Importance of eliminating portal flow to produce large intrahepatic lesions with interstitial laser coagulation

Heisterkamp, Joos; Hillegersberg, Richard van; Mulder, Paul; Sinofsky, Ed; Ijzermans, J. N. M.

doi:10.1002/bjs.1800840914

Cited by 55 publications

(32 citation statements)

References 19 publications

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“…However, further research in this field is needed to elucidate (a) the exact correlation between histopathologic structure and laser energy and (b) the correlation between hepatic blood flow and the actual extent of the area of necrosis (46). …”

Section: Discussionmentioning

confidence: 99%

Laser Thermal Ablation in the Treatment of Small Hepatocellular Carcinoma: Results in 74 Patients

Pacella¹,

Bizzarri²,

Magnolfi³

et al. 2001

Radiology

149

100

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PURPOSE: To evaluate the safety, local effectiveness, and long-term results of laser\ud thermal ablation (LTA) in the treatment of small hepatocellular carcinoma (HCC).\ud MATERIALS AND METHODS: Ninety-two biopsies proved small HCCs (range,\ud 0.8–4.0 cm) in 74 patients who were treated percutaneously with LTA in an\ud outpatient clinic. A laser at a power of 5.0Wwas coupled with one to four fibers that\ud were advanced through 21-gauge needle(s) for 6–12 minutes. All lesions were\ud evaluated with computed tomography (CT) for changes in size and vascular pattern,\ud recurrence rates, and cumulative survival rates. Patients were examined for complications.\ud RESULTS: No major complications occurred in 117 LTA sessions, with an average of\ud 1.3 sessions per tumor. At 3 months, CT scans showed a nonenhancing area\ud (complete necrosis) in 89 (97%) of 92 lesions. During follow-up (range, 6–66\ud months; mean, 25.3 months), 84 tumors (91%) decreased in size. The local recurrence\ud rates (range, 1–5 years) ranged from 1.6% to 6.0%. Recurrence rates (range,\ud 12–60 months) in other liver segments ranged from 24% to 73%. Cancer-free\ud survival rates (range, 1–4 years) ranged from 73% to 24%. Overall survival rates\ud were 99%, 68%, and 15% at 1, 3, and 5 years, respectively. Twenty-one patients\ud (28%) died.\ud CONCLUSION: LTA is a safe and effective treatment for small HCC

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Section: Discussionmentioning

confidence: 99%

Laser Thermal Ablation in the Treatment of Small Hepatocellular Carcinoma: Results in 74 Patients

Pacella¹,

Bizzarri²,

Magnolfi³

et al. 2001

Radiology

149

100

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“…During local ablation, the Pringle manoeuvre is chosen by the majority of surgeons. Portal clamping, which is applied by 4% of surgeons, may be advantageous in thermal destruction techniques, as it provides an increase in lesion size, but minimizes ischaemic damage [10, 24]. By those who clamp routinely during local ablation, intermittent clamping is favoured, corresponding to ischaemia times of 15–30 min, whereas for the majority of surgeons who clamp on indication, a shorter continuous Pringle manoeuvre seems to be preferable.…”

Section: Discussionmentioning

confidence: 99%

“…For non-resectable liver tumours thermal destruction techniques, such as radiofrequency ablation, laser-induced thermotherapy and microwave therapy, provide local tumour control and improve life expectancy [7,8,9]. During thermal ablation, vascular clamping is advised to reduce dissipation of the generated heat, which creates larger destruction volumes, resulting in greater tumour-free margins [10,11,12]. …”

Section: Introductionmentioning

confidence: 99%

European Survey on the Application of Vascular Clamping in Liver Surgery

et al. 2007

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Background: This study evaluated the frequency, the indications and techniques of vascular clamping during liver resection and during thermal destruction therapies, as currently used by hepatic surgeons throughout Europe. Methods: A web-based questionnaire was distributed among 621 physicians, including all members of the European Hepato-Pancreato-Biliary Association and the European Surgical Association. Results: The overall response rate was 50%. During liver resection, vascular clamping is never applied by 10%, on indication by 71%, and routinely by 19%. Routine clamping is particularly performed by high-volume and senior surgeons and appears to be associated with longer ischaemia times. Intermittent inflow occlusion is the clamping method of choice for more than 65% of surgeons and total ischaemia times are usually limited to 15–30 min. During thermal ablation, vascular clamping is never used by 57%, on indication by 37%, and routinely by 7%; it is particularly applied for large tumours and for tumours close to large vessels, and ischaemia times are shorter. Conclusions: Vascular clamping during liver resection is frequently used; during thermal ablation it is preserved for larger tumours or tumours in the vicinity of large vessels. Complete inflow occlusion is the most frequently used technique, with a distinct preference for intermittent clamping.

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“…8 -10 During local ablation, vascular clamping is applied to increase destruction volumes. 11,12 However, vascular clamping induces ischemia/reperfusion (I/R) injury to the liver parenchyma and may contribute to postoperative morbidity. [13][14][15] Moreover, we have recently demonstrated that the outgrowth of pre-established micrometastases was strongly stimulated after I/R in a murine model.…”

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confidence: 99%

Perinecrotic Hypoxia Contributes to Ischemia/Reperfusion-Accelerated Outgrowth of Colorectal Micrometastases

Bilt

Soeters

Duyverman

et al. 2007

The American Journal of Pathology

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Importance of eliminating portal flow to produce large intrahepatic lesions with interstitial laser coagulation

Abstract: Hepatic blood flow substantially reduces the size of the lesion produced by laser coagulation. Portal flow should therefore be occluded during laser treatment to produce lesions of clinically relevant dimensions.

Cited by 55 publications

References 19 publications

Laser Thermal Ablation in the Treatment of Small Hepatocellular Carcinoma: Results in 74 Patients

Laser Thermal Ablation in the Treatment of Small Hepatocellular Carcinoma: Results in 74 Patients

European Survey on the Application of Vascular Clamping in Liver Surgery

Perinecrotic Hypoxia Contributes to Ischemia/Reperfusion-Accelerated Outgrowth of Colorectal Micrometastases

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