Rescue radiofrequency ablation or percutaneous ethanol injection: a strategy for failed RALPPS stage-1 in patients with cirrhosis-related hepatocellular carcinoma

Abstract

Background The future liver remnant (FLR) faces a risk of poor growth in patients with cirrhosis-related hepatocellular carcinoma (HCC) after stage-1 radiofrequency-assisted ALPPS (RALPPS). The present study presents a strategy to trigger further FLR growth using supplementary radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI). Methods At RALPPS stage-1 the portal vein branch was ligated, followed by intraoperative RFA creating a coagulated avascular area between the FLR and the deportalized lobes. During the interstage period, patients not achieving sufficient liver size (≥ 40%) within 2–3 weeks underwent additional percutaneous RFA/PEI of the deportalized lobes (rescue RFA/PEI) in an attempt to further stimulate FLR growth. Results Seven patients underwent rescue RFA/PEI after RALPPS stage-1. In total five RFAs and eight PEIs were applied in these patients. The kinetic growth rate (KGR) was highest the first week after RALPPS stage-1 (10%, range − 1% to 15%), and then dropped to 1.5% (0–9%) in the second week (p < 0.05). With rescue RFA/PEI applied, KGR increased significantly to 4% (2–5%) compared with that before the rescue procedures (p < 0.05). Five patients proceeded to RALPPS stage-2. Two patients failed: In one patient the FLR remained at a constant level even after four rescue PEIs. The other patient developed metastasis. Except one patient died after RALPPS stage-2, no severe complications (Clavien-Dindo ≥ IIIb) occurred among remaining six patients. Conclusions Rescue RFA/PEI may provide an alternative to trigger further growth of the FLR in patients with cirrhosis-related HCC showing insufficient FLR after RALPPS stage-1. Trial registration Retrospectively registered.

Non-Thermal Liver Ablation: Existing and New Technology

“…A 2022 study of 107 patients with large HCC lesions found that transarterial ethanol ablation (TEA) had significantly better tumor response and OS, with the average OS being 21.6 months compared with 9.9 months for historical cohort of TACE and TARE. [24][25][26] Tumor size has been found to be very significant in response to PEI with the best responses for lesions < 5 cm, ideally <3 cm. 27,28 For those patients who are candidates for PEI, a 2020 study demonstrated success in further modulating the localization of the ethanol injection with the use of ethyl cellulose (EC).…”

Treatment of hepatocellular carcinoma with autologous platelets encapsulating sorafenib or lenvatinib: A novel therapy exploiting tumor‐platelet interactions

“…Surgical hepatectomy, percutaneous ethanol injection, percutaneous radiofrequency ablation and hepatic artery chemoembolization are the primary treatment modalities for relatively small HCC tumors, but not diffuse or multiple tumors, and the liver has sufficient reserve capacity. [23][24][25] However, patients with multiple, large tumors or metastases are eligible for systemic chemotherapy. 26 In conventional chemotherapy, hepatocytes detoxify the drug, which reduces the drug efficiency for HCC.…”