TRIPLET combined with microwave ablation:A novel treatment for advanced hepatocellular carcinoma

This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy,in treating advanced hepatocellular carcinoma(HCC).The potential application of this combination therapy for patients with advanced HCC is evaluated.

Camrelizumab,apatinib and hepatic artery infusion chemotherapy combined with microwave ablation for advanced hepatocellular carcinoma

BACKGROUND Hepatic arterial infusion chemotherapy and camrelizumab plus apatinib(TRIPLET protocol)is promising for advanced hepatocellular carcinoma(Ad-HCC).However,the usefulness of microwave ablation(MWA)after TRIPLET is still controversial.AIM To compare the efficacy and safety of TRIPLET alone(T-A)vs TRIPLET-MWA(TM)for Ad-HCC.METHODS From January 2018 to March 2022,217 Ad-HCC patients were retrospectively enrolled.Among them,122 were included in the T-A group,and 95 were included in the T-M group.A propensity score matching(PSM)was applied to balance bias.Overall survival(OS)was compared using the Kaplan-Meier curve with the log-rank test.The overall objective response rate(ORR)and major complications were also assessed.RESULTS After PSM,82 patients were included both the T-A group and the T-M group.The ORR(85.4%)in the T-M group was significantly higher than that(65.9%)in the T-A group(P<0.001).The cumulative 1-,2-,and 3-year OS rates were 98.7%,93.4%,and 82.0%in the T-M group and 85.1%,63.1%,and 55.0%in the T-A group(hazard ratio=0.22;95%confidence interval:0.10-0.49;P<0.001).The incidence of major complications was 4.9%(6/122)in the T-A group and 5.3%(5/95)in the T-M group,which were not significantly different(P=1.000).CONCLUSION T-M can provide better survival outcomes and comparable safety for Ad-HCC than T-A.

Short-term efficacy of microwave ablation in the treatment of liver cancer and its effect on immune function

BACKGROUND Hepatectomy is the first choice for treating liver cancer.However,inflammatory factors,released in response to pain stimulation,may suppress perioperative immune function and affect the prognosis of patients undergoing hepatectomies.AIM To determine the short-term efficacy of microwave ablation in the treatment of liver cancer and its effect on immune function.METHODS Clinical data from patients with liver cancer admitted to Suzhou Ninth People’s Hospital from January 2020 to December 2023 were retrospectively analyzed.Thirty-five patients underwent laparoscopic hepatectomy for liver cancer(liver cancer resection group)and 35 patients underwent medical image-guided microwave ablation(liver cancer ablation group).The short-term efficacy,complications,liver function,and immune function indices before and after treatment were compared between the two groups.RESULTS One month after treatment,19 patients experienced complete remission(CR),8 patients experienced partial remission(PR),6 patients experienced stable disease(SD),and 2 patients experienced disease progression(PD)in the liver cancer resection group.In the liver cancer ablation group,21 patients experienced CR,9 patients experienced PR,3 patients experienced SD,and 2 patients experienced PD.No significant differences in efficacy and complications were detected between the liver cancer ablation and liver cancer resection groups(P>0.05).After treatment,total bilirubin(41.24±7.35 vs 49.18±8.64μmol/L,P<0.001),alanine aminotransferase(30.85±6.23 vs 42.32±7.56 U/L,P<0.001),CD4+(43.95±5.72 vs 35.27±5.56,P<0.001),CD8+(20.38±3.91 vs 22.75±4.62,P<0.001),and CD4+/CD8+(2.16±0.39 vs 1.55±0.32,P<0.001)were significantly different between the liver cancer ablation and liver cancer resection groups.CONCLUSION The short-term efficacy and safety of microwave ablation and laparoscopic surgery for the treatment of liver cancer are similar,but liver function recovers quickly after microwave ablation,and microwave ablation may enhance immune function.

