Subcapsular Hepatocellular Carcinoma Research Articles

Laparoscopic combined with percutaneous ablation for hepatocellular carcinoma under liver capsule: A single Chinese center experience of thirty patients.

For the tumor lesions close to capsule of the liver, traditional percutaneous radiofrequency ablation (PRFA) is limited due to high incidence of postoperative complications. The aim of the present study is to whether laparoscopic combined with PRFA (LCPR) could effectively ablate the tumor lesions close to capsule of the liver. A total of 119 patients with subcapsular hepatocellular carcinoma (HCC) were divided into two groups: PRFA group (89 patients) and LCPR group (30 patients). RFA was accomplished through cool-tip RFA system. For LCPR, PRFA was first carried out to destroy tumors deep inside the liver tissue. Then, laparoscopic RFA was performed under the guide of laparoscopic view and destroyed the superficial part of the tumor. Postoperative morbidity and technique effectiveness between two groups were evaluated. In PRFA group, the rate of fever was 70.8% (63/89), and two patients had gallbladder damage. Five patients had ascites. Pain was found in 26 patients (29.2%). In LCPR group, the rate of fever was 22/30 (73.3%). Two patients had ascites and only two patients complained of pain. In PRFA group, 77.5% (69/89) of the tumors were totally ablated, and in LCPR, 93.3% (28/30) of the tumors were destroyed without any residuals. LCPR could significantly reduce the incidence of postoperative pain and the rate of regional tumor residuals compared to the PRFA, suggesting this method could potentially be useful for subcapsular HCC ablation treatment.

First-line radiofrequency ablation with or without artificial ascites for hepatocellular carcinomas in a subcapsular location: Local control rate and risk of peritoneal seeding at long-term follow-up

To compare the long-term local control of hepatocellular carcinoma (HCC) and risk of peritoneal seeding via percutaneous radiofrequency ablation (RFA) using artificial ascites with those of RFA without artificial ascites. The Institutional Review Board approved this retrospective study. From April 2005 to February 2008, 160 patients (121 men, 39 women; age range 36-79 years) with a single subcapsular HCC (mean size 2.19 cm) were treated with ultrasonography-guided percutaneous RFA as a first-line therapy. Forty-four patients were treated with RFA using artificial ascites, whereas the other 116 patients were treated without artificial ascites. The cumulative local tumour progression (LTP) and peritoneal seeding were compared in both groups using follow-up computed tomography (CT). Cumulative LTP rates were analysed using the Kaplan-Meier method and the log-rank test. Risk of peritoneal seeding was investigated by means of multivariate analysis. The overall median follow-up period was 52.5 months (range 13-76 months). The 1, 2, 4, and 6 year cumulative LTP rates were 17.1, 27.6, 35.2, and 35.2%, respectively, in the group with artificial ascites, and 8, 15.2, 26.6, and 34.4% in the group without artificial ascites, without significant difference (p = 0.332). The rates of peritoneal seeding were 6.8% (3/44) in the group with artificial ascites and 2.6% (3/116) in the group without artificial ascites, a non-significant difference (p = 0.347). The biopsy prior to RFA was the independent risk factor of peritoneal seeding regardless of the use of artificial ascites. Long-term local tumour control and risk of peritoneal seeding were comparable for RFA with or without artificial ascites when used as a first-line therapy for subcapsular HCC.

Radiofrequency ablation combined with transarterial chemoembolization for subcapsular hepatocellular carcinoma: A prospective cohort study

