BACKGROUND Liver interventional surgery is a relatively safe and minimally invasive surgery.However,for patients who have undergone Whipple surgery,the probability of developing a liver abscess after liver interventio...BACKGROUND Liver interventional surgery is a relatively safe and minimally invasive surgery.However,for patients who have undergone Whipple surgery,the probability of developing a liver abscess after liver interventional surgery is very high.Fungal liver abscess has a high mortality rate,especially when complicated with malignant tumors,diabetes,coronavirus disease 2019(COVID-19)and other complications.Fungal liver abscess is rare,and there are no guidelines or expert consensus on the course of antifungal therapy.CASE SUMMARY A 54-year-old woman with pancreatic head cancer received albumin-bound paclitaxel in combination with gemcitabine chemotherapy after laparoscopic pancreaticoduodenectomy.Liver metastasis was found 1 mo after completion of 8 cycles of chemotherapy,followed by ablation of the liver metastasis.After half a month of liver metastasis ablation,the patient experienced fever after chemotherapy and was diagnosed with liver abscess complicated with COVID-19 by contrast-enhanced abdominal computed tomography and real-time polymerase chain reaction detection.The results of pus culture showed Candida albicans,which was sensitive to fluconazole.The patient underwent percutaneous catheter drainage,antifungal therapy with fluconazole,and antiviral therapy with azvudine.During antifungal therapy,the patient showed a significant increase in liver enzyme levels and was discharged after liver protection therapy.Oral fluconazole was continued for 1 wk outside the hospital,and fluconazole was used for a total of 5 wk.The patient recovered well and received 4 cycles of fluorouracil,leucovorin,oxaliplatin,and irinotecan after 2 mo of antifungal therapy.CONCLUSION Effective treatment of Candida albicans liver abscess requires early detection,percutaneous catheter drainage,and 5 wk of antifungal therapy.Meanwhile,complications such as COVID-19 should be actively managed and nutritional support should be provided.展开更多
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 ...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/展开更多
BACKGROUND： Combined hepatectomy and radiofrequency ablation（RFA） provides an additional treatment for patients with Barcelona Clinic Liver Cancer（BCLC） stage B hepatocellular carcinoma（HCC） who are conventiona...BACKGROUND： Combined hepatectomy and radiofrequency ablation（RFA） provides an additional treatment for patients with Barcelona Clinic Liver Cancer（BCLC） stage B hepatocellular carcinoma（HCC） who are conventionally deemed unresectable. This study aimed to analyze the outcome of this combination therapy by comparing it with transarterial chemoembolization（TACE）. METHODS： We retrospectively reviewed 51 patients with unresectable BCLC stage B HCC who had received the combination therapy. We compared the survival of these patients with that of 102 patients in the TACE group（control）. Prognostic factors associated with worse survival in the combination group were analyzed.RESULTS： No differences in tumor status and liver function were observed between the TACE group and combination group. The median survival time for the combination group and TACE group was 38（6-54） and 17（3-48） months, respectively（P〈0.001）. The combination group required longer hospitalization than the TACE group [8（5-14） days vs 4（2-9） days,P〈0.001]. More than two ablations decreased the survival rate in the combination group. CONCLUSIONS： Combined hepatectomy and RFA yielded a better long-term outcome than TACE in patients with unresectable BCLC stage B HCC. Patients with a limited ablated size（≤2 cm）, a limited number of ablations（≤2）, and adequate surgical margin should be considered candidates for combination therapy.展开更多
Background:Ablation is an alternative treatment modality for selected patients with colorectal liver metastases(CRLMs).Although initially widely performed via radiofrequency ablation(RFA),more recently,microwave ablat...Background:Ablation is an alternative treatment modality for selected patients with colorectal liver metastases(CRLMs).Although initially widely performed via radiofrequency ablation(RFA),more recently,microwave ablation(MWA)is being preferred due to its perceived superiority in creating the ablation zones.The aim of this study is to compare the long-term efficacy of these two modalities performed surgically.Methods:Patients undergoing surgical liver ablation from 2005-2023 at a tertiary center by a single surgeon for CRLM were included in a retrospective institutional review board-approved study.Outcomes were compared using Wilcoxon,Chi-square,Kaplan-Meier,and Cox multivariate regression analyses.Continuous data are presented as median(interquartile range).Results:There were a total of 242 patients.Laparoscopic RFA was done in 121 patients with 303 lesions and laparoscopic MWA in 121 patients with 300 lesions.There was no difference between the groups regarding operative time(161 vs.147 minutes,respectively,P=0.4),perioperative morbidity(3%vs.8%,respectively,P=0.2)or hospital stay(1 vs.1 day,P=0.05).Local recurrence(LR)per lesion with at least 1 year of imaging follow-up was 29%in the RFA and 13%in the MWA group(P<0.001).Based on univariate survival analysis,tumor size,blood vessel proximity,ablation margin,and ablation modality were independent predictors of LR.To control these variables,direct matching was performed.Each cohort included 189 lesions.Kaplan-Meier analysis of these cohorts showed increased LR-free survival in the MWA group vs.the RFA group(P=0.005).Conclusions:This large study confirms our initial observation that local tumor control rate is better after MWA vs.RFA.展开更多