Paravertebral block's effect on analgesia and inflammation in advanced gastric cancer patients undergoing transarterial chemoembolization and microwave ablation

BACKGROUND Transarterial chemoembolization(TACE)combined with microwave ablation(MWA)is an effective treatment strategy for patients with advanced gastric cancer and liver metastasis.However,it may cause severe postoperative pain and inflammatory responses.The paravertebral block(PVB)is a regional anesthetic technique that provides analgesia to the thoracic and abdominal regions.AIM To evaluate the effect of PVB on postoperative analgesia and inflammatory response in patients undergoing TACE combined with MWA for advanced gastric cancer and liver metastasis.METHODS Sixty patients were randomly divided into PVB and control groups.The PVB group received ultrasound-guided PVB with 0.375%ropivacaine preoperatively,whereas the control group received intravenous analgesia with sufentanil.The primary outcome was the visual analog scale(VAS)score for pain at 6 h,12 h,24 h,and 48 h after the procedure.Secondary outcomes were the dose of sufentanil used,incidence of adverse events,and levels of inflammatory markers(white blood cell count,neutrophil percentage,C-reactive protein,and procalcitonin)before and after the procedure.RESULTS The PVB group had significantly lower VAS scores at 6 h,12 h,24 h,and 48 h after the procedure compared with the control group(P<0.05).The PVB group also had a significantly lower consumption of sufentanil and a lower incidence of nausea,vomiting,and respiratory depression than did the control group(P<0.05).Compared with the control group,the PVB group had significantly lower levels of inflammatory markers 24 h and 48 h after the procedure(P<0.05).CONCLUSION PVB can effectively reduce postoperative pain and inflammatory responses and improve postoperative comfort and recovery in patients with advanced gastric cancer and liver metastasis treated with TACE combined with MWA.

Effect of CT-Guided Microwave Ablation Combined with TACE on Liver Function and Survival of Patients with Primary Liver Cancer

Objective:To explore the effect of transarterial chemoembolization(TACE)+CT-guided microwave ablation(MWA)on treating patients with primary liver cancer.Methods:78 primary liver cancer cases were enrolled and divided into groups according to their assigned surgical plans.The control group was treated with TACE alone,and the observation group was treated with TACE+CT-guided MWA.The efficacy of the treatment and the liver function indicators and follow-up results of the patients of the two groups were compared.Results:The efficacy of the treatment received by the observation group was higher than that of the control group.Besides,the patients in the observation group exhibited better improvement in liver function indicators after 3 months of treatment.Furthermore,the survival rates of 1 and 2 years after surgery of the observation group were all higher than those of the control group(P<0.05).Conclusion:TACE combined with CT-guided MWA is more effective in treating primary liver cancer compared to TACE alone.Besides,it resulted in better improvement of liver function and long-term survival rate.Therefore,this treatment regime should be popularized.

Laser ablation of liver tumors:An ancillary technique,or an alternative to radiofrequency and microwave?

Radiofrequency ablation(RFA) is currently the most popular and used ablation modality for the treatment ofnon surgical patients with primary and secondary liver tumors, but in the last years microwave ablation(MWA) is being technically improved and widely rediscovered for clinical use. Laser thermal ablation(LTA) is by far less investigated and used than RFA and MWA, but the available data on its effectiveness and safety are quite good and comparable to those of RFA and MWA. All the three hyperthermia-based ablative techniques, when performed by skilled operators, can successfully treat all liver tumors eligible for thermal ablation, and to date in most centers of interventional oncology or interventional radiology the choice of the technique usually depends on the physician's preference and experience, or technical availability. However, RFA, MWA, and LTA have peculiar advantages and limitations that can make each of them more suitable than the other ones to treat patients and tumors with different characteristics. When all the three thermal ablation techniques are available, the choice among RFA, MWA, and LTA should be guided by their advantages and disadvantages, number, size, and location of the liver nodules, and cost-saving considerations, in order to give patients the best treatment option.

Abnormal uterine bleeding successfully treated via ultrasoundguided microwave ablation of uterine myoma lesions: Three case reports

BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment method for heavy menstrual bleeding.However,additional treatment is often required after recurrence of uterine myomas treated with MEA.Additionally,because this treatment ablates the endometrium,it is not indicated for patients planning to become pregnant.To overcome these issues,we devised a method for ultrasound-guided microwave ablation of uterine myoma feeder vessels.We report three patients successfully treated for heavy menstrual bleeding,secondary to uterine myoma,using our novel method.CASE SUMMARY All patients had a favorable postoperative course,were discharged within 4 h,and experienced no complications.Further,no postoperative recurrence of heavy menstrual bleeding was noted.Our method also reduced the myoma’s maximum diameter.CONCLUSION This method does not ablate the endometrium,suggesting its potential appli-cation in patients planning to become pregnant.