ObjectiveThis study evaluated the safety and efficacy of using radiofrequency ablation combined with transarterial chemoembolization to treat hepatocellular carcinoma in a subcapsular location, given the increased risk of complications when using radiofrequency ablation alone. Materials and methodsFrom January 2000 to December 2011, 1213 patients with unresectable hepatocellular carcinoma (up to three nodules) were screened. Of these, 132 patients with 132 subcapsular nodules (mean size, 3.0cm; range, 1.2–5.0cm) were enrolled in the study. After transarterial chemoembolization, percutaneous radiofrequency ablation was performed under ultrasound or C-arm cone-beam computed tomography guidance, on the same day or within 3 days. Local recurrence and survival curves were obtained using the Kaplan–Meier method. ResultsTechnical success of treatment was achieved in 130 patients (98.5%). Major complications, including pleural effusion, secondary peritonitis, and liver abscess, occurred in 3 patients (2.3%); the incidence of complications was associated with the number of needle insertions (1–2 vs. 3–4, P=0.039, Fisher's exact test). No patients developed permanent sequelae, tumor seeding, or tumor bleeding. The 3-year local recurrence rate was 9.7%. Local recurrence was associated with the pretreatment serum des-gamma-carboxy prothrombin level (≤200mAU/mL vs. >200mAU/mL, P=0.019, log-rank test). The 3-, 5-, and 7-year overall survival rates in treatment-naïve cases (n=82) were 79.3%, 60.6%, and 50.9%, respectively. ConclusionCombination therapy using radiofrequency ablation and transarterial chemoembolization was a safe and useful therapeutic option for patients with subcapsular hepatocellular carcinoma.

Percutaneous Radiofrequency Ablation Using Internally Cooled Wet Electrodes for the Treatment of Hepatocellular Carcinoma

The objective of our study was to evaluate the efficacy and safety of percutaneous radiofrequency ablation (RFA) using internally cooled wet electrodes in patients with hepatocellular carcinoma (HCC). From March 2008 to October 2010, 122 patients with 129 HCCs (mean size, 2.2 ± 0.6 [SD] cm; range, 0.7-4 cm) were treated with RFA using internally cooled wet electrodes. Primary technical effectiveness, the frequency of major complications, and local tumor progression rates were evaluated. Two patients (2%) had major complications (liver abscess, significant pleural effusion) after RFA. When evaluated 1 month after RFA, the primary technical effectiveness rate was 99%. The 1- and 2-year local tumor progression rates were 8% and 12%, respectively. Additionally, there was no difference in effectiveness and complication rates between patients with subcapsular HCC and those with nonsubcapsular HCC. Percutaneous RFA using internally cooled wet electrodes is safe and provides successful local tumor control in patients with HCC. The safety and effectiveness of RFA using internally cooled wet electrodes are comparable to those reported in the literature using conventional RFA electrodes and are similar for nonsubcapsular and subcapsular tumors.

Radiofrequency ablation of subcapsular hepatocellular carcinoma: Single center experience

Purpose To present a single center results, regarding radiofrequency ablation (RFA) of subcapsular hepatocellular carcinoma (HCC). Materials and methods Forty patients with subcapsular HCC were treated with RFA under CT guidance for fifty-two discrete lesions in our institution. Twenty-eight patients underwent ablation of a solitary tumor and twelve patients underwent RFA of two tumors. Six patients had a subcapsular HCC with an exofitic location. All lesions had a diameter of <4 cm. We used two types of generators and electrodes: spiral electrode and expandable electrode. Needle track ablation was performed in all cases. Follow-up consisted of an abdomen computed tomography (CT) scan after contrast administration immediately after each session and then after one, three, six, and twelve months. Results In forty-eight lesions complete tumor ablation was depicted at the one month CT scan. In four lesions with residual viable tumor, a second session was performed. After the second ablation no residual tumor was observed in any patient. No major complications occurred in any of our patients. Fever with a temperature up to 39 °C was documented during the first days as part of the post-ablation syndrome in thirteen patients (32.2%). Seeding along the needle track was observed in none of our patients. Local tumor progression, was observed in ten lesions (19.25%) and in all cases a second RFA session was performed with optimal results. Conclusion Subcapsular location should not be considered as a contraindication for liver RFA.

Radiofrequency Ablation of Hepatocellular Carcinoma: Can Subcapsular Tumors Be Safely Ablated?

