Combined transarterial iodized oil injection and computed tomography-guided thermal ablation for hepatocellular carcinoma: utility of the iodized oil retention pattern

Abstract

Purpose To investigate whether the iodized oil (Lipiodol, Guerbet Group, Villepinte, France) retention pattern influences the treatment efficacy of combined transarterial Lipiodol injection (TLI) and thermal ablation in patients with hepatocellular carcinoma (HCC). Methods Data of 198 patients (280 HCC lesions), who underwent TLI plus computed tomography (CT)-guided thermal ablation at three separate medical institutions between June 2014 and September 2020, were reviewed and analyzed. The Lipiodol retention pattern was classified as complete or incomplete based on non-enhanced CT at the time of ablation. The primary outcome was local recurrence-free survival (LRFS) for lesions; the secondary outcome was overall survival (OS) for patients. Propensity score matching (PSM) was performed using a caliper width of 0.1 between the two groups. Differences in LRFS and OS between the two groups were compared using the log-rank test. Results A total of 133 lesions exhibited a complete Lipiodol retention pattern, while 147 exhibited an incomplete pattern. After PSM analysis of baseline characteristics of the lesions, 121 pairs of lesions were matched. LRFS was significantly longer for lesions exhibiting complete retention than for those exhibiting incomplete retention (P = 0.030). After PSM analysis of patient baseline characteristics, 74 pairs of patients were matched. There was no significant difference in OS between the two groups (P = 0.456). Conclusion Lipiodol retention patterns may influence the treatment efficacy of combined TLI and thermal ablation for HCC lesions. However, a survival benefit for the Lipiodol retention pattern among HCC patients was not observed and needs further confirmation.

Local anaesthesia vs. general anaesthesia for percutaneous microwave ablation in hepatocellular carcinoma: efficacy, safety, and cost analysis

“…According to the lipiodol label, the ablation antenna could be inserted through the centre of HCC lesions in most cases regardless of the anaesthesia modality. Moreover, TACE before MWA could diminish the blood flow into the lesions and enhance the power of thermal ablation, thus improving the treatment efficacy of the following MWA ( 25 ).…”

“…The possible reason for this discrepancy may be that all the HCC lesions enrolled in our study were treated by MWA, and the MWA procedure could create high-temperature heating and lack of heat sink effects ( 27 , 28 ). Moreover, lipiodol deposited in the HCC lesions, as aforementioned, could diminish hepatic artery inflow and reduce the “heat-sink” effect, thus enhancing the efficacy of subsequent ablation ( 25 , 29 ).…”

Local Anesthesia vs. General Anesthesia for Percutaneous Microwave Ablation in Hepatocellular Carcinoma, an Efficacy, Safety, and Cost Analysis

“…According to the lipiodol label, ablation antenna could be inserted through the center of HCC lesions in most cases regardless of the anesthesia modality. Moreover, TACE before MWA could diminish the blood ow into the lesions and enhance the power of thermal ablation, thus improving the treatment e cacy of the following MWA [25].…”

“…The possible reason for this discrepancy may be that HCC lesions enrolled in our study were all treated by MWA, and the MWA procedure could create high-temperature heating and lack of heat sink effects [26,27]. Moreover, lipiodol deposited in the HCC lesions, as aforementioned, could diminish the hepatic artery in ow and reduce the "heat-sink" effect, thus enhancing the e cacy of subsequent ablation [25,28].…”

Local Anesthesia vs. General Anesthesia for Percutaneous Microwave Ablation in Hepatocellular Carcinoma, an Efficacy, Safety, and Cost Analysis

“…The possible reason for this discrepancy may be that HCC lesions enrolled in our study were all treated by MWA, and the MWA procedure could create high-temperature heating and lack of heat sink effects [26,27]. Moreover, lipiodol deposited in the HCC lesions, as aforementioned, could diminish the hepatic artery in ow and reduce the "heat-sink" effect, thus enhancing the e cacy of subsequent ablation [25,28]. Subcapsular location is challenging for percutaneous ablation due to the di culty of accurate insertion of the ablation needle and obtaining enough ablative margin along the hepatic capsule.…”