Efficacy of Superselective Conventional Transarterial Chemoembolization Using Guidance Software for Hepatocellular Carcinoma within Three Lesions Smaller Than 3 cm

The indication of transarterial chemoembolization (TACE) has advanced to hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage A when surgical resection (SR), thermal ablation, and bridging to transplantation are contraindicated; however, TACE for small HCC is frequently difficult and ineffective because of less hypervascularity and the presence of tumor portions receiving a dual blood supply. Here, we report outcomes of superselective conventional TACE (cTACE) for 259 patients with HCCs within three lesions smaller than 3 cm using guidance software. Automated tumor feeder detection (AFD) functionality was applied to identify tumor feeders on cone-beam computed tomography during hepatic arteriography (CBCTHA) data. When it failed, the feeder was identified by manual feeder detection functionality and/or selective angiography and CBCTHA. Regarding the technical success in 382 tumors (mean diameter, 17.2 ± 5.9 mm), 310 (81.2%) were completely embolized with a safety margin (5 mm wide for HCC ≤25 mm and 10 mm wide for HCC >25 mm). In 61 (16.0%), the entire tumor was embolized but the safety margin was not uniformly obtained. The entire tumor was not embolized in 11 (2.9%). Regarding the tumor response at 2–3 months after cTACE in 303 tumors excluding those treated with combined radiofrequency ablation (RFA) or SR and lost to follow-up, 287 (94.7%) were classified into complete response, seven (2.3%) into partial response, and nine (3.0%) into stable disease. The mean follow-up period was 44.9 ± 27.6 months (range, 1–109) and the cumulative local tumor progression rates at 1, 3, 5, and 7 years were 17.8, 27.8, 32.0, and 36.0%, respectively. The 1-, 3-, 5-, and 7-year overall and recurrence-free survival rates in 175 patients, excluding those with Child–Pugh C class, who died of other malignancies, or who underwent combined RFA or hepatic resection, were 97.1 and 68.7, 82.8 and 34.9, 64.8 and 20.2, and 45.3 and 17.3%, respectively. Our results indicate the efficacy of superselective cTACE using guidance software for HCC within three lesions smaller than 3 cm.

Anatomical variation in arterial supply of liver – Case study

The variations of blood supply of liver is of great importance for general surgery, particularly hepatic surgery. Blood supply of liver is significant for liver transplantations, radiological procedures, and laparoscopic method of operation and for the healing of penetrating injuries, including the space close to the hepatic area.The pattern of the normal vascular system of the liver comes from the common hepatic artery (CHA), originating from the celiac trunk. The gastroduodenal artery (GDA), right gastric artery (RGA) and proper hepatic artery (PHA) are the main branches of the CHA. After that, the division of the PHA composes the left and right hepatic branches.During a routine dissection with medical students from the Department of Anatomy, Parul institute of Medical sciences and research Vadodara, We found on one cadaver that the blood supply of the liver differed from a normal blood supply of liver.In one cadaver we found that liver is supplied by a direct branch from celiac trunk and in same cadaver liver is also supplied by proper hepatic artery. The knowledge about the variations in hepatic arterial anatomy is very important for surgical gastroenterologists and interventional radiologists for preoperative planning and intraoperative imaging during procedures like liver transplantation, cholecystectomy, gastrectomy, hiatal hernia repair, trans-arterial chemotherapy and hepatic arteriography.