Imaging-based prediction of hepatocellular carcinoma recurrence after microwave ablation as bridge therapy: A glimpse into the future

Liver transplantation(LT)remains the treatment of choice for early-stage hepato-cellular carcinoma(HCC)and offers the best long-term oncological outcomes.However,the increasing waiting list for LT has led to a significant dropout rate as patients experience tumor progression beyond the Milan criteria.Currently,locoregional therapies,such as microwave ablation(MWA),have emerged as promising bridge treatments for patients awaiting LT.These therapies have shown promising results in preventing tumor progression,thus reducing the dropout rate of LT candidates.Despite the efficacy of MWA in treating HCC,tumoral recurrence after ablation remains a major challenge and significantly impacts the prognosis of HCC patients.Therefore,accurately diagnosing tumoral recurrence post-ablation is crucial.Recent studies have developed novel imaging features based on magnetic resonance imaging of HCC,which could provide essential information for predicting early tumoral recurrence after MWA.These advancements could address this unresolved challenge,improving the clinical outcomes of patients on the LT waiting list.This article explored the current landscape of MWA as a bridge therapy for HCC within the Milan criteria,high-lighting the emerging role of novel imaging-based features aimed at improving the prediction of tumor recurrence after MWA.

Recurrence and survival following microwave, radiofrequency ablation, and hepatic resection of colorectal liver metastases: A systematic review and network meta-analysis

Background: Gold standard for colorectal liver metastases(CRLM) remains hepatic resection(HR). However, patients with severe comorbidities, unresectable or deep-situated resectable CRLM are candidates for ablation. The aim of the study was to compare recurrence rate and survival benefit of the microwave ablation(MWA), radiofrequency ablation(RFA) and HR by conducting the first network meta-analysis. Data sources: Systematic search of the literature was conducted in the electronic databases. Both updated traditional and network meta-analyses were conducted and the results were compared between them. Results: HR cohort demonstrated significantly less local recurrence rate and better 3-and 5-year diseasefree(DFS) and overall survival(OS) compared to MWA and RFA cohorts. HR cohort included significantly younger patients and with significantly lower preoperative carcinoembryonic antigen(CEA) by 10.28 ng/m L compared to RFA cohort. Subgroup analysis of local recurrence and OS of solitary and ≤3 cm CRLMs did not demonstrate any discrepancies when compared with the whole sample. Conclusions: For resectable CRLM the treatment of choice still remains HR. MWA and RFA can be used as a single or adjunct treatment in patients with unresectable CRLM and/or prohibitive comorbidities.

Ultrasound-guided microwave ablation for abdominal wall metastatic tumors: A preliminary study

AIM: To evaluate the feasibility, safety and efficacy of ultrasound-guided microwave (MW) ablation for abdominal wall metastatic tumors. METHODS: From August 2007 to December 2010, a total of 11 patients with 23 abdominal wall nodules (diameter 2.59 cm ± 1.11 cm, range 1.3 cm to 5.0 cm) were treated with MW ablation. One antenna was inserted into the center of tumors less than 1.7 cm, and multiple antennae were inserted simultaneously into tumors 1.7 cm or larger. A 21 gauge thermocouple was inserted near important organs which required protection (such as bowel or gallbladder) for real-time temperature monitoring during MW ablation. Treatment outcome was observed by contrast-enhanced ultrasound and magnetic resonance imaging (MRI) [or computed tomography (CT)] during follow-up. RESULTS: MW ablation was well tolerated by all patients. Six patients with 11 nodules had 1 thermocouple inserted near important organs for real-time temperature monitoring and the maximum temperature was 56 ℃. Major complications included mild pain (54.5%), post-ablation fever (100%) and abdominal wall edema (25%). All 23 tumors (100%) in this group were completely ablated, and no residual tumor or local recurrence was observed at a median follow-up of 13 mo (range 1 to 32 mo). The ablation zone was well defined on contrast-enhanced imaging (contrast-enhanced CT, MRI and/or contrast-enhanced ultrasound) and gradually shrank with time. CONCLUSION: Ultrasound-guided MW ablation may be a feasible, safe and effective treatment for abdominal wall metastatic tumors in selected patients.

Outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma:A systematic review and meta-analysis

BACKGROUND Studies to date comparing outcomes of microwave ablation(MWA)with radiofrequency ablation(RFA)on patients with hepatocellular carcinoma have yielded conflicting results,with no clear superiority of one technique over the other.The aim of this systematic review and meta-analysis was to compare the efficacy and safety of MWA with RFA.AIM To perform a systematic review and meta-analysis comparing the efficacy and safety of MWA with RFA.METHODS A systematic literature search was performed using Ovid Medline,Embase,PubMed,Reference Citation Analysis,Cochrane Central and Cochrane Systematic Review databases,and Web of Science.Abstracts and full manuscripts were screened for inclusion utilising predefined inclusion and exclusion criteria comparing outcomes of MWA and RFA.A random-effects model was used for each outcome.Meta-regression analysis was performed to adjust for the difference in follow-up period between the studies.Primary outcome measures included complete ablation(CA)rate,local recurrence rate(LRR),survival[local recurrence-free survival(LRFS),overall survival(OS)]and adverse events.RESULTS A total of 42 published studies[34 cohort and 8 randomised controlled trials(RCT)]with 6719 patients fulfilled the selection criteria.There was no significant difference in tumour size between the treatment groups.CA rates between MWA and RFA groups were similar in prospective cohort studies[odds ratio(OR)0.95,95%confidence interval(CI)0.28–3.23]and RCTs(OR 1.18,95%CI 0.64–2.18).However,retrospective studies reported higher rates with MWA(OR 1.29,95%CI 1.06–1.57).Retrospective cohort studies reported higher OS(OR 1.54,95%CI 1.15–2.05 and lower LRR(OR 0.67,95%CI 0.51–0.87).No difference in terms of LRFS or 30-d mortality was observed between both arms.MWA had an increased rate of adverse respiratory events when compared to RFA(OR 1.99,95%CI 1.07–3.71,P=0.03).CONCLUSION MWA achieves similar CA rates and as good or better longer-term outcomes in relation to LRR and OS compared to RFA.Apart from an increased rate of respiratory events post procedure,MWA is as safe as RFA.

Effect of a poloxamer 407-based thermosensitive gel on minimization of thermal injury to diaphragm during microwave ablation of the liver

AIM To assess the insulating effect of a poloxamer 407(P407)-based gel during microwave ablation of liver adjacent to the diaphragm.METHODS We prepared serial dilutions of P407, and 22.5%(w/w) concentration was identified as suitable for ablation procedures. Subsequently, microwave ablations were performed on the livers of 24 rabbits(gel, saline, control groups, n = 8 in each). The P407 solution and 0.9% normal saline were injected into the potential space between the diaphragm and liver in experimental groups. No barriers were applied to the controls. After microwave ablations, the frequency, size and degree of thermal injury were compared histologically among the three groups. Subsequently, another 8 rabbits were injected with the P407 solution and microwave ablation was performed. The levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), blood urea nitrogen(BUN) and creatinine(Cr) in serum were tested at 1 d before microwave ablation and 3 and 7 d after operation. RESULTS In vivo ablation thermal injury to the adjacent diaphragm was evaluated in the control, saline and 22.5% P407 gel groups(P = 0.001-0.040). However, there was no significant difference in the volume of ablation zone among the three groups(P > 0.05). Moreover, there were no statistical differences among the preoperative and postoperative gel groups according to the levels of ALT, AST, BUN and Cr in serum(all P > 0.05).CONCLUSION Twenty-two point five percent P407 gel could be a more effective choice during microwave ablation of hepatic tumors adjacent to the diaphragm. Further studies for clinical translation are warranted.

Prognostic factors for survival after transarterial chemoembolization combined with microwave ablation for hepatocellular carcinoma

AIM: To analyze prognostic factors for survival after transarterial chemoembolization (TACE) combined with microwave ablation (MWA) for hepatocellular carcinoma (HCC).

Nomogram based on albumin-bilirubin grade to predict outcome of the patients with hepatitis C virus-related hepatocellular carcinoma after microwave ablation

