Efficacy and safety of percutaneous microwave ablation for hepatocellular carcinomas <4 cm in difficult location

Objective: Tumor location is a critical factor for determining technical success and local recurrence following percutaneous ablation of hepatocellular carcinomas (HCC). The purpose of this retrospective study was to evaluate the safety and outcome measures of percutaneous microwave ablation (pMWA) for HCCs <4 cm in difficult locations. Methods: Retrospective review included 81 patients who underwent pMWA for HCCs <4 cm. Fourty-three patients (30 males and 13 females; mean age, 61 years) with 53 HCCs located near the diaphragm, heart, gallbladder, kidney, gastrointestinal tract, large vessel and exophytic location were included under difficult location group. Thirty-eight patients (29 males and nine females; mean age, 60 years) with 48 HCCs in other locations were included under control group. Baseline demographics were recorded. Technical efficacy, local tumor progression (LTP), and complication rates were evaluated. Results: Mean follow-up period was 3.4 months (range 1–7). There was no major complication in both the groups; two patients had a mild perihepatic hemorrhage in the difficult location group which was managed conservatively. There was no difference between the groups in the overall technical efficacy rate (84.9% vs 91.7%, p = 0.294), LTP rate (4.4% vs 2.2%. p = 0.57) or complication rate (4.6% vs 0%, p = 0.177). Conclusion: Our data suggest that there is no significant difference in technical efficacy, LTP or complication rates for MWA in both difficult and normal locations. Advances in knowledge: With proper patient selection, pre-procedural planning and appropriate technique, pMWA is feasible, safe, and effective for small HCCs in difficult location with an acceptable range of complications.

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Safety and efficacy of percutaneous microwave ablation for post-procedural haemostasis: a bi-central retrospective study focusing on safety and efficacy

British Journal of Radiology ◽

10.1259/bjr.20190615 ◽

2020 ◽

Vol 93 (1106) ◽

pp. 20190615

Author(s):

Tian’an Jiang ◽

Alexis Kelekis ◽

Qiyu Zhao ◽

Argyro Mazioti ◽

Jia Liu ◽

...

Keyword(s):

Microwave Ablation ◽

Treatment Algorithm ◽

Doppler Imaging ◽

Percutaneous Ablation ◽

Technical Success ◽

Safety And Efficacy ◽

Contrast Enhanced ◽

Limited Experience ◽

Active Extravasation ◽

Percutaneous Microwave Ablation

Objective: To review safety and efficacy of percutaneous microwave ablation (MWA) for post-procedural haemostasis. Methods: Institutional databases retrospective research identified 10 cases of iatrogenic bleeding who underwent percutaneous MWA for post-procedural haemostasis. Ultrasound examination with Doppler and contrast enhancement identified a source of active bleeding prior to ablation; additionally they were used as guiding modality for antenna insertion whilst, post-ablation, assessed the lack of active extravasation. Target locations included liver intercostal space spleen and thyroid gland. Technical success was defined as positioning of the antenna on the desired location. Treatment end point was considered the disappearance of active extravasation in both Doppler imaging and contrast-enhanced ultrasound. Results: Technical success (i.e. positioning of the antenna on the desired location) was achieved in all cases. No complications were noted. All patients post MWA remained haemodynamically stable with no need for transfusion and were discharged from the hospital the next morning. Imaging and clinical follow-up in all patients before exiting the hospital did not depict any sign of active extravasation or bleeding. Conclusion: Our limited experience reports preliminary data showing that MWA could be added in the armamentarium of percutaneous therapies for iatrogenic bleeding. More prospective studies with larger patient samples are necessary for verification of this technique as well as for drawing broader conclusions in order to evaluate the place of percutaneous ablation in the treatment algorithm of haemorrhage. Advances in knowledge: Percutaneous ablation might have a role in haemostasis in well-selected cases

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CT-Guided Percutaneous Microwave Ablation of Sclerosing Hepatic Carcinoma

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2020/8881978 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Hongshen Song ◽

Huaiyin Ding ◽

Chuandong Zhu

Keyword(s):

