Treatment Of Malignant Liver Tumors Research Articles

An update on liver surgery- a new terminology and modern techniques.

Liver surgery is the cornerstone of the curative treatment of malignant liver tumors. However, the liver anatomy is very complex, and liver surgery is still associated with relevant morbidity despite many technical advances. The Brisbane nomenclature is used worldwide to classify liver resection. However, this nomenclature has several limitations as multiple terms are used for the same type of resection. Non-anatomical resections, multiple resections, and combined bilio-vascular resections were not mentioned. Therefore, new terminologies have been proposed for the precise and simple classification of liver resection. Furthermore, in recent years, many technical innovations have been introduced in liver surgery, such as 3D imaging systems and indocyanine green fluorescence, for better preoperative and intraoperative identification of tumor localization and critical vascular structures. Minimally invasive techniques are used more frequently in liver surgery. Potential benefits include less intraoperative blood loss, less pain, and a shorter hospital stay. The implementation of robotic systems also has an impact on liver surgery, and the number of cases reported in the literature is constantly increasing. The potential benefits of robotic liver resection over laparoscopic liver resection will be the subject of future studies.

Machine Learning Combined with Radiomics Facilitating the Personal Treatment of Malignant Liver Tumors.

In the realm of managing malignant liver tumors, the convergence of radiomics and machine learning has redefined the landscape of medical practice. The field of radiomics employs advanced algorithms to extract thousands of quantitative features (including intensity, texture, and structure) from medical images. Machine learning, including its subset deep learning, aids in the comprehensive analysis and integration of these features from diverse image sources. This potent synergy enables the prediction of responses of malignant liver tumors to various treatments and outcomes. In this comprehensive review, we examine the evolution of the field of radiomics and its procedural framework. Furthermore, the applications of radiomics combined with machine learning in the context of personalized treatment for malignant liver tumors are outlined in aspects of surgical therapy and non-surgical treatments such as ablation, transarterial chemoembolization, radiotherapy, and systemic therapies. Finally, we discuss the current challenges in the amalgamation of radiomics and machine learning in the study of malignant liver tumors and explore future opportunities.

Complications and local recurrence of malignant liver tumor after ablation in risk areas: a retrospective analysis.

Microwave ablation (MWA) is an effective local treatment for malignant liver tumors; however, its efficacy and safety for liver tumors adjacent to important organs are debatable. Forty-three cases with liver tumors adjacent to important organs were the risk group and 66 cases were the control group. The complications between two groups were compared by chi-square test and t-test. Local tumor recurrence (LTR) was analyzed by log-rank test. Factors affecting complications were analyzed by logistic regression and Spearman analyses. Factors affecting LTR were analyzed by Cox regression analysis. A receiver operating characteristic curve predicted pain treated with drugs and LTR. We found no significant difference in complications and LTR between two groups. The risk group experienced lower ablation energy and more antennas per tumor than control group. Necrosis volume after MWA was positively correlated with pain; necrosis volume and ablation time were positively correlated with recovery duration. Major diameter of tumor >3 cm increased risk of LTR by 3.319-fold, good lipiodol deposition decreased risk of LTR by 73.4%. The area under the curve (AUC) for necrosis volume in predicting pain was 0.74, with a 69.1 cm3 cutoff. AUC for major diameter of tumor in predicting LTR was 0.68, with a 27.02 mm cutoff. MWA on liver tumors in at-risk areas is safe and effective, this is largely affected by proper ablation energy, antennas per tumor, and experienced doctors. LTR is primarily determined by major diameter of tumor and lipiodol deposition status.

