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radiofrequency ablation for hepatic hemangiomas: A consensus from a Chinese panel of experts

World Journal of Gastroenterology 2017年第39期23卷 7077-7086页

作者： Jun Gao Rui-Fang Fan Jia-Yin Yang Yan Cui Jian-Song Ji Kuan-Sheng Ma Xiao-Long Li Long Zhang Chong-Liang Xu Xin-Liang Kong Shan Ke Xue-Mei Ding Shao-Hong Wang Meng-Meng Yang Jin-Jin Song Bo Zhai Chun-Ming Nin Shi-Gang Guo Zong-Hai Xin Jun Lu Yong-Hong Dong Hua-Qiang Zhu Wen-Bing Sun Department of Hepatobiliary Surgery Beijing Chaoyang Hospital Affiliated to Capital Medical University Department of Hepatobiliary Surgery Lanzhou General Hospital of Lanzhou Military Region Center of Liver Transplantation West China Hospital Sichuan University Department of General Surgery the 306th Hospital of Chinese people’s Liberation Army Department of Radiology Lishui Central Hospital The Fifth Affiliated Hospital of Wenzhou Medical College Institute of Hepatobiliary Surgery Southwest Hospital The Third Military Medical University Department of General Surgery Affiliated Hospital of Chifeng University Department of Hepatobiliary Surgery Rizhao People’s Hospital Department of Tumor Intervention Renji Hospital Shanghai Jiao Tong University School of Medicine Department of General Surgery Chaoyang Central Hospital Department of General Surgery Zhanhua People’s Hospital Department of General Surgery Shandong Provincial People’s Hospital Department of General Surgery Shanxi Provincial People’s Hospital

Recent studies have shown that radiofrequency(RF) ablation therapy is a safe, feasible, and effective procedure for hepatic hemangiomas, even huge hepatic hemangiomas. RF ablation has the following advantages in the treatment of hepatic hemangiomas: minimal invasiveness, definite efficacy, high safety, fast recovery, relatively simple operation, and wide applicability. It is necessary to formulate a widely accepted consensus among the experts in China who have extensive expertise and experience in the treatment of hepatic hemangiomas using RF ablation, which is important to standardize the application of RF ablation for the management of hepatic hemangiomas, regarding the selection of patients with suitable indications to receive RF ablation treatment, the technical details of the techniques, therapeutic effect evaluations, management of complications, etc. A final consensus by a Chinese panel of experts who have the expertise of using RF ablation to treat hepatic hemangiomas was reached by means of literature review, comprehensive discussion, and draft approval.

关键词：肝的 hemangiomas radiofrequency 脱离一致

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Rate of local tumor progression following radiofrequency ablation of pathologically early hepatocellular carcinoma

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World Journal of Gastroenterology 2017年第17期23卷 3111-3121页

作者： Yoshiteru Hao Kazushi Numata Tomohiro Ishii Hiroyuki Fukuda Shin Maeda Masayuki Nakano Katsuaki Tanaka Gastroenterological Center Yokohama City University Medical Center Division of Gastroenterology Yokohama City University Graduate School of Medicine Pathological Department Shonan Fujisawa Tokusyukai Hospital

AIM To evaluate whether pathologically early hepatocellular carcinoma(HCC) exhibited local tumor progression after radiofrequency ablation(RFA) less often than typical HCC.METHODS Fifty pathologically early HCCs [tumor diameter(mm): mean, 15.8; range, 10-23; follow-up days after RFA: median, 1213; range, 216-2137] and 187 typical HCCs [tumor diameter(mm): mean, 15.6; range, 6-30; follow-up days after RFA: median, 1116; range, 190-2328] were enrolled in this retrospective study. The presence of stromal invasion(namely, tumor cell invasion into the intratumoral portal tracts) was considered to be the most important pathologic finding for the diagnosis of early HCCs. Typical HCC was defined as the presence of a hyper-vascular lesion accompanied by delayed washout using contrastenhanced computed tomography or contrast-enhanced magnetic resonance imaging. Follow-up examinations were performed at 3-mo intervals to monitor for signs of local tumor progression. The local tumor progression rates of pathologically early HCCs and typical HCCs were then determined using the Kaplan-Meier method.RESULTS During the follow-up period for the 50 pathologically early HCCs, 49(98%) of the nodules did not exhibit local tumor progression. However, 1 nodule(2%) was associated with a local tumor progression found 636 d after RFA. For the 187 typical HCCs, 46(24.6%) of the nodules exhibited local recurrence after RFA. The follow-up period until the local tumor progression of typical HCC was a median of 605 d, ranging from 181 to 1741 d. Among the cases with typical HCCs, local tumor progression had occurred in 7.0%(7/187), 16.0%(30/187), 21.9%(41/187) and 24.6%(46/187) of the cases at 1, 2, 3 and 4 years, respectively. Pathologically early HCC was statistically associated with a lower rate of local tumor progression, compared with typical HCC, when evaluated using a log-rank test(P = 0.002). CONCLUSION The rate of local tumor progression for pathologically early HCCs after RFA was significantly lower than that for typical HCCs.