Our purpose was to retrospectively evaluate percutaneous radiofrequency ablation of unifocal subcapsular hepatocellular carcinoma (HCC) in comparison with nonsubcapsular tumors with regard to the technical and clinical outcomes. A total of 42 patients (23 men and 18 women; age range, 22-83 years) with unifocal HCC underwent percutaneous radiofrequency ablation as their sole interventional treatment between May 1998 and August 2003. Subcapsular tumors were selected for ablation if there was no large exophytic component, and they were ablated through an indirect puncture, a gradual increase in radiofrequency power output, and needle track ablation. Technical effectiveness after single-session radiofrequency ablation, complications, local tumor progression, overall survival, and event-free survival rates were compared between the two groups. There were 15 patients with subcapsular HCC and 27 patients with nonsubcapsular HCC. The technical effectiveness was 93% (14/15) in the subcapsular HCC group and 96% (26/27) in the nonsubcapsular group (p > 0.99), complication rates were 0% (0/15) and 7.4% (2/27) (p = 0.53), and rates of local tumor progression were 21% (3/14) and 15% (4/26) (p = 0.68), respectively. No needle track or peritoneal seeding was found in either group. No significant differences were found in overall survival (3 years: 60% vs 56%; p = 0.78) and event-free survival rates (3 years: 59% vs 48%; p > 0.99) between the two groups. Radiofrequency ablation of subcapsular HCC can be comparable to that of nonsubcapsular HCC with regard to the technical and clinical outcomes when there is proper patient selection and an optimized technique is used.

MDCT Anatomic Assessment of Right Inferior Phrenic Artery Origin Related to Potential Supply to Hepatocellular Carcinoma and its Embolization

To prospectively assess the anatomic variation of the right inferior phrenic artery (RIPA) origin with multidetector computed tomography (MDCT) scans in relation to the technical and angiographic findings during transcatheter arterial embolization of hepatocellular carcinoma (HCC). Two hundred patients with hepatocellular carcinomas were examined with 16-section CT during the arterial phase. The anatomy of the inferior phrenic arteries was recorded, with particular reference to their origin. All patients with subcapsular HCC located at segments VII and VIII underwent arteriography of the RIPA with subsequent embolization if neoplastic supply was detected. The RIPA origin was detected in all cases (sensitivity 100%), while the left inferior phrenic artery origin was detected in 187 cases (sensitivity 93.5%). RIPAs originated from the aorta (49%), celiac trunk (41%), right renal artery (5.5%), left gastric artery (4%), and proper hepatic artery (0.5%), with 13 types of combinations with the left IPA. Twenty-nine patients showed subcapsular HCCs in segments VII and VIII and all but one underwent RIPA selective angiography, followed by embolization in 7 cases. MDCT assesses well the anatomy of RIPAs, which is fundamental for planning subsequent cannulation and embolization of extrahepatic RIPA supply to HCC.

Duodenopleural Fistula Formation After Percutaneous Radiofrequency Ablation for Recurrent Hepatocellular Carcinoma

Radiofrequency ablation (RFA) is a treatment option in the management of unresectable or recurrent hepatocellular carcinoma (HCC). It can be performed either through laparotomy or in a minimally invasive manner by percutaneous, laparoscopic or thoracoscopic routes. Percutaneous RFA is associated with reduced surgical trauma and thus can be performed in patients with significant comorbidities. The procedure can be repeated after short intervals for sequential ablation of multiple liver lesions. However, the associated risks should not be underestimated. This is the first report of a rare complication of duodeno-pleural fistula after percutaneous RFA of a recurrent subcapsular HCC. The risk of bowel perforation during the ablation of subcapsular HCC requires special attention, since only the position of the tip of the electrode, but not the zone of ablation, can be assessed accurately by imaging during the procedure. Our case demonstrated that there was leakage of bowel content from the duodenal injury site into the pleural cavity through the RFA track. Subsequent uncontrolled infection resulted in empyema thoracis and led to the death of the patient.