Advances In the Study of Hypoxia Inducible Factors and Prognosis of Hepatocellular Carcinoma Development

Hypoxia-inducible factors (HIF) plays a major role in the regulation of hypoxia. It occurs not only under normal physiological conditions but also under pathological conditions such as some inflammatory reactions and tumor diseases. Studies have shown that the mechanisms of hepatocarcinogenesis include cellular molecules signaling pathways and gene levels in which Hypoxia-inducible factors play an important role. At present, surgical resection liver transplantation and chemotherapy are still the main treatment methods in the clinical treatment of patients with liver cancer but conventional chemotherapy drugs have toxic side effects on human body and the prognosis is poor. HIF is not only involved in reducing the efficacy of radiotherapy chemotherapy and targeted therapy but also closely related to angiogenesis and immune escape. In this article, we will focus on the Hypoxia-inducible factors of liver cancer and discuss its relationship with the development and prognosis of liver cancer and provide new ideas for the precise treatment of malignant liver tumors.

Ablation technologies

Ablative therapies have recently emerged as an alternate to the gold-standard liver resection in treatment of malignant liver tumors. These modalities include radiofrequency ablation and microwave ablation which utilize thermocoagulative energy and microwave energy, respectively, to create a complete necrosis zone encircling the lesion. In this review, we aimed to show different perspectives of these treatment methods including indications, outcomes, surgical techniques, and perioperative management.

Laparoscopic Left Hemihepatectomy for Intrahepatic Cholangiocellular Carcinoma: An Adequate Lymphadenectomy is Also Possible in Artery Variation

BackgroundLaparoscopic liver resection (LLR) is becoming essential in the treatment of malignant liver tumors but only a few reports exist about LLR for intrahepatic cholangiocarcinoma (IHCC).MethodsWe present a video of a laparoscopic left hemihepatectomy with lymphadenectomy for IHCC.Case presentationA 67-year-old asymptomatic male underwent a routine abdominal ultrasound, revealing a 15 × 9 mm solid nodular iso-hyperechoic lesion, located in SIII, with SII/III biliary duct dilation. Magnetic resonance imaging confirmed a 32 × 22 mm lesion in SII/III, with mild hyper-intensity on T2-weighted images and strong hypo-intensity on T1-weighted images. After administration of contrast medium, the lesion showed light peripheral enhancement on the portal and delayed phases, and hypo-intensity on the hepatospecific phase. No relevant comorbidities were reported (KPS 100). Laboratory tests showed normal liver function and normal CA19-9 levels. A laparoscopic left hemihepatectomy was indicated.ResultsOperative time was 330 min. Four intermittent Pringle maneuver cycles were applied and no blood transfusions were administered. Intraoperative ultrasound confirmed preoperative findings and additionally highlighted involvement of the SIV duct. A full replacing right hepatic artery arising from the superior mesenteric artery was identified and was preserved during hilar dissection. Postoperative course was uneventful and the patient was discharged on postoperative day 3. The pathology report indicated cholangiocellular carcinoma pT1bN0. Twelve lymph nodes were retrieved.ConclusionsAccording to recent literature reports and our experience, laparoscopic surgery for intrahepatic cholangiocellular carcinoma should be considered feasible and safe in selected patients. Hepatic artery variations allow for adequate lymphadenectomy. Oncological long-term results require multicenter randomized studies in order to be validated.

Irreversible electroporation versus radiofrequency ablation for malignant hepatic tumor: A prospective single-center double-arm trial

ObjectiveIrreversible electroporation (IRE) is a nonthermal ablation technique for the treatment of malignant liver tumors. IRE has demonstrated efficacy and safety in the treatment of malignant liver tumors and its unique advantages in the treatment of nearby vascular lesions. This study aimed to compare the efficacy, safety, and intermediate-term outcomes of IRE and radiofrequency (RF) therapy in malignant liver tumors. MethodsTwenty-four patients with primary or secondary liver malignancies were included in this prospective, double-arm clinical trial. Patients were randomly divided into the IRE and RF groups. The primary outcome was the efficacy (local ablation control evaluation at 90 days). The secondary outcomes were safety (procedure-related complications at ​≤ ​90 days) and intermediate-term survival (at 24 months). ResultsThe ablation assessment at 90 days after surgery with mRECIST for IRE versus RF were 70%, 20%, 0%, and 10% versus 92.9%, 7.1%, 0%, and 0% (CR, PR, SD, and PD, respectively). The complication rates of IRE versus RF with Clavien-Dindo classification were 16.7%, 25%, 0%, 8.3%, and 8.3% versus 8.3%, 50%, 0%, 0%, and 0% (Grade I, II, III, IV, and V, respectively). The average overall survival (OS) was 17.55 months in the IRE group (95% CI 15.13-22.37) and 18.75 months in the RF group (95% CI 12.48-22.61). There was no statistical difference between the IRE and RF groups in terms of efficacy (p ​= ​0.48), safety(p ​= ​0.887), or 24-month OS (p ​= ​0.959). ConclusionsIRE ablation revealed similar efficacy and safety in a short-term follow-up, and similar OS in mid-term survival as RF ablation in treating malignant hepatic tumors.

