Percutaneous radiofrequency ablation is superior to hepatic resection in patients with small hepatocellular carcinoma

BACKGROUND It is not known whether percutaneous radiofrequency ablation(PRFA)has the same treatment efficacy and fewer complications than laparoscopic resection in patients with small centrally located hepatocellular carcinoma(HCC).AIM To compare the effectiveness of PRFA with classical laparoscopic resection in patients with small HCC and document the safety parameters.METHODS In this retrospective study,85 patients treated with hepatic resection(HR)and 90 PRFA-treated patients were enrolled in our hospital from July 2016 to July 2019.Treatment outcomes,including major complications and survival data,were evaluated.RESULTS The results showed that minor differences existed in the baseline characteristics between the patients in the two groups.PRFA significantly increased cumulative recurrence-free survival(hazard ratio 1.048,95%CI:0.265-3.268)and overall survival(hazard ratio 0.126,95%CI:0.025-0.973);PRFA had a lower rate of major complications than HR(7.78%vs 20.0%,P<0.05),and hospital stay was shorter in the PRFA group than in the HR group(7.8±0.2 d vs 9.5±0.3 d,P<0.001).CONCLUSION Based on the data obtained,we conclude that PRFA was superior to HR and may reduce complications and hospital stay in patients with small HCC.

Percutaneous radiofrequency ablation versus repeat hepatectomy for recurrent hepatocellular carcinoma:retrospective randomized control study

Objective:Percutaneous radiofrequency ablation(PRFA) is known to be as effective as hepatectomy for small hepatocellular carcinoma(HCC) in the long-term.We wished to ascertain how it is for recurrent small HCC.Methods:From January 2009 to November 2011,a series of sixty-one patients were included in the study according to the criteria:each patient had one recurrent HCC,less than 5 cm in diameter.Twenty-six of the 61 patients were treated with PRFA and the other 35 were treated with repeat hepatectomy.Results:The interval from first surgery to recurrent for repeat hepatectomy and PRFA groups were(1,239.60±1,017.00) d and(903.42±975.11) d respectively(P=0.066).The tumor-free time after repeat hepatectomy and PRFA were(310.23±159.50) d and(278.27±123.29) d respectively(P=0.584).Size of tumor in repeat hepatectomy and PRFA were(7.34±3.16) cm^2 and(5.59±3.40) cm^2(P=0.215),the total expenditure for each patient of the two groups were(26,150.66±7,923.60) yuan and(21,135.00±1,156.76) yuan(RMB),and the time of hospitalization for each of the two groups were(15.29±4.28) d and(7.46±2.20) d(P<0.001).Conclusion:PRFA is proved to be as effective as repeat hepatectomy in the treatment of recurrent small HCC,and superior to repeat hepatectomy as it is less invasive.

Application of ultrasound-guided percutaneous radiofrequency ablation in treatment of liver cancer.

Objective To investigate the therapeutic efficacy and its influencing factors of ultrasoundguided percutaneous radiofrequency ablation (PRFA) in the treatment of liver carcinoma. Methods With a temperature-controlled multi-electrode needle, ultrasound-guided PRFA was employed to treat forty-seven patients with 67 tumor nodules, with a diameterof 2.6 ± 1.1 cm (1.0 - 5.5 cm). Results A complete ablation (CA) rate of 80. 6% was achieved in the present series, with a CA rate of 91.7 % in the tumors ≤3 cm in diameter,75. 0% in tumors from 3.1 to 4. 0 cm,and 14. 3% in tumors 】4 cm. The CA rate was significantly greater in tumors with a temperature rising up to 70℃ within the initial 2 minutes at ablation as compared with that longer than 2 minutes (P 【 0.05). A markedly higher CA rate was obtained in tumors with an ablation-maintaining temperature of over 80℃ than that between 70℃ and 80℃ ( P 【 0. 01). All patients were followed up with a mean time of 11. 3 months. The local recurrence rate was 9.3% (5/

Comparison of laparoscopic hepatectomy,percutaneous radiofrequency ablation and open hepatectomy in the treatment of small hepatocellular carcinoma