Percutaneous Radiofrequency Ablation Therapy of Hepatocellular Carcinoma Using Multitined Expandable Electrodes: Comparison of Subcapsular and Nonsubcapsular Tumors

Our objective was to compare the prognosis of subcapsular and nonsubcapsular hepatocellular carcinoma after percutaneous radiofrequency ablation using multitined expandable electrodes. Some controversies exist about the clinical usefulness of percutaneous radiofrequency ablation of subcapsular hepatocellular carcinoma. Twenty-eight patients underwent percutaneous radiofrequency ablation of 43 hepatocellular carcinomas using multitined expandable electrodes. Twelve tumors were subcapsular and 31 were nonsubcapsular. We attempted to use normal liver as a pathway to the tumor when possible. Tumor size ranged from 1.0 to 4.2 cm (mean, 1.8 cm). Median follow-up was 16 months. Initial ablation was considered to have been complete when no enhancement was seen in the region of the ablated lesion on 1-month follow-up CT or on follow-up CT performed immediately after repeated ablation. Initial complete ablation and local tumor progression rates were compared between subcapsular and nonsubcapsular tumors. Eleven patients had subcapsular tumors (group 1), whereas the other 17 patients did not have subcapsular tumors (group 2). Major complication and mortality rates were compared between the two groups. No significant differences in initial complete ablation rate (100% vs 96.7%, p = 1.000) or local tumor progression rate (0% vs 10.0%, p = 0.545) were found between subcapsular and nonsubcapsular tumors. No procedure-related major complication or mortality occurred. The overall 1- and 3-year survival rates were 89.3% and 60.3%, respectively. The rates of local tumor progression and complications for radiofrequency ablation using multitined expandable electrodes for subcapsular hepatocellular carcinomas were comparable to those for nonsubcapsular hepatocellular carcinomas.

Radiofrequency Ablation of Needle Tract Seeding in Hepatocellular Carcinoma

A tumor needle tract seeding, 20 mm in diameter, was detected with magnetic resonance (MR) imaging in a 72-year-old man, 10 months after radiofrequency ablation of a 55-mm subcapsular hepatocellular carcinoma. This seeding was successfully treated with ultrasound-guided percutaneous radiofrequency ablation. No recurrence was found after a 2-year follow-up either on contrast-enhanced computed tomography or MR imaging. Needle tract seeding treatment is not well established. Percutaneous radiofrequency ablation of such seeding is one elegant potential treatment option. Efficacy seems promising but has to be confirmed in larger series. Further evaluation is needed.

Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease.

Laparoscopic liver resection for subcapsular hepatocellular carcinoma in patients with chronic liver disease is associated with lower morbidity than open resections. A case-comparison study. A tertiary referral center. From December 1, 1998, to November 30, 2000, 13 patients with chronic liver disease who underwent laparoscopic resection of hepatocellular carcinoma formed the laparoscopic group (LG). Tumors were 5 cm or smaller, subcapsular, and located in anterolateral segments (segments II-VI). A control group was created by matching each laparoscopic case with patients identical for liver disease, tumor size, and location and type of hepatectomy who underwent open liver resection. Fourteen patients fulfilled the criteria and formed the open group (OG). Postoperative mortality and morbidity. One segment or less was resected in 21 patients and 2 in 6 patients. Operative duration and cumulative portal triad clamping times were longer in the LG (267 +/- 79 minutes vs 182 +/- 57 minutes, P =.006; 68 +/- 24 minutes vs 25 +/- 19 minutes, P =.006, respectively). Mortality rates were 0% in the LG and 14% (2/14) in the OG (P =.2). Postoperative liver failure and ascites occurred in 8% (1/13) in the LG and 36% (5/14) in the OG (P =.15). Surgical margin was not different in the 2 groups. Three-year survival was significantly higher in the LG (89% vs 55%; P =.04), but 3-year recurrence rates were similar (46% vs 44%). Our study suggests that, despite longer operative and clamping times without clinical consequences, the rate of decompensation of liver disease could be lower after laparoscopy.