关键词：早 hepatocellular 癌本地肿瘤前进 radiofrequency 脱离夺格的边缘提高对比的 ultrasonography

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Severe esophageal injury after radiofrequency ablation-a deadly complication

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World Journal of Gastroenterology 2017年第18期23卷 3374-3378页

作者： Nurit Katz-Agranov Moises I Nevah Rubin Department of Internal Medicine The University of Texas Health Science Center at Houston Department of Gastroenterology Hepatology and Nutrition the University of Texas Health Science Center at Houston

Various degrees of esophageal injury have been described after radiofrequency ablation performed for treatment of atrial fibrillation. The main mechanism of injury is thermal and may lead to a range of esophageal mucosal changes, some clinically insignificant, however when deep ulceration occurs, this may be further complicated by perforation and mediastinitis, a rare but life threatening sequelae. We present a case of a severe esophageal injury leading to mediastinitis, with interesting endoscopic findings.

关键词： Atrial 纤维性颤动 radiofrequency 脱离食道的穿孔溃疡 Mediastinitis

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

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World Journal of Radiology 2017年第3期9卷 91-96页

作者： Sergio Sartori Francesca Di Vece Francesca Ermili Paola Tombesi Section of Interventional Ultrasound St Anna Hospital44100 FerraraItaly

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.

关键词： radiofrequency 脱离肝瘤激光脱离微波脱离 Hepatocellular 癌肝转移

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Endoscopy-guided ablation of pancreatic lesions:Technical possibilities and clinical outlook

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World Journal of Gastrointestinal Endoscopy 2017年第2期9卷 41-54页

作者： Marianna Signoretti Roberto Valente Alessandro Repici Gianfranco Delle Fave Gabriele Capurso Silvia Carrara Digestive and Liver Disease Unit S.Andrea HospitalUniversity Sapienza Digestive Endoscopy Unit Division of GastroenterologyHumanitas Research Hospital

Endoscopic ultrasound(EUS) and endoscopic retrograde cholangiopancreatography(ERCP)-guided ablation procedures are emerging as a minimally invasive therapeutic alternative to radiological and surgical treatments for locally advanced pancreatic cancer(LAPC), pancreatic neuroendocrine tumours(PNETs), and pancreatic cystic lesions(PCLs). The advantages of treatment under endoscopic control are the real-time imaging guidance and the possibility to reach a deep target like the pancreas. Currently, radiofrequency probes specifically designed for ERCP or EUS ablation are available as wel as hybrid cryotherm probe combining radiofrequency with cryotechnology. To date, many reports and case series have confirmed the safety and feasibility of that kind of ablation technique in the pancreatic setting.Moreover, EUS-guided fine-needle injection is emerging as a method to deliver ablative and anti-tumoral agents inside the tumuor. Ethanol injection has been proposed mostly for the treatment of PCLs and for symptomatic functioning PNETs, and the use of gemcitabine and paclitaxel is also interesting in this setting. EUS-guided injection of chemical or biological agents including mixed lymphocyte culture, oncolytic viruses, and immature dendritic cells has been investigated for the treatment of LAPC. Data on the long-term efficacy of these approaches,and large prospective randomized studies are needed to confirm the real clinical benefits of these techniques for the management of pancreatic lesions.