文摘BACKGROUND Liver interventional surgery is a relatively safe and minimally invasive surgery.However,for patients who have undergone Whipple surgery,the probability of developing a liver abscess after liver interventional surgery is very high.Fungal liver abscess has a high mortality rate,especially when complicated with malignant tumors,diabetes,coronavirus disease 2019(COVID-19)and other complications.Fungal liver abscess is rare,and there are no guidelines or expert consensus on the course of antifungal therapy.CASE SUMMARY A 54-year-old woman with pancreatic head cancer received albumin-bound paclitaxel in combination with gemcitabine chemotherapy after laparoscopic pancreaticoduodenectomy.Liver metastasis was found 1 mo after completion of 8 cycles of chemotherapy,followed by ablation of the liver metastasis.After half a month of liver metastasis ablation,the patient experienced fever after chemotherapy and was diagnosed with liver abscess complicated with COVID-19 by contrast-enhanced abdominal computed tomography and real-time polymerase chain reaction detection.The results of pus culture showed Candida albicans,which was sensitive to fluconazole.The patient underwent percutaneous catheter drainage,antifungal therapy with fluconazole,and antiviral therapy with azvudine.During antifungal therapy,the patient showed a significant increase in liver enzyme levels and was discharged after liver protection therapy.Oral fluconazole was continued for 1 wk outside the hospital,and fluconazole was used for a total of 5 wk.The patient recovered well and received 4 cycles of fluorouracil,leucovorin,oxaliplatin,and irinotecan after 2 mo of antifungal therapy.CONCLUSION Effective treatment of Candida albicans liver abscess requires early detection,percutaneous catheter drainage,and 5 wk of antifungal therapy.Meanwhile,complications such as COVID-19 should be actively managed and nutritional support should be provided.
文摘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/
文摘BACKGROUND： Combined hepatectomy and radiofrequency ablation（RFA） provides an additional treatment for patients with Barcelona Clinic Liver Cancer（BCLC） stage B hepatocellular carcinoma（HCC） who are conventionally deemed unresectable. This study aimed to analyze the outcome of this combination therapy by comparing it with transarterial chemoembolization（TACE）. METHODS： We retrospectively reviewed 51 patients with unresectable BCLC stage B HCC who had received the combination therapy. We compared the survival of these patients with that of 102 patients in the TACE group（control）. Prognostic factors associated with worse survival in the combination group were analyzed.RESULTS： No differences in tumor status and liver function were observed between the TACE group and combination group. The median survival time for the combination group and TACE group was 38（6-54） and 17（3-48） months, respectively（P〈0.001）. The combination group required longer hospitalization than the TACE group [8（5-14） days vs 4（2-9） days,P〈0.001]. More than two ablations decreased the survival rate in the combination group. CONCLUSIONS： Combined hepatectomy and RFA yielded a better long-term outcome than TACE in patients with unresectable BCLC stage B HCC. Patients with a limited ablated size（≤2 cm）, a limited number of ablations（≤2）, and adequate surgical margin should be considered candidates for combination therapy.
文摘Background:Ablation is an alternative treatment modality for selected patients with colorectal liver metastases(CRLMs).Although initially widely performed via radiofrequency ablation(RFA),more recently,microwave ablation(MWA)is being preferred due to its perceived superiority in creating the ablation zones.The aim of this study is to compare the long-term efficacy of these two modalities performed surgically.Methods:Patients undergoing surgical liver ablation from 2005-2023 at a tertiary center by a single surgeon for CRLM were included in a retrospective institutional review board-approved study.Outcomes were compared using Wilcoxon,Chi-square,Kaplan-Meier,and Cox multivariate regression analyses.Continuous data are presented as median(interquartile range).Results:There were a total of 242 patients.Laparoscopic RFA was done in 121 patients with 303 lesions and laparoscopic MWA in 121 patients with 300 lesions.There was no difference between the groups regarding operative time(161 vs.147 minutes,respectively,P=0.4),perioperative morbidity(3%vs.8%,respectively,P=0.2)or hospital stay(1 vs.1 day,P=0.05).Local recurrence(LR)per lesion with at least 1 year of imaging follow-up was 29%in the RFA and 13%in the MWA group(P<0.001).Based on univariate survival analysis,tumor size,blood vessel proximity,ablation margin,and ablation modality were independent predictors of LR.To control these variables,direct matching was performed.Each cohort included 189 lesions.Kaplan-Meier analysis of these cohorts showed increased LR-free survival in the MWA group vs.the RFA group(P=0.005).Conclusions:This large study confirms our initial observation that local tumor control rate is better after MWA vs.RFA.