Microwave Ablation ◽

Tracking System ◽

Control Group ◽

Multiple Site ◽

Hepatic Carcinoma ◽

Adequate Treatment ◽

Ct Guided ◽

Significant Difference ◽

High Thermal Resistance ◽

Histological Characteristics

Sclerosing http://mts.hindawi.com/update/) in our Manuscript Tracking System and after you have logged in click on the ORCID link at the top of the page. This link will take you to the ORCID website where you will be able to create an account for yourself. Once you have done so, your new ORCID will be saved in our Manuscript Tracking System automatically."?>hepatic carcinoma (SHC) is a rare subtype of hepatic carcinoma that can be caused by various pathogeneses. The histological characteristics of SHC demonstrate its high resistance to chemoembolization and thermal ablation; thus, surgical resection represents the primary option for the majority of patients. However, a small proportion of patients who cannot withstand surgery or who have inoperable tumors may not receive adequate treatment, causing the progression of cancer and related high mortality. To overcome the high puncture resistance, high thermal resistance, and poor thermal conductivity of microwave ablation, we developed percutaneous no-touch multiple-site microwave ablation (NTMSWA) to ablate SHC lesions. In this retrospective study, 96 and 41 patients underwent NTMSWA and surgery, respectively. In the NTMSWA group, tumor size and histological classification were determined by medical imaging and tissue biopsy before ablation, and then a personalized ablation regimen was performed. Complete ablation was achieved in a single session in 81 out of 96 (84.4%) patients. The median survival (MS) of the 90 patients who underwent NTMSWA was 51 months, and the overall survival (OS) rate at 5 years was 49.1%. In contrast, the MS in the control group was 57 months, and the OS rate at 5 years was 56.3%. There was no significant difference between the two groups, indicating that SHC <50 mm in size can be effectively ablated with NTMSWA. By adopting no-touch, multiple-site, low-power, intermittent ablation, SHC less than 50 mm in size can be completely ablated.

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Evaluation of an enhanced recovery protocol on patients having radical cystectomy for bladder cancer

Canadian Urological Association Journal ◽

10.5489/cuaj.5273 ◽

2018 ◽

Vol 12 (12) ◽

Cited By ~ 4

Author(s):

Bonnie Liu ◽

Trustin Domes ◽

Kunal Jana

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Enhanced Recovery ◽

Effective Means ◽

Control Group ◽

Complication Rates ◽

Readmission Rates ◽

Significant Difference ◽

And Gender ◽

Eras Protocol

Introduction: Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care protocols that are designed to shorten recovery time and reduce complication rates.1,2 An ERAS protocol was implemented in the Saskatoon Health region for radical cystectomy patients in 2013. This study evaluates the safety and efficacy of the protocol for patients having radical cystectomy for bladder cancer. Methods: Length of stay (LOS), early in-hospital complication rates, 30-day readmission rates, age, and gender were collected for patients seen for bladder cancer requiring radical cystectomy in Saskatoon between January 2007 and December 2016. Of these patients, 176 were pre-ERAS implementation (control group) and 84 were post-ERAS implementation (experimental group). The data from each variable was compared between the groups using a Z-test. Results: There was no significant difference in age or gender of patients between the groups. Average LOS pre-ERAS was 14.25±14.57 days, which is significantly longer than the post-ERAS average of 10.91±8.56 days (p=0.043). There was no significant difference in 30-day readmission rate (19.87% pre-ERAS vs. 19.05% post-ERAS; p=0.873) or complication rate (51.7% pre-ERAS vs. 46.4% post-ERAS; p=0.425). Conclusions: The implementation of an ERAS protocol for radical cystectomy reduces LOS, with no effect on early complication rates or 30-day readmission rates. This indicates that the protocol is safe for patients when compared to previous practices and is an effective means of reducing LOS.

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Tapered, Double-Lead Threads Single Implants Placed in Fresh Extraction Sockets and Healed Sites of the Posterior Jaws: A Multicenter Randomized Controlled Trial with 1 to 3 Years of Follow-Up

BioMed Research International ◽

10.1155/2017/8017175 ◽

2017 ◽

Vol 2017 ◽

pp. 1-16 ◽

Cited By ~ 3

Author(s):

Alessandro Cucchi ◽

Elisabetta Vignudelli ◽

Simonetta Franco ◽

Luca Levrini ◽

Dario Castellani ◽

...