Laparoscopic Liver Resection for Subcapsular Hepatocellular Carcinoma Complicating Chronic Liver Disease—Invited Critique

Hypothesis: Laparoscopic liver resection for subcapsular hepatocellular carcinoma in patients with chronic liver disease is associated with lower morbidity than open resections. Design: A case-comparison study. Setting: A tertiary referral center. Patients and Intervention: From December 1, 1998, to November 30, 2000, 13 patients with chronic liver disease who underwent laparoscopic resection of hepatocellular carcinoma formed the laparoscopic group (LG). Tumors were 5 cm or smaller, subcapsular, and located in anterolateral segments (segments II-VI). A control group was created by matching each laparoscopic case with patients identical for liver disease, tumor size, and location and type of hepatectomy who underwent open liver resection. Fourteen patients fulfilled the criteria and formed the open group (OG). Main Outcome Measures: Postoperative mortality and morbidity. Results: One segment or less was resected in 21 patients and 2 in 6 patients. Operative duration and cumulative portal triad clamping times were longer in the LG (267 ± 79 minutes vs 182 ± 57 minutes, P=.006; 68 ± 24 minutes vs 25 t 19 minutes, P=.006, respectively). Mortality rates were 0% in the LG and 14% (2/14) in the OG (P=.2). Postoperative liver failure and ascites occurred in 8% (1/13) in the LG and 36% (5/14) in the OG (P=.15). Surgical margin was not different in the 2 groups. Three-year survival was significantly higher in the LG (89% vs 55%; P=.04), but 3-year recurrence rates were similar (46% vs 44%). Conclusion: Our study suggests that, despite longer operative and clamping times without clinical consequences, the rate of decompensation of liver disease could be lower after laparoscopy.

Percutaneous ethanol injection under general anaesthesia for hepatocellular carcinoma: 3 year survival in 112 patients

Objective: percutaneous ethanol injection (PEI) under general anesthesia (One Shot PEI) is a new therapy for large and multiple hepatocellular carcinoma (HCC) by the injection of large amount of ethanol in the tumor. We report our results with 3 years survival rates in patients with HCC on cirrhosis treated with One Shot PEI. Patients and methods: between October 1992 and July 1996, 112 cirrhotic patients (79 males; age: 45–80; mean: 64 years) with 215 HCC nodules (diameter 0.6–14 cm; mean 4.1 cm) underwent One Shot PEI. Fifty-three patients had a single nodule (diameter=3–14 cm; mean=4.5 cm), 59 had two or more (two to five) nodules (diameter=0.6–13 cm; mean=4.9). Ethanol injected ranged between 16 and 120 ml per session. Survival rates were calculated according to Kaplan-Meier method and Wilcoxon test was used for statistical analysis. Results: five patients died within 7 h–10 days after the treatment for rupture of oesophageal varices in three cases, rupture of subcapsular HCC in one case and liver failure in one case. In the remaining 107 patients, dynamic CT or spiral CT, performed 72 h–1 month after the treatment, showed complete necrosis in 76 cases (71%) and incomplete necrosis (although always >50%) in 31. Survival rates at 1, 2, 3 years in all 107 patients were 88, 76, and 76% respectively. Survival rates in Child A Class patients were 100, 92, 92% and in Class B patients were 84, 72, and 72% at 1, 2, 3 years respectively; in Class C were 70 and 40% at 1 and 2 years respectively ( P=0.01). Survival rates in patients with single nodule were 95, 82 and 82% at 1, 2 and 3 years, while in patients with multiple nodules were 80, 68 and 58% at 1, 2 and 3 years respectively ( P=n.s.). During the follow-up (6–46 months) 48 patients showed intrahepatic recurrences; 41 out of them were retreated with new sessions of One Shot PEI or traditional PEI. Conclusions: PEI One Shot is more aggressive than traditional PEI. Survival rates of PEI One Shot seems similar to those obtainable by conventional PEI and even better than surgery.