Septic Shock and Death after Microwave Ablation of Hepatocellular Carcinoma in a Liver Transplant Patient with a Bilioenteric Anastomosis

Melikian, Raymond; Minocha, Jeet

doi:10.1055/s-0039-1688430

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…Death as a result of MWA is extremely rare. However, in a very recent report in 2019, following MWA of HCC in a liver transplant patient with bilioenteric anastomosis (BEA), death was caused by septic shock [ 100 ]. In a study of complications of percutaneous MWA on 554 patients with various tumor size and types, no deaths were reported, but major complications were reported in 17 (3%) cases [ 101 ].…”

Section: Complications Of Hepatic Microwave Ablationmentioning

confidence: 99%

Percutaneous microwave ablation applications for liver tumors: recommendations for COVID-19 patients

Afaghi

Lapolla

Ghandi

2021

Heliyon

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Microwave ablation (MWA) is an alternative locoregional therapy to surgical resection of solid tumors in the treatment of malignancies, and is widely used for hepatic tumors. It has a slightly higher overall survival (OS) rate compared to external beam radiation therapy (EBRT), and proton beam therapy (PBT), and better long-term recurrence-free OS rate compared to radiofrequency ablation (RFA). In this paper, current commercial devices, most recent noncommercial designs, and the principles behind them alongside the recently reported developments and issues of MWA are reviewed. The paper also provides microscopic insights on effects of microwave irradiation in the body. Our review shows that MWA is a safe and effective, minimally invasive method with high ablation completion rates. However, for large tumors, the completion rates slightly decrease, and recurrences increase. Thus, for large tumors we suggest using a cooled shaft antenna or multiple antenna placements. Comparisons of the two common ablation frequencies 915 MHz and 2.45 GHz have shown inconsistent results due to non-identical conditions. This review suggests that 915 MHz devices are more effective for ablating large tumors and the theory behind MWA effects corroborates this proposition. However, for small tumors or tumors adjacent to vital organs, 2.45 GHz is suggested due to its more localized ablation zone. Among the antenna designs, the double-slot antenna with a metallic choke seems to be more effective by localizing the radiation around the tip of the antenna, while also preventing backward radiation towards the skin. The review also pertains to the use of MWA in COVID-19 patients and risk factors associated with the disease. MWA should be considered for COVID-19 patients with hepatic tumors as a fast treatment with a short recovery time. As liver injury is also a risk due to COVID-19, it is recommended to apply liver function tests to monitor abnormal levels in alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, and other liver function indicators.

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Section: Complications Of Hepatic Microwave Ablationmentioning

confidence: 99%

Percutaneous microwave ablation applications for liver tumors: recommendations for COVID-19 patients

Afaghi

Lapolla

Ghandi

2021

Heliyon

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“…Thermal ablation is often regarded as a simple technique of inserting a needle to "burn" the tumor, without getting much attention to the details, assisting methods and skills. Despite minimal invasion of thermal ablation, its major complication is non-trivial and sometimes may lead to death (16,17). Avoiding major complication by improving the special skill of the operators, therefore, is crucial.…”

Section: Introductionmentioning

confidence: 99%

The Learning Curve for Thermal Ablation of Liver Cancers: 4,363-Session Experience for a Single Central in 18 Years

et al. 2020

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This study aimed to explore the special efforts required to achieve proficiency in performing thermal ablation of liver cancers, including tumors in difficult locations, and clarify the effects of handing-down teaching on the corresponding process. Major complications of patients receiving percutaneous thermal ablation of liver cancer were analyzed. Polynomial fitting was used to describe the connection between major complication rates and special experience. Learning curve of major complications was plotted both for the whole group and for each operator, respectively. Tumors in difficult locations were further studied. A total of 4,363 thermal ablation sessions were included in this study. 143 of 4,363 patients had major complications, corresponding to an incidence rate of 3.27%. 806 thermal ablation sessions were performed for tumors in difficult locations. The major complication rate of these sessions is 6.33%. According to the trend of the learning curve of the 4363 patients, the experience of the whole group can be classified into five stages, that is, the high-risk, relatively stable, unstable, proficient and stable periods. A learning curve for an individual operator can be classified into the highrisk, proficient and stable periods. The major complication rates for the chronologically first, second and third operator of the group are 3.23, 3.35, and 3.31%, respectively. The special experience needed to bypass the first stage corresponds to 410, 510, and 440 sessions, the second stage, 1850, 850, and 870 sessions, by the three operators, respectively. The major complication rates for the tumors in difficult locations for the first, second and third operator were 7.04, 5.53, and 5.98%, respectively. For the tumors in difficult locations, the special experience needed to bypass the first stage corresponds to 150, 130, and 140 sessions, the second stage, 290, 175, and 185 sessions, by the three operators, respectively. In conclusion, the learning process of an operator percutaneous

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Prednisone/tacrolimus

2019

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Septic Shock and Death after Microwave Ablation of Hepatocellular Carcinoma in a Liver Transplant Patient with a Bilioenteric Anastomosis

Cited by 4 publications

References 22 publications

Percutaneous microwave ablation applications for liver tumors: recommendations for COVID-19 patients

Percutaneous microwave ablation applications for liver tumors: recommendations for COVID-19 patients

The Learning Curve for Thermal Ablation of Liver Cancers: 4,363-Session Experience for a Single Central in 18 Years

Prednisone/tacrolimus

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