CHEMOEMBOLIZATION OF THE HEPATIC ARTERY IN THE TREATMENT OF PATIENTS WITH CHEMORESISTANT METASTASES OF COLORECTAL CANCER. REVIEW

In the structure of the incidence of malignant tumors for a number of years, colorectal cancer occupies one of the leading positions, with a steady tendency to growth. The five-year survival rate of patients with metastatic liver damage in colorectal cancer does not exceed 28%. A significant breakthrough in the study of the biology of colorectal cancer has led to a deep understanding of individual processes of carcinogenesis and a personalized approach to treatment tactics. Despite this, the problem of chemoresistance remains one of the most acute. The high toxicity of systemic chemotherapy limits its use in this group of patients. In this connection, minimally invasive and at the same time effective methods of local treatment of malignant liver tumors have been introduced into clinical practice. These methods include: hepatic artery chemoinfusion, chemoembolization, oil chemoembolization and radioembolization. At present, a large world experience has already been accumulated in the application of the above-described methods of treatment. However, the question of the application of methods of interventional surgery in the treatment of patients with chemoresistant metastases is still open. The presented review reflects the results of the analysis of scientific literature on the treatment of this group of patients. The main stages of development and improvement of X-ray endovascular methods of treatment are presented.

Assessment of a new 150 W single-antenna microwave ablation system in the treatment of malignant liver tumors: The first worldwide experience.

Data in literature regarding liver microwave ablation pertain to systems delivering 100 W of maximum power. Our aim is to assess a new 150 W microwave system for liver tumor ablation. This was an institutional review board-approved study of patients undergoing ablation of malignant liver tumors using a 150 W microwave system. Feasibility, safety, ablation algorithm, perioperative outcomes, and efficacy were analyzed. Comparison was made to historical patients undergoing ablation using a 100 W microwave system. There were 33 patients with 76 malignant liver lesions who underwent ablation with the 150 W system. Using a step-wise algorithm, ablations without intraoperative complications were performed for tumors ranging in size from 0.3 to 6.7 cm. Ninety-day morbidity was 5%, with no mortality. Compared to the 100 W system, the 150 W system shortened ablation time and created larger ablation zones with a single stick. This first worldwide experience showed that surgical ablations could be safely created at 150 W using a step-wise algorithm with complete tumor destruction achieved at short-term follow-up. Advantages versus 100 W systems include reduction in ablation time and creation of larger ablation zones with a single stick.

