Major complications after radiofrequency ablation for liver tumors: Analysis of 255 patients

Kong, Wencheng; Zhang, Weiwei; Qiu, Yudong; Zhou, Tong; Qiu, Junlan; Zhang, Wei; Ding, Yi-Tao

doi:10.3748/wjg.15.2651

Cited by 91 publications

(72 citation statements)

References 29 publications

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“…Mortality related to the procedure is low, reported in the literature to be less than 1% [7][8][9] . Tumor type, type of approach, number of lesions, tumor localization, underlying hepatic disease, the physician's experience, associated hepatic resection and lesion size have been described as factors significantly associated with complications [9][10][11][12] . In one of their papers, Poon et al [10] concluded that after the physician's first 50 procedures, the incidence of complications is lower, as well as a shorter hospital stay and higher complete ablation rate.…”

Section: Topic Highlightmentioning

confidence: 99%

“…This group of complications consists of hepatic abscess, wound infection and sepsis. Hepatic abscess is a potentially dangerous complication with an incidence ranging in the literature from 0.3% to 1.7% [6,9,11,12,[21][22][23] . It can appear up to more than 60 d after the procedure [23] .…”

Section: Infectionmentioning

confidence: 99%

“…Patients who have undergone previous hepatectomy are also at risk for this complication [14] . Its incidence ranges from 0.2% to 4.3% [4,9,11,12] . Child Pugh classification has been significantly related to post treatment liver failure [4,11] .…”

Section: Liver Failurementioning

confidence: 99%

“…Its incidence ranges from 0.2% to 4.3% [4,9,11,12] . Child Pugh classification has been significantly related to post treatment liver failure [4,11] . Hepatic infarction due to injuries to major feeding vessels is believed to be responsible for its occurrence.…”

Section: Liver Failurementioning

confidence: 99%

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Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors

Fonseca

Santin

Gomes

et al. 2014

WJH

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Radiofrequency ablation (RFA) has become an important option in the therapy of primary and secondary hepatic tumors. Surgical resection is still the best treatment option, but only a few of these patients are candidates for surgery: multilobar disease, insufficient liver reserve that will lead to liver failure after resection, extra-hepatic disease, proximity to major bile ducts and vessels, and co-morbidities. RFA has a low mortality and morbidity rate and is considered to be safe. Thus, complications occur and vary widely in the literature. Complications are caused by thermal damage, direct needle injury, infection and the patient's co-morbidities. Tumor type, type of approach, number of lesions, tumor localization, underlying hepatic disease, the physician's experience, associated hepatic resection and lesion size have been described as factors significantly associated with complications. The physician in charge should promptly recognize high-risk patients more susceptible to complications, perform a close post procedure follow-up and manage them early and adequately if they occur. We aim to describe complications from RFA of hepatic tumors and their risk factors, as well as a few techniques to avoid them. This way, others can decrease their morbidity rates with better outcomes.

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Section: Topic Highlightmentioning

confidence: 99%

Section: Infectionmentioning

confidence: 99%

Section: Liver Failurementioning

confidence: 99%

Section: Liver Failurementioning

confidence: 99%

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Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors

Fonseca

Santin

Gomes

et al. 2014

WJH

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“…It is unclear if this alteration also affects the efficacy of intra-arterial therapies. Additionally, liver reserve may be more tenuous in the setting of large hepatic ablations [5,6].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Locoregional Tumor Therapy for Patients with Hepatocellular Carcinoma and Transjugular Intrahepatic Portosystemic Shunts

Padia

Chewning

Kogut

et al. 2014

Cardiovasc Intervent Radiol

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Purpose Locoregional therapy for hepatocellular carcinoma (HCC) can be challenging in patients with a transjugular intrahepatic portosystemic shunt (TIPS). This study compares safety and imaging response of ablation, chemoembolization, radioembolization, and supportive care in patients with both TIPS and HCC. Methods This retrospective study included 48 patients who had both a TIPS and a diagnosis of HCC. Twenty-nine of 48 (60 %) underwent treatment for HCC, and 19/48 (40 %) received best supportive care (i.e., symptomatic management only). While etiology of cirrhosis and indication for TIPS were similar between the two groups, treated patients had better baseline liver function (34 vs. 67 % Child-Pugh class C). Tumor characteristics were similar between the two groups. A total of 39 ablations, 17 chemoembolizations, and 10 yttrium-90 radioembolizations were performed on 29 patients.Results Ablation procedures resulted in low rates of hepatotoxicity and clinical toxicity. Post-embolization/ ablation syndrome occurred more frequently in patients undergoing chemoembolization than ablation (47 vs. 15 %). Significant hepatic dysfunction occurred more frequently in the chemoembolization group than the ablation group. Follow-up imaging response showed objective response in 100 % of ablation procedures, 67 % of radioembolization procedures, and 50 % of chemoembolization procedures (p = 0.001). When censored for OLT, patients undergoing treatment survived longer than patients receiving supportive care (2273 v. 439 days, p = 0.001). Conclusions Ablation appears to be safe and efficacious for HCC in patients with TIPS. Catheter-based approaches are associated with potential increased toxicity in this patient population. Chemoembolization appears to be associated with increased toxicity compared to radioembolization.

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Imaging review of hepatocellular carcinoma after thermal ablation: The good, the bad, and the ugly

Bouda

Lagadec

Alba

et al. 2016

Magnetic Resonance Imaging

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Image-guided thermal ablation is a well-established locoregional technique for the treatment of hepatocellular carcinoma (HCC). HCC surveillance programs have led to an increase in the number of patients diagnosed at an early stage of the disease who are eligible for thermal ablation. Tumor response is assessed on imaging and requires extensive follow-up; thus, radiologists play a key role in defining the technical success and efficacy of treatment as well as identifying progressive disease. Although they are rare, complications, such as secondary infections, must also be identified. Several contrast-enhanced imaging techniques can be used at different postprocedural timepoints but magnetic resonance imaging (MRI) and computed tomography (CT), which allow both liver-centered and whole-body imaging are the cornerstones of follow-up. This review describes the imaging features of HCC following thermal ablation. After describing the basic technical elements of follow-up imaging, imaging findings are divided into three groups: normal and expected features (the good), abnormal features, uncontrolled disease, and complications (the bad), and atypical or rare presentations (the ugly). J. Magn. Reson. Imaging 2016;44:1070-1090.

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Major complications after radiofrequency ablation for liver tumors: Analysis of 255 patients

Cited by 91 publications

References 29 publications

Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors

Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors

Outcomes of Locoregional Tumor Therapy for Patients with Hepatocellular Carcinoma and Transjugular Intrahepatic Portosystemic Shunts

Imaging review of hepatocellular carcinoma after thermal ablation: The good, the bad, and the ugly

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