Keyword(s):

Controlled Trial ◽

Survival Rates ◽

Test Group ◽

Primary Stability ◽

Control Group ◽

Complication Rates ◽

Significant Difference ◽

Multicenter Randomized Controlled Trial ◽

Implant Crown

Purpose. To evaluate the survival, success, and complication rates of tapered double-lead threads single implants, placed in fresh extraction sockets and healed sites of the posterior jaws. Methods. The enrolled patients were randomly divided into 2 groups: in the test group (TG), all implants were inserted at the time of tooth extraction; in the control group (CG), all implants were placed 3 months after extraction. The implants were followed for a period of 1 to 3 years after loading. The main outcomes were implant survival, complications, and implant-crown success. Results. Ninety-two patients had 97 installed implants (49 in the TG, 48 in the CG). Only two implants failed, in the TG; the survival rates were therefore 95.9% (47/49) and 100% (48/48) for TG and CG, respectively. In the surviving implants, no complications were reported, for an implant-crown success of 100%. Conclusions. Although a significant difference was found in the levels of primary stability between TG and CG, single implants placed in fresh extraction sockets and healed sites of the posterior jaws had similar survival and complication rates. Crestal bone levels and peri-implant bone resorption showed similar values. A longer follow-up period is however required, to confirm these positive outcomes.

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Resection of Carotid Body Tumors in Patients of Advanced Age: Experience From a Single Center

Ear Nose & Throat Journal ◽

10.1177/0145561320981442 ◽

2021 ◽

pp. 014556132098144

Author(s):

Lifeng Li ◽

Hongbo Xu ◽

Jing Zhou ◽

Wojciech K. Mydlarz ◽

Zhengya Yu ◽

...

Keyword(s):

Vocal Cord ◽

Carotid Body ◽

Vascular Reconstruction ◽

Vocal Cord Palsy ◽

Advanced Age ◽

Control Group ◽

Complication Rates ◽

Shamblin Classification ◽

Significant Difference ◽

Postoperative Length

Introduction: Resection of carotid body tumor (CBT) in patients of advanced ages has not been appreciated. Objectives: This study aims to assess the clinical characteristics and perioperative comorbidities for CBT resection in patients of advanced age and to validate the application of an “isolated island” technique for extirpation of CBT. Methods: Eight patients of advanced age (≥60 years) who underwent CBT resection were enrolled as the study group (SG). Another 29 patients of younger age (<45 years old) underwent CBT extirpation were assigned as the control group (CG). The perioperative issues were compared between these 2 groups. Results: The “isolated island” technique was successfully applied for resection of CBT in all 37 patients. The prevalence of Shamblin classification I, II, and III tumors in the SG was 12.5%, 62.5%, and 25%; whereas in the CG was 10.3%, 55.2%, and 34.5%, respectively. Bilateral CBT was observed in 7 patients of the CG and none in the SG. Vascular reconstruction was required for 1 (12.5%) patient in the SG, while it was required for 8 (27.6%) patients in the CG. Postoperative vocal cord palsy occurred in 37.5% of patients in SG, whereas the vocal cord palsy (34.5%) and dysphagia (6.9%) were commonly encountered in CG. In addition to postoperative length of stay ( P = .004), no significant difference for operative time, intraoperative blood loss, or mortality were observed between these 2 groups ( P > .05). Conclusion: Extirpation of CBT in patients of advanced age is rationale in appropriately selected patients. The “isolated island” technique is safe for CBT resection with seemingly low complication rates.

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Security and Efficiency of Percutaneous Microwave Ablation using Combined Computed Tomography and Ultrasound-Guided Imaging in Patients with Hepatocellular Carcinoma: A Prospective Study

10.21203/rs.3.rs-31844/v1 ◽

2020 ◽

Author(s):

Wenpeng Zhao ◽

Jiang Guo ◽

Honglu Li ◽

Liang Cai ◽

Youjia Duan ◽

...

Keyword(s):