Influence on the Kinetic Growth Rate after PVE and ALPPS

Purpose: "Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy" (ALPPS) and "Portal Vein Embolization" (PVE) have an important role in the treatment of malignant liver tumors. Both procedures induce rapid and effective hypertrophy of the future liver remnant (FLR) to prevent postoperative liver failure. The aim of this study is to determine impact factors on the kinetic growth rate (KGR) and subsequently FLR, in terms of complications, posthepatectomy liver failure (PHLF) and survival. Method: Patients undergoing ALPPS and PVE from 2010 until 2020 were included. KGR was defined as the quotient of hypertrophy and the time interval in weeks between intervention (PVE/ALPPS step 1) and resection. Results: Overall, 90 patients underwent ALPPS and 82 patients received PVE. The association between KGR and PHLF indicates a significant nonlinear effect in PVE (p=0.009) and ALPPS (p=0.05). For ALPPS, the incidence of PHLF significantly decreased from 30% to 8% (p=0,032) at cutoff value of KGR of >7 %/week. Patients with a KGR of >7%/week had a higher preoperative skeletal muscle index (p=0,029), but the same body mass index (p=0,301). Tumor anemia showed an association with a reduction of KGR (p=0,159). However, the KGR had no effect on postoperative morbidity, mortality, and long-term survival. For patients undergoing PVE, no valuable cutoff value for KGR could be calculated for a reduction of PHLF. Furthermore, the KGR was not influenced by preoperative metabolic or laboratory values. Conclusion: A KGR >7%/week showed a reduction of PHLF after ALPPS, but did not influence the morbidity and mortality. Skeletal muscle index and tumor anemia could be adjustable preoperative parameters to improve the KGR for patients undergoing ALPPS. For PVE, the KGR seems to be stable and no influencing factors could be found.

Clinical Observation of Laparoscopic Anatomic Hepatectomy for Early Primary Liver Cancer

At present, liver resection is the most effective treatment for malignant liver tumors, and with the rapid development of medical technology, anatomical liver resection has been widely used in clinical practice. This paper mainly studies the clinical effect of laparoscopic anatomic hepatectomy in the treatment of early primary liver cancer. According to the surgical method, the patients were divided into anatomic and non-anatomic hepatectomy groups. Preoperative, intraoperative and postoperative efficacy data of the two groups were analyzed. According to the clinical results, the anatomical resection of liver cancer has short operation time, fewer postoperative complications, fast recovery of liver function, and long survival time without tumor, with obvious clinical effect and definite curative effect, which is worthy of promotion.

Modern therapeutic approaches for the treatment of malignant livertumours.

Malignant liver tumours include a wide range of primary and secondary tumours. Although surgery remains the mainstay of curative treatment, modern therapies integrate a variety of neoadjuvant and adjuvant strategies and have achieved dramatic improvements in survival. Extensive tumour loads, which have traditionally been considered unresectable, are now amenable to curative treatment through systemic conversion chemotherapies followed by a variety of interventions such as augmentation of the healthy liver through portal vein occlusion, staged surgeries or ablation modalities. Liver transplantation is established in selected patients with hepatocellular carcinoma but is now emerging as a promising option in many other types of tumour such as perihilar cholangiocarcinomas, neuroendocrine or colorectal liver metastases. In this Review, we summarize the available therapies for the treatment of malignant liver tumours, with an emphasis on surgical and ablative approaches and how they align with other therapies such as modern anticancer drugs or radiotherapy. In addition, we describe three complex case studies of patients with malignant liver tumours. Finally, we discuss the outlook for future treatment, including personalized approaches based on molecular tumour subtyping, response to targeted drugs, novel biomarkers and precision surgery adapted to the specific tumour.

Stereotactic Image-Guided Microwave Ablation for Malignant Liver Tumors-A Multivariable Accuracy and Efficacy Analysis.

Background: Therapeutic success of thermal ablation for liver tumors depends on precise placement of ablation probes and complete tumor destruction with a safety margin. We investigated factors influencing targeting accuracy and treatment efficacy of percutaneous stereotactic image-guided microwave ablation (SMWA) for malignant liver neoplasms.Materials and methods: All consecutive patients treated with SMWA for malignant liver tumors over a 3-year period were analyzed. A computed tomography-based navigation system was used for ablation probe trajectory planning, stereotactic probe positioning, and validation of probe positions and ablation zones. Factors potentially influencing targeting accuracy [target positioning error (TPE)] and treatment efficacy within 6 months [ablation site recurrence (ASR)] were analyzed in a multivariable regression model, including challenging lesion locations (liver segments I, VII, and VIII; subphrenic location).Results: Three hundred one lesions (174 hepatocellular carcinomas, 87 colorectal liver metastases, 17 neuroendocrine tumors, and 23 others) were targeted in 191 interventions in 153 patients. The median TPE per ablation probe was 2.9 ± 2.3 mm (n = 384). Correction of ablation probe positions by repositioning was necessary in 4 out of 301 lesions (1%). Factors significantly influencing targeting accuracy were cirrhosis (R 0.67, CI 0.22–1.12) and targeting trajectory length (R 0.21, CI 0.12–0.29). Factors significantly influencing early ASR were lesion size >30 mm (OR 5.22, CI 2.44–11.19) and TPE >5 mm (OR 2.48, CI 1.06–5.78). Challenging lesion locations had no significant influence on targeting accuracy or early ASR.Conclusions: SMWA allows precise and effective treatment of malignant liver tumors even for lesions in challenging locations, with treatment efficacy depending on targeting accuracy in our model. Allowing for many tumors to be safely reached, SMWA has the potential to broaden treatment eligibility for patients with otherwise difficult to target tumors.