Objective： Three mainstream techniques-laparoscopic hepatectomy （LH）, percutaneous radiofrequency ablation （pRFA）, and open hepatectomy （OH）--were compared in this study, in terms of their efficacies in the treat- ment of small hepatocellular carcinoma （HCC）. Methods： A comparative study was performed within a total of 94 patients diagnosed with small HCC in our hospital from 2005 to 2010, who underwent LH （28）, RFA （33）, or OH （33）. They had either a single tumor lesion of less than 5 cm or up to three nodules with diameters of less than 3 cm each. Outcomes were carefully evaluated throughout a 3-year follow-up interval and statistically interpreted. Results： The pRFA group had a significantly lower disease-free survival rate compared with the two surgical groups （P=0.001） and significantly shorter overall survival （P=-0.005）, while the LH group and the OH group had no difference in survival results. For patients younger than 60 years old, surgical approaches offered a better long-term overall survival prognosis （P=0.008）. There were no statistically significant differences among the three groups in overall survival for elderly patients （P=0.104）. Conclusions： Among patients with small HCC, LH may provide better curative effects than pRFA without increasing complication rates, pRFA leads to faster recurrence than surgical resections. LH has similar therapeutic effects to OH and causes less trauma. For patients younger than 60 years old, LH may be the best curative treatment. Elderly patients may choose either surgery or pRFA.

Radiofrequency ablation for treatment of hypersplenism: A feasible therapeutic option

We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation and measured the total spleen and ablated volumes with contrast-enhanced computed tomography and volumetry. No major complications occurred, thrombocytopenia was resolved, and platelet levels remained stable, which allowed for early treatment of the patient's underlying disease. Previous work has shown that splenic radiofrequency ablation is an attractive alternative treatment for hypersplenism induced by liver cirrhosis. We aimed to contribute to the currently sparse literature evaluating the role of radiofrequency ablation(RFA) in the management of hypersplenism. We conclude that splenic RFA appears to be a viable and promising option for the treatment of hypersplenism.

Endoscopic biliary treatment of unresectable cholangiocarcinoma: A meta-analysis of survival outcomes and systematic review

BACKGROUND Endoscopic radiofrequency ablation(ERFA),percutaneous radiofrequency ablation(PRFA),and photodynamic therapy(PDT),when used in conjunction with conventional biliary stenting,have demonstrated a survival benefit in patients with unresectable cholangiocarcinoma.AIM To compare pooled survival outcomes,adverse event rates,and mean stent patency for those undergoing these procedures.METHODS A comprehensive literature review of published studies and abstracts from January 2011 to December 2020 was performed comparing survival outcomes in patients undergoing ERFA with stenting,biliary stenting alone,PRFA with stenting,and PDT with stenting for unresectable cholangiocarcinoma(CCA).RESULTS Data from four studies demonstrated a pooled mean survival favoring ERFA as compared to biliary stenting alone(12.0±0.9 mo vs 6.8±0.3 mo,P<0.001)as well as statistically improved median survival time(13 mo vs 8 mo,P<0.001).Both ERFA with stenting and PRFA with stenting groups demonstrated statistical superiority to biliary stenting alone(P<0.001 and P=0.004,respectively).However,when comparing ERFA to PRFA,pooled data demonstrated overall higher mean survival in the ERFA with stenting cohort as compared to PRFA with stent cohort(12.0+0.9 mo vs 8.1+2.1 mo,P<0.0001).Data from two studies demonstrated a pooled median survival favoring ERFA with stenting as compared to PDT with stenting(11.3 mo vs 8.5 mo,P=0.02).CONCLUSION While further prospective,randomized studies are needed to assess efficacy of ERFA,our metaanalysis demonstrated that this technique offers endoscopists a reasonable palliative method by which to treat patients with unresectable CCA that results in longer survival as compared to biliary stenting alone,percutaneous radiofrequency ablation with biliary stenting,and PDT with biliary stenting as well as an acceptable adverse event profile based on available published data.

Prognostic factors for hepatocellular carcinoma recurrence

The recurrence of hepatocellular carcinoma,the sixth most common neoplasm and the third leading cause of cancer-related mortality worldwide,represents an important clinical problem,since it may occur after both surgical and medical treatment.The recurrence rate involves 2 phases:an early phase and a late phase.The early phase usually occurs within 2 years after resection;it is mainly related to local invasion and intrahepatic metastases and,therefore,to the intrinsic biology of the tumor.On the other hand,the late phase occurs more than 2 years after surgery and is mainly related to de novo tumor formation as a consequence of the carcinogenic cirrhotic environment.Since recent studies have reported that early and late recurrences may have different risk factors,it is clinically important to recognize these factors in the individual patient as soon as possible.The aim of this review was,therefore,to identify predicting factors for the recurrence of hepatocellularcarcinoma,by means of invasive and non-invasive methods,according to the different therapeutic strategies available.In particular the role of emerging techniques(e.g.,transient elastography)and biological features of hepatocellular carcinoma in predicting recurrence have been discussed.In particular,invasive methods were differentiated from non-invasive ones for research purposes,taking into consideration the emerging role of the genetic signature of hepatocellular carcinoma in order to better allocate treatment strategies and surveillance follow-up in patients with this type of tumor.