关键词：内视镜的脱离 radiofrequency 脱离 Cryoablation 内视镜的指导超声的脱离乙醇白酒脱离 Chemoablation 内视镜的超声胰腺的癌症内视镜后退 cholagiopancreatography 胰腺的膀胱的瘤胰腺的内分泌的瘤

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Local ablative treatments for hepatocellular carcinoma:An updated review

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2016年第4期7卷 477-489页

作者： Antonio Facciorusso Gaetano Serviddio Nicola Muscatiello Gastroenterology Unit Department of Medical and Surgical SciencesUniversity of Foggia Internal Medicine Unit University of Foggia

Ablative treatments currently represent the first-line option for the treatment of early stage unresectable hepatocellular carcinoma(HCC).Furthermore,they are effective as bridging/downstaging therapies before orthotopic liver transplantation.Contraindications based on size,number,and location of nodules are quite variable in literature and strictly dependent on local expertise.Among ablative therapies,radiofrequency ablation(RFA) has gained a pivotal role due to its efficacy,with a reported 5-year survival rate of 40%-70%,and safety.Although survival outcomes are similar to percutaneous ethanol injection,the lower local recurrence rate stands for a wider application of RFA in hepato-oncology.Moreover,RFA seems to be even more cost-effective than liver resection for very early HCC(single nodule ≤ 2 cm) and in the presence of two or three nodules ≤ 3 cm.There is increasing evidence that combining RFA to transarterial chemoembolization may increase the therapeutic benefit in larger HCCs without increasing the major complication rate,but more robust prospective data is still needed to validate these pivotal findings.Among other thermal treatments,microwave ablation(MWA) uses high frequency electromagnetic energy to induce tissue death via coagulation necrosis.In comparison to RFA,MWA has several theoretical advantages such as a broader zone of active heating,higher temperatures within the targeted area in a shorter treatment time and the lack of heatsink effect.The safety concerns raised on the risks of this procedure,due to the broader and less predictable necrosis areas,have been recently overcome.However,whether MWA ability to generate a larger ablation zone will translate into a survival gain remains unknown.Other treatments,such as high-intensity focused ultrasound ablation,laser ablation,and cryoablation,are less investigated but showed promising results in early HCC patients and could be a valuable therapeutic option in the next future.

关键词：肝癌症 Hepatocellular 癌 radiofrequency 脱离微波脱离 radiofrequency 脱离

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Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma

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World Journal of Gastrointestinal Endoscopy 2015年第7期7卷 675-687页

作者： Dushant S Uppal Andrew Y Wang Division of Gastroenterology and Hepatology University of Virginia Health System

Cholangiocarcinoma(CCA) is a malignancy of the bileducts that carries high morbidity and mortality. Patients with CCA typically present with obstructive jaundice, and associated complications of CCA include cholangitis and biliary sepsis. Endoscopic retrograde cholangiopancreatography(ERCP) is a valuable treatment modality for patients with CCA, as it enables internal drainage of blocked bile ducts and hepatic segments by using plastic or metal stents. While there remains debate as to if bilateral(or multi-segmental) hepatic drainage is required and/or superior to unilateral drainage, the underlying tenant of draining any persistently opacified bile ducts is paramount to good ERCP practice and good clinical outcomes. Endoscopic therapy for malignant biliary strictures from CCA has advanced to include ablative therapies via ERCP-directed photodynamic therapy(PDT) or radiofrequency ablation(RFA). While ERCP techniques cannot cure CCA, advancements in the field of ERCP have enabled us to improve upon the quality of life of patients with inoperable and incurable disease. ERCP-directed PDT has been used in lieu of brachytherapy to provide neoadjuvant local tumor control in patients with CCA who are awaiting liver transplantation. Lastly, mounting evidence suggests that palliative ERCP-directed PDT, and probably ERCPdirected RFA as well, offer a survival advantage to patients with this difficult-to-treat malignancy.

关键词：内视镜后退 cholangiopancreatography Cholangiocarcinoma Stents 自我可扩充的金属 stents 光力学的治疗光力学的治疗 radiofrequency 脱离 radiofrequency 脱离

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