Therapeutic Results of Resection, Transcatheter Arterial Embolization and Percutaneous Transhepatic Ethanol Injection in 3225 Patients With Hepatocellular Carcinoma: A Retrospective Multicenter Study

Ryu, Munemasa; Shimamura, Yoshiyuki; Kinoshita, Taira; Konishi, Masaru; Kawano, Noriaki; Iwasaki, M.; Furuse, Junji; Matsuo, Yoshino; Moriyama, Noriyuki; Sugita, Minoru

doi:10.1093/jjco/27.4.251

Cited by 115 publications

(69 citation statements)

References 17 publications

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“…According to Ryu et al, PEI was the choice of treatment for clinical stage II patients with tumors smaller than 3 cm. For clinical stage I patients with such small tumors, selective PEI or surgical resection should be considered [11] . In these cases, the outcomes of PEI and surgery were similar but better than TACE.…”

Section: Discussionmentioning

confidence: 99%

CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

Zuo¹,

Wang²,

Shao³

et al. 2004

WJG

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AIM:To explore the feasibility of computed tomography (CT)-guided percutaneous ethanol injection (PEI) using a disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes. METHODS:CT-guided PEI was conducted using a disposable curved needle in 26 malignant liver tumors smaller than 5 cm in diameter and 5 lymph node metastases of liver cancer in the retroperitoneal space. The disposable curved needle was composed of a straight trocar (21G) and stylet, a disposable curved tip (25 G) and a fine stylet. For the tumors found in deep sites and difficult to reach, or for hepatic masses inaccessible to the injection using a straight needle because of portal vein and bile ducts, the straight trocar was used at first to reach the side of the tumor. Then, the disposable curved needle was used via the trocar. When the needle reached the tumor center, appropriate amount of ethanol was injected. For relatively large malignant liver tumors, multi-point injection was carried out for a better distribution of the ethanol injected throughout the masses. The curved needle was also used for treatment of the metastasis in retroperitoneal lymph nodes blocked by blood vessels and inaccessible by the straight needle. RESULTS:All of the 26 liver tumors received 2 or more times of successful PEI, through which ethanol was distributed throughout the whole tumor mass. Effect of the treatment was monitored by contrast-enhanced multi-phase CT and magnetic resonance imaging (MRI) examinations three months later. Of the 18 lesions whose diameters were smaller than 3 cm, the necrotic change across the whole mass and that in most areas were observed in 15 and 3 tumors, respectively. Among the 8 tumors sizing up to 5 cm, 5 were completely necrotic and 3 largely necrotic. Levels of tumor seromarkers were significantly reduced in some of the cases. In 5 patients with metastases of liver cancer in retroperitoneal lymph nodes who received 1 to 3 times of PEI, all the foci treated were completely necrotic and smaller demonstrated by dynamic contrast-enhanced CT or MRI 3 months later.CONCLUSION: CT-guided PEI using a disposable curved needle is effective, time-saving and convenient, providing an alternative therapy for the treatment of malignant liver tumors and their retroperitoneal lymph node metastases.Zuo CJ, Wang PJ, Shao CW, Wang MJ, Tian JM, Xiao Y, Ren FY, Hao XY, Yuan M. CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes.

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Section: Discussionmentioning

confidence: 99%

CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

Zuo¹,

Wang²,

Shao³

et al. 2004

WJG

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“…For those with the same tumor characteristics and poorer hepatic functional reserve, PEI showed better outcome than surgery. 29 Meanwhile, a Japanese nationwide comparative study, which was based on the analysis of comparable patients treated by PEI (n ϭ 4,037) or surgery (n ϭ 8,010) at approximately 800 hospitals, indicated that surgery gave better overall survival than PEI for patients with solitary 2-5 cm tumors at any liver function status. For solitary Յ 2 cm tumors arising from the liver with poor functional reserve, PEI was almost as efficacious as surgery.…”