Objective:To construct a nomogram based on the albumin-bilirubin(ALBI)grade to provide prognostic value for hepatitis C virus(HCV)-related hepatocellular carcinoma(HCC)patients who underwent ultrasound-guided percutaneous microwave ablation(US-PMWA).Methods:From April 2005 to January 2018,183 treatment-naIve patients with 251 HCV-related HCCs according to the Milan criteria received US-PMWA subsequently.The overall survival(OS)and recurrence-free survival(RFS)were compared between groups classified by ALBI grade.Cox proportional hazard regression model based on risk factors for survival and recurrence was used to construct the nomogram.Results:The cumulative OS rates at 1-,3-,5-and 10-year were 97.7%,73.6%,54.5%and 34.5%,respectively.Stratified according to ALBI grade,the 1-,3-,and 5-year OS in the ALBI grade 1 group and grade 2 group were 99.2%,92.4%,77.9% and 97.7%,52.3%,38.6%,respectively,with significant statistical difference(P<0.001).No significant statistical difference was detected in the1-,3-,and 5-year RFS rates in the ALBI grade 1 group and grade 2 group(P=0.220).The major complication rate was 1.6%.Multivariate analysis results showed age,α-fetoprotein level,tumor number,platelet count,location,Child-Turcotte-Pugh(CTP)and ALBI grade were associated with OS,which generated the nomograms.Internal validation with 1000 bootstrapped sample sets had good concordance index of 0.769(95%CI 0.699-0.839)in OS.Conclusions:This nomogram based on ALBI grade was a visualization risk model,which could provide personalized prediction of long-term outcomes for HCV-related HCC patients after US-PMWA.

Experimental study of destruction to porcine spleen in vivo by microwave ablation

AIM: To discuss the safety, feasibility and regularity of destruction to porcine spleen in vivo with congestion and tumescence by microwave ablation (MWA). METHODS: Ligation of the splenic vein was used to induce congestion and tumescence in vivo in five porcine spleens, and microwave ablation was performed 2-4 h later. A total of 56 ablation points were ablated and the ablation powers were 30-100 W. The ablation time (1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 min) was performed at a power of 60 W. After ablation, the ablation size was measured in pigs A, C, D and E and spleen resection. In pig B, the ablation size was measuredand 2 ablation points were sent for pathology analysis and all tissues were sutured following ablation. Pig B was killed 1 wk later and the ablation points were sent for pathology analysis. Bleeding, tissue carbonization surrounding electrodes, and pathological changes were observed, and the effect on destruction volume relative to different ablation powers, times and positions was analyzed. RESULTS: The incidence of bleeding (only small amounts, < 20 mL) in the course of ablation was 5.4% (3/56) and was attributed to tissue carbonization surrounding electrodes, which also exhibited an incidence of 5.4% (3/56). The destruction volume was influenced by different ablation powers, times and points. It showed that the ablation lesion size increased with increased ablation time, from 1 to 10 min, when the ablation power was 60 W. Also, the ablation lesion size increased with the increase of ablation power, ranging from 30 to 100 W when the ablation time was set to 3 min. A direct correlation was seen between the destruction volume and ablation time by the power of 60 W (r = 0.97542, P < 0.0001, and also between the destruction volume and ablation powers at an ablation time of 3 min (r = 0.98258, P < 0.0001). The destruction volume of zone Ⅱ (the extra-2/3 part of the spleen, relative to the fi rst or second class vascular branches), which was near the hilum of the spleen, was noteably larger than the destruction volume of zoneⅠ(the intra-1/3 part of the spleen) which was distal from the hilum of the spleen (P = 0.0015). Pathological changes of ablation occurring immediately and 1 wk after MWA showed large areas of coagulation. Immediately following ablation, intact spleen tissues were observed in the areas of coagulation necrosis, mainly around arterioles, and there were no obvious signs of hydropsia and inflammation, while 1 wk following the ablation, the coagulation necrosis was well distributed and complete, as many nuclear fragmentations were detected, and there were obvious signs of hydropsia and inflammation.CONCLUSION: In vivo treatment of congestion and tumescence in the spleen using microwave ablation of water-cooled antenna is a safe and feasible method that is minimally invasive.

Effects of microwave ablation on serum Golgi protein 73 in patients with primary liver cancer

