Percutaneous Navigation under Local Anesthesia for Computed Tomography-Guided Microwave Ablation of Malignant Liver Lesions Located in the Hepatic Dome

Filippiadis, Dimitrios; Velonakis, Georgios; Mazioti, Argyro; Tsochatzis, Athanasios; Vrachliotis, Thomas G.; Kelekis, Alexis; Kelekis, Nikolaos

doi:10.3390/medicina57101056

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…MWA can be also combined with other locoregional therapies such as trans-arterial conventional chemoembolization, as was shown in a retrospective study which reported survival at 6, 12 and 24 months of 88.5%, 69.2% and 61.5%, respectively [48]. Furthermore, stereotactic navigation systems contribute to shortening the duration of ablation sessions by increasing the accuracy of access, even in challenging anatomic locations of the liver or for tumors located in proximity to important vasculature as well as for tumors invisible on ultrasound and CT [74,75]. Thermal ablative therapies (RFA and MWA) display promising potential as treatment modalities for iCCA with satisfactory outcome and good safety profile as was shown in published meta-analyses and systematic reviews [35,66,73] showing pooled technical efficacy of 91.9%, major complications incidence of 5.7% and pooled OS at 1, 3 and 5 years of 82.4%, 42.1% and 28.5%, respectively, with primary tumors showing higher 3-year OS rates than recurrent ones [66].…”

Section: Microwave Ablationmentioning

confidence: 99%

Section: Interventional Ablative Treatment For Iccamentioning

confidence: 99%

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Role of Percutaneous Ablation in the Management of Intrahepatic Cholangiocarcinoma

et al. 2023

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Cholangiocarcinoma (CCA) is an invasive cancer accounting for <1% of all cancers and 10–15% of primary liver cancers. Intrahepatic CCA (iCCA) is associated with poor survival rates and high post-surgical recurrence rates whilst most diagnosed patients are not surgical candidates. There is a growing literature suggesting percutaneous ablative techniques for the management of patients with iCCA measuring ≤3 cm with contraindications to surgery as well as for recurrent or residual tumors aiming to provide local cancer treatment and control. Most used ablative therapies for iCCA include radiofrequency and microwave ablation with irreversible electroporation, cryoablation and reversible electroporation (electrochemotherapy) being less commonly encountered techniques. Due to the infiltrative margins of the lesion, there is a need for larger safety margins and ablation zone; multi-apparatus ablation or other variations of the technique such as balloon-assisted approaches can be utilized aiming to increase size of the zone of necrosis. The present review paper focuses upon the current role of percutaneous ablative techniques for the therapeutic management of iCCA. The purpose of this review is to present the current minimally invasive ablative techniques in the treatment of iCCA, including local control and survival rates.

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Section: Microwave Ablationmentioning

confidence: 99%

Section: Interventional Ablative Treatment For Iccamentioning

confidence: 99%

Role of Percutaneous Ablation in the Management of Intrahepatic Cholangiocarcinoma

et al. 2023

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“…Navigation systems also confirm their reliability when approaching ‘unablatable’ lesions, that are tumours situated in challenging locations (such as near large blood vessels, bile ducts, sub‐diaphragmatic or sub‐capsular regions or next proximity to nearby organs). Filippiadis et al 40 . reported a primary technical efficacy of 93.75% in ablating 16 lesions located at the hepatic dome by using a patient‐mounted device for navigation under local anaesthesia combined with intravenous analgesia.…”

Section: Imaging Guidance and Margin Assessmentmentioning

confidence: 99%

Thermal ablation of hepatocellular carcinoma

Crocetti,

Scalise,

Bozzi

et al. 2023

J Med Imag Rad Onc

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SummaryPercutaneous treatment of hepatocellular carcinoma (HCC) by means of thermal ablation (TA) has been introduced in clinical guidelines as a potentially curative treatment for the early stages of the disease since the early 2000s. Due to its safety profile and cost‐effectiveness, TA can be offered as a first‐line treatment for patients with HCC smaller than 3 cm. Thermal ablative techniques are in fact widely available at many centres worldwide and include radiofrequency (RF) and microwave (MW) ablation, with the latter increasingly applied in clinical practice in the last decade. Pre‐clinical studies highlighted, as potential advantages of MW‐based ablation, the ability to achieve higher temperatures (>100°C) and larger ablation zones in shorter times, with less susceptibility to blood flow‐induced heat sink effects. Despite these advantages, there is no evidence of superior overall survival in patients treated with MW as compared to those treated with RF ablation. Local control has been proven to be superior to MW ablation with a similar complication rate. It is expected that further improvement of TA results in the treatment of HCC will result from the refinement of guidance and monitoring tools and the careful assessment of ablation margins. Thermal ablative treatments may also be performed on nodules larger than 3 cm by applying multiple devices or combining percutaneous and intra‐arterial approaches. The role of novel immunotherapy regimens in combination with ablation is also currently under evaluation in clinical trials, with several potential benefits. In this review, indications, technical principles, results, and future prospects of TA for the treatment of HCC will be examined.

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“…For robotic systems that do not insert automatically (and only guide), the actual insertion of the instruments is performed by the physician, which preserves the haptic experience, allowing for the early detection of incorrect needle positioning. Therefore, utilization of navigation and robotic systems constitutes an attractive option in the management of challenging liver tumors, such as lesions hidden in US or to non-contrast-enhanced CT, large-sized tumors, or tumors located in technically difficult locations, such as in proximity to hepatic venous confluence, diaphragm, hepatic capsule, and heart, among others [ 71 , 72 , 73 , 74 , 75 , 76 ].…”

Section: Clinical Applications and The Literature Evidencementioning

confidence: 99%

Navigation and Robotics in Interventional Oncology: Current Status and Future Roadmap

Charalampopoulos,

Bale,

Filippiadis

et al. 2023

Diagnostics

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Interventional oncology (IO) is the field of Interventional Radiology that provides minimally invasive procedures under imaging guidance for the diagnosis and treatment of malignant tumors. Sophisticated devices can be utilized to increase standardization, accuracy, outcomes, and “repeatability” in performing percutaneous Interventional Oncology techniques. These technologies can reduce variability, reduce human error, and outperform human hand-to-eye coordination and spatial relations, thus potentially normalizing an otherwise broad diversity of IO techniques, impacting simulation, training, navigation, outcomes, and performance, as well as verification of desired minimum ablation margin or other measures of successful procedures. Stereotactic navigation and robotic systems may yield specific advantages, such as the potential to reduce procedure duration and ionizing radiation exposure during the procedure and, at the same time, increase accuracy. Enhanced accuracy, in turn, is linked to improved outcomes in many clinical scenarios. The present review focuses on the current role of percutaneous navigation systems and robotics in diagnostic and therapeutic Interventional Oncology procedures. The currently available alternatives are presented, including their potential impact on clinical practice as reflected in the peer-reviewed medical literature. A review of such data may inform wiser investment of time and resources toward the most impactful IR/IO applications of robotics and navigation to both standardize and address unmet clinical needs.

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Percutaneous Navigation under Local Anesthesia for Computed Tomography-Guided Microwave Ablation of Malignant Liver Lesions Located in the Hepatic Dome

Cited by 5 publications

References 19 publications

Role of Percutaneous Ablation in the Management of Intrahepatic Cholangiocarcinoma

Role of Percutaneous Ablation in the Management of Intrahepatic Cholangiocarcinoma

Thermal ablation of hepatocellular carcinoma

Navigation and Robotics in Interventional Oncology: Current Status and Future Roadmap

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