-specific abdominal symptoms.Even though some cases are still suitable for surgical treatment,due to its aggressiveness adjuvant chemotherapy is becoming the standard treatment for controlling the disease.Radiofrequency ablation(RFA)is a thermal therapy that has been used as one of the standard treatments for liver malignancy.It can also be performed intraoperatively.There are several reports on percutaneous RFA treatment for pancreatic malignancy using transabdominal ultrasound and guided by computed tomography scan.However,due to its anatomical location and the risk of high radiation exposure,these methods seem to be very limited.Endoscopic ultrasound(EUS)has been widely used for pancreatic abnormality evaluation due to its ability to detect more accurately,especially small pancreatic lesions,compared to other imaging modalities.By the EUS approach,it is easier to achieve good visualization of tumor ablation and necrosis as the echoendoscope position is closer to the tumor area.Based on studies and a recent meta-analysis,EUS-guided RFA is a promising treatment approach for most pancreatic malignancy cases,but most studies only collected data from a small sample size.Larger studies are needed before clinical recommendations can be made.

A case of splenic abscess after radiofrequency ablation

Radiofrequency ablation （RFA） is an innovative technique used primarily for the palliative treatment of unresectable liver tumors. Its therapeutic indications however, have been expanded and now include various other organs and diseases. There is a paucity of data regarding technical details and complications of the use of RFA in the spleen. We report a case of partial splenectomy using radiofrequency ablation for splenic hydatid disease, complicated by an abscess formation.

Recent Advances in Radio Frequency Ablation Techniques of Atrial Fibrillation

Multiple wavelet hypothesis and fibrillatory conduction are believed to be atrial fibrillation's pathogenesis. Radio frequency ablation(RFA) technique, a therapy for atrial fibrillation(AF), applies radio frequency(RF) energy to targeted tissue to make it transmural. Research on AF ablation has already been conducted in China. Currently, there are single-electrode and dual-electrode ablation electrodes. It is discovered that the latter can reduce the treatment time and maintain the ablation shape of the tissue. Clinical application has shown that it has become the first-line treatment option for part of indications patients with AF.

Radiological findings in non-surgical recurrent hepatocellular carcinoma:From locoregional treatments to immunotherapy

Since hepatocellular carcinoma(HCC)represents an important cause of mortality and morbidity all over the world.Currently,it is fundamental not only to achieve a curative treatment but also to manage in the best way any possible recurrence.Even if the latest update of the Barcelona Clinic Liver Cancer guidelines for HCC treatment has introduced new locoregional techniques and confirmed others as well-established clinical practices,there is still no consensus about the treatment of recurrent HCC(RHCC).Locoregional treatments and medical therapy represent two of the most widely accepted approaches for disease control,especially in the advanced stage of liver disease.Different medical treatments are now approved,and others are under investigation.On this basis,radiology plays a central role in the diagnosis of RHCC and the assessment of response to locoregional treatments and medical therapy for RHCC.This review summarized the actual clinical practice by underlining the importance of the radiological approach both in the diagnosis and treatment of RHCC.

Intraperitoneal hemorrhage during and after percutaneous radiofrequency ablation of hepatic tumors: reasons and management

Background Introperitoneal hemorrhage is one of the most common complications of radiofrequency （RF） ablation of hepatic tumors. This study was designed to investigate the reason and management of intraperitoneal hemorrhage occurred during or after percutaneous RF ablation of hepatic tumors.Methods Three hundred and flfty-six patients with hepatic tumors have been treated at 592 procedures of ultrasound guided RF ablation. Intraperitoneal hemorrhage occurred in 5 patients （0. 8% ）. The reasons and management of intraperitoneal hemorrhage in these 5 cases were retrospectively analyzed.Results Two patients with liver metastasis and one hepatocellular carcinoma （HCC） patient suffered from hemorrhage during the RF treatment. Two patients with recurrent HCC after surgery developed hemorrhage 20 minutes or 4 hours after RF treatment. One case of hemorrhage was due to the inappropriate electrode positioning induced liver laceration while treating a 1 cm liver metastasis near the liver capsule. One was due to the injury of a small vessel by the RF needle in another liver metastasis patient. Three cases were due to tumor rupture with two cases induced by cough or position change after treating large protruding HCC lesions. Four （80%） of the 5 cases of hemorrhage were rapidly identified by ultrasound. The causes and sites of bleeding during the RF treatment in three cases were confirmed through ultrasound, which were successfully treated using RF coagulation to achieve hemostasis of the bleeding site. Two patients with post-ablation hemorrhage recovered in one hour and 24 hours, respectively after given blood transfusion and other conservative measures. No surgical intervention was required. Two patients died of wide spread metastasis 23-36 months afterwards and the other three patients have lived for 18-25 months to date.Conclusions It is important to perform close monitoring during and after RF ablation in order to identify intraperitoneal hemorrhage in time. RF ablation of the bleeding sites was a simple and effective management when the bleeding site could be confirmed by ultrasound. The hemorrhage due to the rupture of large and protruding liver tumors could be serious and should be considered as contraindication for RF treatment.

Role of diabetes mellitus on the recurrence rate of hepatocellular carcinomas after radiofrequency ablation in chronic hepatitis C patients

Aim:The aim was to assess the impact of hyperglycemia on the recurrence of hepatocellular carcinoma(HCC)as well as evaluate survival after curative ablation by radiofrequency.Methods:This study,which was conducted retrospectively on 107 chronic hepatitis C(CHC)patients with 159 HCCs,was presented to the Hepatology Unit of Internal Medicine Department at Tanta University Hospitals.All lesions were curatively treated by radiofrequency ablation(RFA)and the surveillance of HCC recurrence was evaluated radiologically every 3 months for periods between 6 and 36 months.Of 107 subjects,70 were males and 37 were females,with mean age 50.4±9.4 years.All patients were divided according to their glycemic state into the following three groups:Group I,which included 37 type 2 diabetic patients,with adequate maintenance of blood glucose,has 52 HCCs;Group II,which included 25 type 2 diabetic patients with inadequate maintenance of blood glucose,has 43 HCCs;and Group III,which included 45 euglycemic non-diabetic patients,has 64 HCCs.Results:Our results showed that,there was signifi cant increase in recurrence rate in diabetic patients with inadequate maintenance of blood glucose(Group II)compared to those in Group I and Group III(P<0.0001).Interestingly,there was no signifi cant difference concerning HCC recurrence between diabetic patients with adequate maintenance of blood glucose(Group I)and non-diabetic euglycemic patients(Group III).Our results also identifi ed that,inadequate maintenance of blood glucose in diabetic patients was also a signifi cant predictor of poor survival.Conclusion:Inadequate maintenance of blood glucose in diabetic patients is a signifi cant risk factor for recurrence of HCC and for poor survival after curative RFA therapy in CHC patients.