Computed Tomography ◽

Hepatocellular Carcinoma ◽

Local Recurrence ◽

Recurrence Rate ◽

Microwave Ablation ◽

Local Recurrence Rate ◽

Treatment Time ◽

Combination Group ◽

Significant Difference ◽

Percutaneous Microwave Ablation

Abstract Background: We prospectively evaluated the security and efficiency of percutaneous microwave ablation (MWA) using combined computed tomography (CT) and ultrasound (US)-guided imaging in patients with BCLC-A1-3 hepatocellular carcinoma (HCC) given that they have shortcomings when used alone.Methods: We included 88 consecutive patients with single HCC who were treated with transcatheter hepatic arterial chemoembolization (TACE). The patients were divided into 3 groups at random by using draw lots 1 week after TACE. The combination group (34 patients) received MWA under the guidance of CT and US, while the single group (CT group, 30 patients; US group, 24 patients) received MWA under the guidance of CT or US alone. Contrast-enhanced MRI or CT scans were performed in all patients 1, 3, 6 and 12 months after the procedure. The study endpoints included the treatment time, puncture time, local recurrence rate, and adverse events.Results: The median diameter of the lesions was 3.1 (1.5-4.2) cm. The median treatment time was 38.6 (30-45) min and 36.7 (30-47) min in the combination group and US group, respectively. The median puncture number was 1.2 (1-2) times and 1.1 (1-2) times, respectively. Both were significantly less than in the CT group (45.8 min and 4.2 times). The local recurrence rate was 5.9% in the combination group, which was significantly inferior to that in the US group (16.7%). The grade C complication rate in the combination group was 5.9%, while it was 13.3% and 8.3% in the CT group and US group, respectively. There was a statistically significant difference between the combination group and CT group.Conclusions: Using CT- and US-guided microwave ablation in patients with BCLC-A1-3 hepatocellular carcinoma appeared to be much better in terms of security and efficiency than the use of microwave ablation under the guidance of CT or US alone.

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Oral Presentation I

World Journal of Endocrine Surgery ◽

10.5005/wjoes-8-1-1 ◽

2016 ◽

Vol 8 (1) ◽

pp. 1-7

Author(s):

Özer Makay ◽

Esra Yuksel ◽

Asuman Sargin ◽

Murat Ozdemir ◽

Varlik Erol ◽

...

Keyword(s):

Blood Pressure ◽

Blood Loss ◽

Pressure Fluctuations ◽

Conventional Laparoscopy ◽

Categorical Variables ◽

Control Group ◽

Complication Rates ◽

Robot Assisted ◽

Respiratory Parameters ◽

Significant Difference

ABSTRACT BACKGROUND AND AIMS Minimally invasive surgery of the adrenal gland is widespread. Although reports demonstrate the safety and feasibility of robot-assisted adrenalectomy, the objective benefits are still unclear, compared to those of conventional laparoscopy. Recently, robot-assisted approach has also become possible for pheochromocytoma resection. Since cardiopulmonary changes during robot-assisted dissection of the pheochromocytoma patient has not been studied in detail, we aimed to assess these concerns, compared to the routine laparoscopic technique. METHODS In this case-control study, 19 consecutive robot-assisted adrenal resections were compared with a control group consisting of 14 conventional laparoscopic adrenalectomy. Patient characteristics and intraoperative hemodynamic and respiratory parameters were assessed. Groups were compared using the χ2 test for categorical variables and Student's t-test for continuous variables. Significance was considered p < 0.05. RESULTS The robot-assisted procedure was performed successfully in all patients, except one. The duration of the robot-assisted procedure, compared to the conventional laparoscopy group, was significantly longer (p < 0.05). Intraoperative blood loss was significantly less in the robot-assisted group (p < 0.05). Dissection of pheochromocytoma showed a significant difference between the groups, according to the incidence of intraoperative blood pressure fluctuations (p < 0.05). The robot-assisted approach resulted in less incidents. Other hemodynamic and respiratory parameters did not differ between groups significantly. There were no perioperative deaths. Complication rates and postoperative hospital stays were not significantly different. CONCLUSION Robot-assisted adrenalectomy is a safe and technically feasible procedure for a pheochromocytoma patient. Robot-assisted resection of pheochromocytoma minimized the occurrence of intraoperative blood pressure fluctuations and blood loss.

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Similar complication rates for irreversible electroporation and thermal ablation in patients with hepatocellular tumors

Radiology and Oncology ◽

10.2478/raon-2019-0011 ◽

2019 ◽

Vol 53 (1) ◽

pp. 116-122 ◽

Cited By ~ 8

Author(s):

Niklas Verloh ◽

Isabel Jensch ◽

Lukas Lürken ◽

Michael Haimerl ◽

Marco Dollinger ◽

...