Periportal fields cause stronger cooling effects than veins in hepatic microwave ablation: an in vivo porcine study.

Vascular cooling effects are a well-known source for tumor recurrence in thermal in situ ablation techniques for hepatic malignancies. Microwave ablation (MWA) is an ablation technique to be considered in the treatment of malignant liver tumors. The impact of vascular cooling in MWA is still controversial. To evaluate the influence of different intrahepatic vessel types, vessel sizes, and vessel-to-antenna-distances on MWA geometry in vivo. Five MWAs (902-928 MHz) were performed with an energy input of 24.0 kJ in three porcine livers in vivo. MWA lesions were cut into 2-mm slices. The minimum and maximum radius of the ablation area was measured for each slice. Distances were measured from ablation center toward all adjacent hepatic vessels with a diameter of ≥1 mm and within a perimeter of 20 mm around the antenna. The respective vascular cooling effect relative to the maximum ablation radius was calculated. In total, 707 vessels (489 veins, 218 portal fields) were detected; 370 (76%) hepatic veins and 185 (85%) portal fields caused a cooling effect. Portal fields resulted in higher cooling effects (37%) than hepatic veins (26%, P < 0.01). No cooling effect could be observed in close proximity of vessels within the central ablation zone. Hepatic vessels influenced MWA zones and caused a distinct cooling effect. Portal fields resulted in more pronounced cooling effect than hepatic veins. No cooling effect was observed around vessels situated within the central white zone.

The Safety and Efficacy of Spherical Microwave Ablation for the Treatment of Malignant Liver Tumors

The Safety and Efficacy of Spherical Microwave Ablation for the Treatment of Malignant Liver Tumors

Minimally invasive liver resection for hepatocellular carcinoma of patients with liver damage B: A propensity score-based analysis.

Minimally invasive liver resection (MILR) is considered a safe and feasible treatment for malignant liver tumors. However, few studies have investigated the surgical outcomes of MILR in patients with impaired liver function. Liver damage is used for consideration of hepatectomy. The aim of this study is to clarify the efficacy of MILR for patients with impaired liver function by using propensity score matching. Ninety-nine patients with liver damage B underwent hepatic resection were analyzed. The patients were divided into two groups, the MILR group (n = 24) and the open liver resection (OLR) group (n = 75). After matching of a propensity score, we compared clinicopathological features and surgical outcomes. After matching, 36 patients (18 patients from each group) were selected and the patients' characteristics and tumor characteristics were not significantly different between the two groups. Blood loss (P = 0.0163) and complication rate (P = 0.0162) were significantly decreased in the MILR group. Complications were observed in eight patients, comprising one patient in the MILR group and seven patients in the OLR group. The postoperative hospital stay was significantly shortened in the MILR group (P = 0.0118). Minimally invasive liver resection might be effective for patients with impaired liver function. It reduces surgical complications and consequently shortens hospitalization time.

Contrast-enhanced ultrasonography of the liver using SonoVue.

