Percutaneous Ablation of Hepatic Tumors at the Hepatocaval Confluence Using Irreversible Electroporation: A Preliminary Study

Abstract

Background: Tumors at the hepatocaval confluence are difficult to treat, either surgically or ablatively. Methods: A retrospective longitudinal study on patients ineligible for thermal ablation who underwent computed tomography-guided IRE for hepatic tumors at the hepatocaval confluence was conducted. Factors analyzed included patient and tumor characteristics, IRE procedure details, treatment-related complications, and prognosis. Results: Between 2017 and 2021, 21 patients at our institute received percutaneous IRE. Of the 38 lesions, 21 were at the hepatocaval confluence. Complete ablation was achieved in all cases. Local and distant recurrence was observed in 4.8% (1/21) and 42.6% (9/21) of the ablated tumors, respectively. All postcava remained perfused at follow-up, except for 1 (4.8%) hepatic vein near the lesion found to be temporarily occluded and restored within 1 month. The ratio of the maximum diameter of ablation area at 1, 3, and 6 months post procedure compared to that immediately after IRE was 0.68 (0.50–0.84), 0.49 (0.27–0.61), and 0.38 (0.25–0.59), respectively. Progression-free survival of the patients with recurrence was 121 (range, 25–566) days. Four (19.0%) patients died at the end of follow-up with median overall survival of 451.5 (range, 25–716) days. Conclusions: IRE could be a safe and effective treatment for hepatic tumors at the hepatocaval confluence. This article provides valuable prognostic data; further clinical research is needed for better prognosis.

Threatment Strategies for Recurrent Hepatocellular Carcinoma Patients: Ablation and its Combination Patterns

“…With the exception of 1 hepatic vein located near the lesion that was temporarily occluded and recovered within 1 month, all postcava remained perfused with PFS of 121 days and mOS of 451.5 days. These results suggest that IRE can safely and effectively treat HCC at the hepatocaval confluence 59 .…”

Pulsed Electric Fields in Oncology: A Snapshot of Current Clinical Practices and Research Directions from the 4th World Congress of Electroporation

“…A range of complications can occur when delivering IRE to the liver. These vary from minor side effects such as mild pain and fever [ 90 ] to major complications such as hydrothorax [ 90 ], pneumothorax, and brachial plexus injuries [ 91 ]. The overall complication rate is 23.7% from collective data, with severe adverse events arising in 6.9% of cases [ 78 ].…”

Irreversible electroporation and electrochemotherapy in oncology: State of the art

“…After the first study by Thomson et al that described IRE ablation of liver tumors [18], several reports have suggested IRE as a useful ablation modality for hepatic malignancies adjacent to major blood vessels and/or the biliary tree, where thermal ablation techniques are associated with risk of complications and heating effect [19] [20,21], [22]. In a meta-analysis including nine studies and 300 patients undergoing IRE for liver tumors, major complications were reported in seven patients including four hepatic abscesses, one bile duct dilatation, one arrhythmia, and one portal vein thrombosis [23].…”