Section: Discussionmentioning

confidence: 99%

Treatment strategy for small hepatocellular carcinoma: Comparison of long-term results after percutaneous ethanol injection therapy and surgical resection

Yamamoto¹

2001

Hepatology

206

116

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This comparative study was conducted to clarify the efficacy of percutaneous ethanol injection (PEI) and surgical resection in the treatment of small hepatocellular carcinomas (HCC). Thirtynine patients treated by PEI and 58 who underwent hepatic resection for small HCC (smaller than 3 cm and 3 or less in number) during the same period were enrolled. The surgery group included more patients with large and multiple bilobar nodules than the PEI group. The histological differentiation of the treated tumors became worse in the surgery patients than in those treated by PEI. On the other hand, the PEI group included more patients with a poor hepatic reserve, according to ChildPugh grading, the ICG test, and the serum total bilirubin value. The 1-, 3-, and 5-year overall survival rates were almost identical between the 2 cohorts (100%, 82.1%, and 59.0%, respectively, in the PEI group; 96.6%, 84.4%, and 61.5%, respectively, in the surgery group) (P ‫؍‬ .96). During the follow-up period, 33 of 39 (85%) and 41 of 58 (71%) patients developed tumor recurrence after PEI and surgery, respectively. Cumulative 1-, 3-, and 5-year tumor-free survival rates in the PEI group were 63.4%, 30.3%, and 9.7 %, whereas those in the surgery group were 75.5%, 44.7%, and 25.7%, respectively (P ‫؍‬ .10). Our overall findings show that local therapy can achieve an actual 5-year survival rate of around 60% for patients with small HCC with the proper selection of treatment. A prospective randomized comparative trial is required to settle this longstanding issue. (HEPATOLOGY 2001;34:707-713.)Since the surveillance of high-risk populations has been developed, small asymptomatic hepatocellular carcinomas (HCC) have been increasingly recognized, especially in endemic areas like Japan, Southeast Asia, and Southern Europe. [1][2][3][4] The optimal therapeutic strategy for these small HCCs remains to be determined because nonsurgical local ablation, 5-9 chemoembolization, 10 surgery, 11-15 and orthotopic liver transplantation [16][17][18] have all been credited with good results. Surgical resection has generally been accepted as the first treatment of choice for HCC. Percutaneous ethanol injection is one of the most frequently used nonsurgical local ablation therapies. [19][20][21][22][23] The aim of this study was to clarify the efficacy of each therapy as an initial treatment for small HCC (3 or less tumors each 3 cm or smaller) by comparing the clinicopathologic background and post-treatment outcome of patients with this disease who underwent either PEI or surgery during the same period in a single institute. PATIENTS AND METHODSSelection Criteria. In our Hepatobiliary and Pancreatic Surgery division, patients with HCC were diagnosed and treated as shown in Fig. 1. First, the diagnosis and staging of the neoplasm were established by increased alpha-fetoprotein (AFP) levels, ultrasound (US), dynamic computed tomography (CT), and hepatic digital subtraction angiography (DSA) in combination with CT during arteriography or arterioportography. HCC nodule...

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“…No RCTs have demonstrated that surgical resection is superior to percutaneous ablation. In nonrandomized comparative studies, hepatectomy was better than percutaneous ablation in one study [213] whereas others reported no significant difference between the two therapies [310][311][312]. Thus, it is difficult to conclude that surgical resection is the treatment of choice for resectable HCC.…”

Section: Local Ablation Is a First-line Treatment Of Unresectable Smmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. 123Hepatol Int (2010) 4: 439-474 DOI 10.1007/s12072-010-9165-7 Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.

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Therapeutic Results of Resection, Transcatheter Arterial Embolization and Percutaneous Transhepatic Ethanol Injection in 3225 Patients With Hepatocellular Carcinoma: A Retrospective Multicenter Study

Cited by 115 publications

References 17 publications

CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

Treatment strategy for small hepatocellular carcinoma: Comparison of long-term results after percutaneous ethanol injection therapy and surgical resection

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

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