Laparoscopic thermal ablation of hepatic neuroendocrine tumor metastases

Siperstein, Allan; Rogers, Stanley J.; Hansen, Paul; Gitomirsky, Alexis

doi:10.1016/s0039-6060(97)90221-x

Cited by 239 publications

(130 citation statements)

References 14 publications

Supporting

Mentioning

122

Contrasting

Unclassified

Order By: Relevance

“…1 However, newer surgical modalities, including cryoablation [2][3][4][5][6] and radiofrequency ablation (RFA), [7][8][9] have been introduced to treat patients with unresectable tumors. Cryoablation involves the circulation of liquid nitrogen through metallic probes placed into the center of the tumor or on the liver surface, inducing cell death by a variety of mechanisms, including internal freezing, solute-solvent shifts, and small vessel obliteration.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, similar systemic complications have not been noted when RFA has been used for tumor ablation. 7,8 Because technology limitations of most available RFA systems allow ablation of liver tumor volumes of no more than 3 cm in maximum diameter, it has been unclear whether RFA is a safer method of ablation or whether the minimal reported side effects have been related to the small volume of treatment.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hepatic Cryoablation, But Not Radiofrequency Ablation, Results in Lung Inflammation

Chapman

Debelak²,

Pinson³

et al. 2000

Annals of Surgery

111

View full text Add to dashboard Cite

ObjectiveTo compare the effects of 35% hepatic cryoablation with a similar degree of radiofrequency ablation (RFA) on lung inflammation, nuclear factor B (NF-B) activation, and production of NF-B dependent cytokines. Summary Background DataMultisystem injury, including acute lung injury, is a severe complication associated with hepatic cryoablation of 30% to 35% or more of liver parenchyma, but this complication has not been reported with RFA. MethodsSprague-Dawley rats underwent 35% hepatic cryoablation or RFA and were killed at 1, 2, and 6 hours. Liver and lung tissue were freeze-clamped for measurement of NF-B activation, which was detected by electrophoretic mobility shift assay. Serum concentrations of tumor necrosis factor ␣ and macrophage inflammatory protein 2 were measured by enzyme-linked immunosorbent assay. Histologic studies of pulmonary tissue and electron microscopy of ablated liver tissue were compared among treatment groups. ResultsHistologic lung sections after cryoablation showed multiple foci of perivenular inflammation, with activated lymphocytes, foamy macrophages, and neutrophils. In animals undergoing RFA, inflammatory foci were not present. NF-B activation was detected at 1 hour in both liver and lung tissue samples of animals undergoing cryoablation but not after RFA, and serum cytokine levels were significantly elevated in cryoablation versus RFA animals. Electron microscopy of cryoablationtreated liver tissue demonstrated disruption of the hepatocyte plasma membrane with extension of intact hepatocyte organelles into the space of Disse; RFA-treated liver tissue demonstrated coagulative destruction of hepatocyte organelles within an intact plasma membrane. To determine the stimulus for systemic inflammation, rats treated with cryoablation had either immediate resection of the ablated segment or delayed resection after a 15-minute thawing interval. Immediate resection of the cryoablated liver tissue prevented NF-B activation and lung injury; however, pulmonary inflammatory changes were present when as little as a 15-minute thaw interval preceded hepatic resection. ConclusionsHepatic cryoablation, but not RFA, induces NF-B activation in the nonablated liver and lung and is associated with acute lung injury. Lung inflammation is associated with the thawing phase of cryoablation and may be related to soluble mediator(s) released from the cryoablated tissue. These findings correlate the clinical observation of an increased incidence of multisystem injury, including adult respiratory distress syndrome (ARDS), after cryoablation but not RFA.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hepatic Cryoablation, But Not Radiofrequency Ablation, Results in Lung Inflammation

Chapman

Debelak²,

Pinson³

et al. 2000

Annals of Surgery

111

View full text Add to dashboard Cite

show abstract

“…If distant metastases are found, there is no indication for surgical intervention unless the patient develops diarrhea, for which tumor debulking may be beneficial. Unfortunately, standard chemotherapeutic regimens have not proven beneficial in patients with metastatic MTC (112)(113)(114), and the tumors are not very sensitive to x-ray or thermal radiation therapy (115,116). Above all it should be remembered that some patients with substantial burdens of metastatic MTC can remain asymptomatic and live for many years.…”

Section: Mtc In Men2mentioning

confidence: 99%

CONSENSUS: Guidelines for Diagnosis and Therapy of MEN Type 1 and Type 2

Brandi¹,

Gagel²,

Angeli³

et al. 2001

The Journal of Clinical Endocrinology & Metabolism

1,462

445

View full text Add to dashboard Cite

“…The use of radiofrequency (RF) energy to produce thermal tissue destruction has been the focus of increasing research and practice for the past several years [16][17][18][19]. During the application of RF energy, a high frequency alternating current moves from the tip of an electrode into the tissue surrounding that electrode.…”

Section: Background and Basics Of Radiofrequency Tissue Ablationmentioning

confidence: 99%

“…Our group uses a laparoscopic approach for patients with no prior history of extensive abdominal operations, and one or two liver tumors <4.0 cm in diameter located centrally in the liver near major intrahepatic blood vessels. Laparoscopic RFA has also been described to treat patients with symptomatic, i.e., hormone-releasing, neuroendocrine tumor liver metastases [16].…”

Section: Rfa Treatment Approachesmentioning

confidence: 99%

Radiofrequency Ablation of Malignant Liver Tumors

2001

View full text Add to dashboard Cite

The majority of patients with primary or metastatic hepatic tumors are not candidates for resection because of tumor size, location near major intrahepatic blood vessels precluding a margin-negative resection, multifocality, or inadequate hepatic function related to coexistent cirrhosis. Radiofrequency ablation (RFA) is an evolving technology being used to treat patients with unresectable primary and metastatic hepatic cancers. RFA produces coagulative necrosis of tumor through local tissue heating. Liver tumors are treated percutaneously, laparoscopically, or during laparotomy using ultrasonography to identify tumors and guide placement of the RFA needle electrode. For tumors smaller than 2.0 cm in diameter, one or two deployments of the monopolar multiple array needle electrode are sufficient to produce complete coagulative necrosis of the tumor. However, with increasing size of the tumor, there is a concomitant increase in the number of deployments of the needle electrode and the overall time necessary to produce complete coagulative necrosis of the tumor. In general, RFA is a safe, well-tolerated, effective treatment for unresectable hepatic malignancies less than 6.0 cm in diameter. Effective treatment of larger tumors awaits the development of more powerful, larger array monopolar and bipolar RFA technologies.

show abstract

Laparoscopic thermal ablation of hepatic neuroendocrine tumor metastases

Cited by 239 publications

References 14 publications

Hepatic Cryoablation, But Not Radiofrequency Ablation, Results in Lung Inflammation

Hepatic Cryoablation, But Not Radiofrequency Ablation, Results in Lung Inflammation

CONSENSUS: Guidelines for Diagnosis and Therapy of MEN Type 1 and Type 2

Radiofrequency Ablation of Malignant Liver Tumors

Contact Info

Product

Resources

About