BACKGROUND Microwave ablation(MWA)is an effective treatment option for patients with primary liver cancer.However,it has been reported that the MWA procedure induces a hepatic inflammatory response and injury,which may negatively affect the efficacy of MWA.As such,the discovery of reliable markers to monitor the patient’s response to MWA is needed.Golgi protein 73(GP73)has been shown to be associated with chronic liver disease.To date,the potential value of serum GP73 in the dynamic monitoring during MWA of liver cancer remains unclear.AIM To examine the effects of MWA on the serum levels of GP73 in patients with primary liver cancer.METHODS A total of 150 primary liver cancer patients with a single small lesion(≤3 cm in diameter)were retrospectively enrolled spanning the period between January 2016 and October 2018.All of the patients received MWA for the treatment of primary liver cancer.Serum GP73,alpha-fetoprotein(AFP),and widely used liver biochemical indicators[serum albumin,total bilirubin(TBIL),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)]were compared before MWA and at different time points,including 1,2,and 4 wk following the ablation procedure.RESULTS Complete tumor ablation was achieved in 95.33%of the patients at 1 mo after MWA.The 1-,2-,and 3-year disease-free survival rates were 74.67%,59.33%,and 54.00%,respectively.The serum AFP levels were significantly decreased at 1,2,and 4 wk after MWA;they returned to the normal range at 12 wk after MWA;and they remained stable thereafter during follow-up in those cases without recurrence.In contrast,the serum GP73 levels were significantly increased at 1 and 2 wk after MWA.The serum GP73 levels reached the peak at 2 wk after MWA,started to decline after hepatoprotective treatment with glycyrrhizin and reduced glutathione,and returned to the pretreatment levels at 12 and 24 wk after MWA.Notably,the changes of serum GP73 in response to MWA were similar to those of TBIL,ALT,and AST.CONCLUSION Serum GP73 is markedly increased in response to MWA of liver cancer.Thus,serum GP73 holds potential as a marker to monitor MWA-induced inflammatory liver injury in need of amelioration.

Effectiveness of microwave endometrial ablation combined with hysteroscopic transcervical resection in treating submucous uterine myomas

BACKGROUND Hypermenorrhea is characterized by excessive menstrual bleeding that causes severe anemia and interferes with everyday life.This condition can restrict women’s social activities and decrease their quality of life.Microwave endometrial ablation(MEA)using a 2.45-GHz energy source is a minimally invasive alternative to conventional hysterectomy for treating hypermenorrhea that is resistant to conservative treatment,triggered by systemic disease or medications,or caused by uterine myomas and fibrosis.The popularity of MEA has increased worldwide.Although MEA can safely and effectively treat submucous myomas,some patients may still experience recurrent hypermenorrhea postoperatively and may require additional treatment.AIM To investigate the efficacy of MEA combined with transcervical resection(TCR).METHODS Participants underwent cervical and endometrial evaluations.Magnetic resonance imaging and hysteroscopy were performed to evaluate the size and location of the myomas.TCR was performed before MEA using a hystero-resectoscope.MEA was performed using transabdominal ultrasound.The variables included operation time,number of ablation cycles,length of hospital stay,and visual analog scale cores for hypermenorrhea,dysmenorrhea,and treatment satisfaction at 3 and 6 mo postoperatively.The postoperative incidence of amenorrhea,changes in hemoglobin concentrations,and MEA-related complications were evaluated.RESULTS A total of 34 women underwent a combination of MEA and TCR during the study period.Two patients were excluded from the study as their histopathological tests identified uterine malignancies(uterine sarcoma and endometrial cancer).The 32 eligible women(6 nulliparous,26 multiparous)had a mean age of 45.2±4.3 years(range:36–52 years).Patients reported very severe hypermenorrhea(10/10 points on the visual analog scale)before the procedure.However,after the procedure,the hypermenorrhea scores decreased to 1.2±1.3 and 0.9±1.3 at 3 and 6 mo,respectively(P<0.001).The mean follow-up duration was 33.8±16.8 mo.Although 10 women(31.3%)developed amenorrhea during this period,none experienced a recurrence of hypermenorrhea.No surgical complications were observed.CONCLUSION Reducing the size of uterine myomas by combining MEA and TCR can safely and effectively treat hypermenorrhea in patients with submucous myomas.

Retroperitoneoscopic Microwave Ablation of Renal Hamartoma:Middle-term Results

The safety and efficacy of retroperitoneoscopic microwave ablation (MWA) in the treatment of renal hamartoma were evaluated.From July 2007 to July 2009, a total of 16 cases of renal hamartoma were treated with retroperitoneoscopic MWA.Peri-and post-operative findings were observed.Middle-term efficacy was assessed by contrast-enhanced computerized tomography (CT) in follow-up period.All patients received MWA of 1-5 points.The mean operative time was 85 min and the mean blood loss was 65 mL.During a median follow-up of 16 months, no evidence of disease recurrence was observed despite of incomplete ablation in 1 case.Retroperitoneoscopic MWA is a relatively simple procedure with less impact to renal function and less complication.The outcome of middle-term follow-up is satisfactory.Thus, retroperitoneoscopic MWA appears to be a safe and effective technique for renal hamartoma in selected patients.