Keyword(s):

Adverse Events ◽

Thermal Ablation ◽

Liver Tumors ◽

Irreversible Electroporation ◽

Percutaneous Ablation ◽

Complication Rates ◽

Significant Difference ◽

Malignant Liver Tumors ◽

Malignant Liver ◽

Grade Iii

Abstract Background To compare the frequency of adverse events of thermal microwave (MWA) and radiofrequency ablation (RFA) with non-thermal irreversible electroporation (IRE) in percutaneous ablation of hepatocellular carcinoma (HCC). Patients and methods We retrospectively analyzed 117 MWA/RFA and 47 IRE procedures (one tumor treated per procedure; 144 men and 20 women; median age, 66 years) regarding adverse events, duration of hospital and intensive care unit (ICU) stays and occurrence of a post-ablation syndrome. Complications were classified according to the Clavien & Dindo classification system. Results 70.1% of the RFA/MWA and 63.8% of the IRE procedures were performed without complications. Grade I and II complications (any deviation from the normal postinterventional course, e.g., analgesics) occurred in 26.5% (31/117) of MWA/RFA and 34.0% (16/47) of IRE procedures. Grade III and IV (major) complications occurred in 2.6% (3/117) of MWA/RFA and 2.1% (1/47) of IRE procedures. There was no significant difference in the frequency of complications (p = 0.864), duration of hospital and ICU stay and the occurrence of a post-ablation syndrome between the two groups. Conclusions Our results suggest that thermal (MWA and RFA) and non-thermal IRE ablation of malignant liver tumors have comparable complication rates despite the higher number of punctures and the lack of track cauterization in IRE.

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Metabolomics-Based Clinical Efficacy of Compound Shenlu Granule, a Chinese Patent Medicine, in the Supportive Management of Aplastic Anemia Patients: A Randomized Controlled Pilot Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/6655848 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Zhou Feng ◽

Xiaoying Hu ◽

Weiying Qu ◽

Xiaoqin Zhu ◽

Jiaying Lu ◽

...

Keyword(s):

Aplastic Anemia ◽

Clinical Efficacy ◽

Pilot Trial ◽

Control Group ◽

Efficacy Rate ◽

Metabolomics Data ◽

Significant Difference ◽

Group A ◽

Group B ◽

Tcm Syndrome

Objective. To explore the clinical efficacy and mechanism of compound Shenlu granule (SLG) treatment in patients with aplastic anemia (AA). Methods. A total of 89 AA patients were randomly divided into an SLG supportive group (group A, n = 44) and a control group (group B, n = 45) while continuing Western medical management. After 6 months, hemograms, traditional Chinese medicine (TCM) syndrome scores, and overall clinical efficacy rate were assessed. Serum metabolomics characteristics were observed using ultraperformance liquid chromatography-mass spectrometry after SLG intervention. Results. The levels of red blood cell (RBC), hemoglobin (Hb), and platelet (PLT) were increased in both groups after treatment for 6 months ( P < 0.05 ), and in group A, the elevation of PLT became much more significant ( P < 0.01 ). The TCM syndrome score was lower in group A than in group B after treatment ( P < 0.05 ). Metabolomics data showed a significant difference in the patients using SLG after 6 months, and 14 biomarkers were identified. Conclusion. SLG supportive treatment showed positive results in patients with AA, and metabolomics data indicated that SLG influenced aminoacyl-tRNA biosynthesis and glycerophospholipid metabolism to gradually return to normal.

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Platelet-Rich Plasma in the Treatment of Subcutaneous Venous Access Device Scars: A Head-to-Head Patient Survey

BioMed Research International ◽

10.1155/2015/630601 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

C. Eichler ◽

M. Najafpour ◽

A. Sauerwald ◽

J. Puppe ◽

M. Warm

Keyword(s):

Surgical Outcome ◽

Platelet Rich Plasma ◽

Venous Access ◽

Outcome Evaluation ◽

Control Group ◽

Complication Rates ◽

Access Device ◽

Port Area ◽

Significant Difference ◽

Venous Access Device

Introduction. Platelet-rich plasma (PRP) is a product widely used in sports medicine, tissue repair, and general surgery. A recent meta-analysis showed this product to be beneficial when introduced into a wound area, be it intra-articular (i.e., joint-injections) or direct introduction onto the wound surface.Methods. Between the years of 2012 and 2014 a questionnaire evaluating surgical outcome after port (venous access device) removal was answered by 100 patients in the control group and 20 patients in a PRP group, leading to a total of 120 patients in this single center, retrospective, subjective outcome evaluation.Results. No statistical difference was shown in postsurgical complication rates, postsurgical pain, decreased mobility, and overall quality of life. A significant difference was shown in overall patient satisfaction and the desire to further improve port area scarring. Results differed significantly in favor of the PRP group. Interestingly, approximately 40.2% of patients are dissatisfied with the surgical outcome after port removal in the control group. This result, though surprising, may be improved to 10% dissatisfaction when a PRP product is used.Conclusion. PRP products such as Arthrex ACP are safe to use and present an additional option in improving surgical outcome.

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