This review focuses on the use of contrast-enhanced ultrasonography (CEUS) with SonoVue (Bracco Imaging) for the diagnosis of focal liver lesions (FLLs), guidance during ablative treatment, and follow-up of liver tumors. Multicenter trials have shown that the performance of CEUS for the characterization of FLLs is similar to that of contrast-enhanced computed tomography or contrast-enhanced magnetic resonance imaging. CEUS with SonoVue has been effectively used for guiding the percutaneous treatment of malignant liver tumors that are invisible or poorly visualized in traditional gray-scale ultrasonography. Postprocedural CEUS may be used to detect and retreat residual viable tissue in the same ablative session. The use of CEUS for the assessment of diffuse liver disease is also discussed.

Therapeutic value of 3-D printing template-assisted 125I-seed implantation in the treatment of malignant liver tumors.

ObjectiveTo explore the therapeutic value of 3-D printing template-assisted 125I-seed implantation in the treatment of malignant liver tumors.Materials and methodsFifteen liver cancer patients with 47 total lesions were treated with 3-D printing template-assisted radioactive seed implantation (group A), and 25 liver-tumor patients with 66 total lesions were treated with 125I-seed implantation without a template auxiliary (group B). Operation time, in-hospital time, operation complications, dose distribution, and response rate (number) were compared between the two groups.ResultsShorter operation times and better dose distribution were observed in group A than in group B, and the differences were statistically significant. The response rate after 2 months was 86.7% (13 of 15) in group A and 84% (21 of 25) in group B; differences between the two groups were not significant.ConclusionApplication of 3-D printing template-assisted radioactive seed implantation in the treatment of malignant liver tumors can help shorten operation time and optimize radiation-dose distribution, is worthy of further study, and has clinical significance.

РЕНТГЕНОЭНДОВАСКУЛЯРНАЯ ХИМИОЭМБОЛИЗАЦИЯ ПЕЧЕНОЧНОЙ АРТЕРИИ - СОВРЕМЕННЫЙ МЕТОД РЕГИОНАЛЬНОЙ ХИМИОТЕРАПИИ ЗЛОКАЧЕСТВЕННЫХ ПОРАЖЕНИЙ ПЕЧЕНИ

The paper deals with the review of literature devoted to one of the most important issues of contemporary oncology: treatment of malignant liver tumors. Much attention is paid to the analysis of modern endovascular treatment methods research, namely – transcatheter chemoembolization of the hepatic artery. The morphological and functional bases of chemoembolization are described in detail. The comparison between chemoembolization drugs are noted in the article, too. The results of research are shown. The conclusions about the efficiency that allows achieving positive dynamics and stabilization of the process are drawn.

US-Guide Microwave and Radiofrequency Ablation for Liver Tumors

Hepatocellular carcinoma and hepatic metastases are the common malignancy in Taiwan. Surgical resection remains the reference standard in the treatment of malignant liver tumors; however, a large number of patients have disease that is not amenable to surgical therapy. Therefore, several ablative treatment modalities have been developed for local control of liver tumors in patients with malignant hepatic tumors. Radiofrequency ablation (RFA) is the most frequently used of these methods because of its effectiveness, safety in both percutaneous and surgical settings, and relative ease of use. However, RFA is fundamentally restricted by the need to conduct electric energy into the body. The majority of tissue heating is thus due to thermal conduction, which decreases exponentially away from the source. RFA is most effective in the treatment of the hepatic tumors smaller than 3cm. Using multi-probes with switch-controller RFA system can create a larger ablated area for the malignant tumor and can enhance the therapeutic effect in the treatment of medium size (3 to 5 cm) malignant hepatic tumors. Microwave (MW) ablation offers many of the advantages of RF ablation while possibly overcoming some of the limitations. Since MW ablation does not rely on conduction of electricity into tissue, it is not limited by charring. Therefore, temperatures greater than 100°C are readily achieved, which potentially results in a larger zone of ablation, faster treatment time, and more complete tumor kill. In addition, MW ablation has a much broader power field than does RF ablation. This may allow for larger zones of thermal ablation and a more uniform tumor kill. Because the cooling effect of blood flow is most pronounced within the zone of conductive rather than active heating, a larger power field may also enhance treatment of perivascular tumors. MW ablation and multiple-probes RFA with switch controller are both promising new options in the treatment of malignant hepatic neoplasms.