Cholecystectomy is associated with higher risk of recurrence after microwave ablation of hepatocellular carcinoma:a propensity score matching analysis

Objective:To explore the association between cholecystectomy and the prognostic outcomes of patients with hepatocellular carcinoma(H CC)who underwent microwave ablation(MWA).Methods:Patients with HCC(«=921)who underwent MWA were included and divided into cholecystectomy(n=114)and non-cholecystectomy groups(n=807).After propensity score matching(PSM)at a 1:2 ratio,overall survival(OS)and disease-free survival(DFS)rates were analyzed to compare prognostic outcomes between the cholecystectomy(«=114)and non-cholecystectomy groups(n=228).Univariate and multivariate Cox analyses were performed to assess potential risk factors for OS and DFS.Major complications were also compared between the groups.Results:After matching,no significant differences between groups were observed in baseline characteristics.The 1-,3-,and 5-year OS rates were 96.5%,82.1%,and 67.1%in the cholecystectomy group,and 97.4%,85.2%,and 74.4%in the non-cholecystectomy group(P=0.396);the 1-,3-,and 5-year DFS rates were 58.4%,34.5%,and 26.6%in the cholecystectomy group,and 73.6%,44.7%,and 32.2%in the non-cholecystectomy group(P=0.026),respectively.The intrahepatic distant recurrence rate in the cholecystectomy group was significantly higher than that in the non-cholecystectomy group(P=0.026),and the local tumor recurrence and extrahepatic recurrence rates did not significantly differ between the groups(P=0.609 and P=0.879).Multivariate analysis revealed that cholecystectomy(HR=1.364,95%Cl 1.023-1.819,P=0.035),number of tumors(2 vs.1:HR=2.744,95%Cl 1.925-3.912,P<0.001;3 vs.1:HR=3.411,95%Cl 2.021-5.759,P<0.001),and y-GT levels(HR=1.003,95%Cl 1.000-1.006,P<0.024)were independent risk factors for DFS.The best y-GT level cut-off value for predicting median DFS was 39.6 U/L(area under the curve=0.600,P<0.05).A positive correlation was observed between cholecystectomy and y-GT level(r=0.108,95%Cl-0.001-0.214,P=0.047).Subgroup analysis showed that the DFS rates were significantly higher in the non-cholecystectomy group than the cholecystectomy group when Y-GT>39.6 U/L(i3=0.044).The 5-,10-,15-,20-,and 25-year recurrence rates from the time of cholecystectomy were 2.63%,21.93%,42.11%,58.77%,and 65.79%,respectively.A significant positive correlation was observed between cholecystectomy and the time from cholecystectomy to recurrence(r=0.205,95%Cl 0.016-0.379,P=0.029).There were no significant differences in complications between groups(P=0.685).Conclusions:Patients with HCC who underwent cholecystectomy were more likely to develop intrahepatic distant recurrence after MWA,an outcome probably associated with increased y-GT levels.Moreover,the recurrence rates increased with time.

Minimally invasive treatment of hepatic hemangioma by transcatheter arterial embolization combined with microwave ablation:A case report

BACKGROUND Hepatic hemangioma is the most common benign tumor of the liver.However,patients with large hemangiomas that cause compression symptoms or that are at risk of rupture may need further intervention.It is necessary to explore additional minimally invasive and personalized treatment options for hemangiomas.CASE SUMMARY A 47-year-old woman was diagnosed with a right hepatic hemangioma for more than 10 years.Abdominal contrast-enhanced computed tomography(CT)and contrast-enhanced ultrasound revealed that there was a large hemangioma in the right liver,with a size of approximately 95 mm×97 mm×117 mm.Due to the patient's refusal of surgical treatment,hepatic artery embolization was performed in the first stage.After 25 d of liver protection treatment,the liver function indexes decreased to normal levels.Then,ultrasound-guided microwave ablation of the giant hepatic hemangioma was performed.Ten days after the treatment,hepatobiliary ultrasonography showed that the hemangioma of the right liver was smaller than the previous size(the volume was reduced by approximately 30%).Then the patient was discharged from the hospital.One year after discharge,CT showed that the hepatic hemangioma had shrunk by about 80%CONCLUSION Transcatheter arterial embolization combined with microwave ablation is a safe and effective minimally invasive treatment for hepatic hemangioma.