Development of human hepatocellular carcinoma in X-linked severe combined immunodeficient pigs: An orthotopic xenograft model

Hepatocellular carcinoma (HCC) is the fifth most common primary tumor and the third leading cause of cancer-related deaths worldwide. Rodent models of HCC have contributed to the advancement of studies investigating liver carcinogenesis, tumor-host interactions, and drug screening. However, their small size renders them unsuitable for surgical or clinical imaging studies, necessitating the development of larger-size HCC models. Here, we developed a xenograft model of human HCC in X-linked interleukin-2 receptor gamma chain gene (Il2rg)-targeted severe combined immunodeficient (SCID) pigs. HepG2 cell suspension in serum-free medium containing 50% membrane matrix was directly injected into the liver parenchyma of eight X-linked Il2rg-targeted SCID pigs (6.6–15.6 kg) via ultrasonography-guided percutaneous puncture. Tumor engraftment was evaluated weekly using ultrasonography, and cone-beam computed tomography was performed during arterial portography (CTAP) and hepatic arteriography (CTHA) to evaluate the hemodynamics of engrafted tumors. The engrafted tumors were histologically analyzed following necropsy and assessed for pathological similarities to human HCCs. Macroscopic tumor formation was observed in seven of the eight pigs (simple nodular tumors in three and multinodular tumors in four). Engrafted tumors were identified as low-echoic upon ultrasonography and as perfusion-defect nodules on the CTAP images. Meanwhile, CTHA showed that the tumors were hyperattenuating. Further, histopathological findings of the engrafted tumors were consistent with those of human HCC. In conclusion, the porcine model of human HCC, successfully generated herein, might help develop more effective therapeutic strategies for HCC.

Hepatic Artery Variations Analyzed in 1141 Patients Undergoing Digital Subtraction Angiography

Background: The hepatic artery has several variations that can be observed by digital subtraction angiography (DSA). In recent years, clinical studies have continued to explore its diversity, leading to the discovery of rare variations and the development of new classifications.Methods: Institutional Review Board approval was attained. This retrospective study was based on analysis of DSA images in 1141 patients who were pathologically or clinically diagnosed with liver tumor from May 2015 to December 2019. All patients involved in this study had undergone hepatic arteriography at our hospital. The study aimed to complete angiographic assessments of the left gastric artery (LGA), superior mesenteric artery (SMA) and HA, which supply the liver parenchyma. Results: It was worth mentioning that we found five new cases of hepatic artery variations. The four major types of hepatic artery anatomy were identified. Normal hepatic artery anatomy was pointed in 871 (76.3%) of 1141 patients, and the incidence of hepatic artery variation was 270 (23.7%) cases. Variation in hepatic artery origin was identified in 240 (21.1%) cases. Variation in bifurcation was identified in 18 (1.6%) cases. Three (0.5%) cases had synchronized bifurcate and variation of origin, which has not been reported previously. Conclusion: Hepatic artery variation have diversity and complexity. The known and newly is covered variations were thoroughly analyzed in detail, which has important clinical significance for hepatobiliary surgeries and interventional operations.

OCCUPATIONAL RADIATION DOSE PERFORMING HEPATOBILIARY MINIMALLY INVASIVE PROCEDURES IN CHILDREN WEIGHING LESS THAN 20 kg

Our objective is to retrospectively evaluate the effective dose (E) of operators performing pediatric Hepatobiliary Minimally Invasive Procedures (HMIP). Between October 2015 and December 2017, 58 consecutive HMIP were performed on 26 children weighing less than 20 kg (mean 12.3 kg, median 13 kg, range 2.4–20 kg). About 31 vascular procedures (n = 9 hepatic venograms with/without stenting; n = 9 retrograde wedge portography; n = 8 transhepatic portography with angioplasty and/or stenting and n = 5 hepatic arteriography/embolization) and 27 non-vascular procedures (n = 6 percutaneous transhepatic biliary drainage (PTBD); n = 3 bilioplasty; n = 15 biliary catheter change and n = 3 cholangiogram) were performed. Electronic personal dosimeters were used to measure radiation doses to the interventional radiologist, radiographer and anesthesia nurse. The results shows the highest mean effective dose: interventional radiologist’s in PTBD (1.18 μSv); radiographer’s in hepatic veins phlebography with/without stenting (0.25 μSv) and nurse’s in hepatic arteriography/embolization (0.26 μSv). Operators’ E can vary depending on the complexity of procedure performed and the position of the operators within the angiosuite.