Malignant liver tumors, including primary malignant liver tumors and liver metastases, are among the most frequent malignancies worldwide. The disease carries a poor prognosis and poor overall ...survival, particularly in cases involving liver metastases. Consequently, the early detection and precise differentiation of malignant liver tumors are of paramount importance for making informed decisions regarding patient treatment. Significant research efforts are currently directed towards the development of diagnostic tools for different types of cancer using minimally invasive techniques. A prominent area of focus within this research is the evaluation of circulating microRNA, for which dysregulated expression is well documented in different cancers. Combining microRNAs in panels using serum or plasma samples derived from blood holds great promise for better sensitivity and specificity for detection of certain types of cancer.
Malignant liver tumors include primary malignant liver tumors and liver metastases. They are among the most common malignancies worldwide. The disease has a poor prognosis and poor overall survival, ...especially with liver metastases. Therefore, early detection and differentiation between malignant liver tumors are critical for patient treatment selection. The detection of cancer and the prediction of its origin is possible with a DNA methylation profile of the tumor DNA compared to that of normal cells, which reflects tissue differentiation and malignant transformation. New technologies enable the characterization of the tumor methylome in circulating tumor DNA (ctDNA), providing a variety of new ctDNA methylation biomarkers, which can provide additional information to clinical decision-making. Our review of the literature provides insight into methylation changes in ctDNA from patients with common malignant liver tumors and can serve as a starting point for further research.
Purpose Liver abscess is a rare and serious complication after transarterial chemoembolization (TACE) for liver cancer; however, its impact on the prognosis is unclear. This retrospective study ...examined the outcomes of patients with liver abscess formation following TACE for malignant liver tumors to elucidate the impact of liver abscess formation on the prognosis of these patients. Methods From January 2017 to January 2022, 1,387 patients with malignant tumors underwent 3,341 sessions of TACE at our hospital. Clinical characteristics of patients at baseline and follow-up were examined, including treatment and outcome of liver abscess, tumor response to the TACE leading to liver abscess, and overall survival time. Results Of 1,387 patients, 15 (1.1%) patients with liver abscess complications after TACE resulted in a total of 16 (0.5%) cases of liver abscess after 3,341 TACE sessions (including one patient with two events). After antibiotic or percutaneous catheter drainage (PCD) treatment, all the infections associated with liver abscesses were controlled. In the PCD group, eight patients died before drainage tube removal, one retained the drainage tube until the end of follow-up, and five underwent drainage tube removal; the mean drainage tube removal time was 149.17 ± 134.19 days. The efficacy of TACE leading to liver abscess was evaluated as partial response (18.75%), stable disease (37.5%), and progressive disease (43.75%). Eleven patients died during the follow-up period owing to causes unrelated to infections caused by liver abscesses. The survival rates at 3 months, 6 months, 1 year, and 5 years were 86.7%, 50.9%, 25.5%, and 17%, respectively. Conclusion Patients with liver abscess formation following TACE for malignant liver tumors experienced prolonged drainage tube removal time after PCD; while this condition did not directly cause death, it indirectly contributed to a poor prognosis in these patients.
Purpose: Laparoscopic liver resection is safe, feasible and associated with less blood loss, shorter hospital stays and fewer postoperative complications in the working age patients with malignant ...liver tumors. However, it is still unclear if the elderly patients with malignant liver tumors would also benefit from that approach as the younger patients. So, the aim of the study was to compare the clinical outcomes of laparoscopic versus open liver resection for malignant liver tumors in elderly patients. Materials and Methods: Between March 2009 and July 2016, all elderly patients (≥70 years old) who underwent laparoscopic (n = 40) and open (n = 202) liver resection for malignant liver tumors were included. A one to one propensity score matching analysis was performed, based on 6 covariates, to decrease the selection bias. Results: There was no significant difference between the laparoscopic and open liver resection groups regarding the patient characteristics and tumor features. The operative time was comparable between both groups (Laparoscopic group 259 min vs Open group 308 min, p = .86), while patients who underwent laparoscopic liver resection had lower intraoperative blood loss (30 ml vs 517 ml, p < .0001), shorter hospital stays (10 days vs 23 days, p < .0001), and less overall morbidity (15% vs 38%, p = .04). The one-, three-, and five-year survival for patients with hepatocellular carcinoma was comparable between both groups (Laparoscopic group 96%, 74%, 47%, vs Open group 94%, 71%, 48%, p = .82), whereas The one-, three-, and five-year recurrence-free survival for patients with hepatocellular carcinoma was significantly higher in the laparoscopic group (88%, 60%, 60% vs 54%, 25%, 19%, p = .019). Conclusions: Laparoscopic approach for minor liver resection in elderly patients is safe and feasible with less blood loss, a shorter hospital stay, less postoperative complications and a better oncological outcome.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background and Objectives
Data in literature regarding liver microwave ablation pertain to systems delivering 100 W of maximum power. Our aim is to assess a new 150 W microwave system for liver tumor ...ablation.
Methods
This was an institutional review board‐approved study of patients undergoing ablation of malignant liver tumors using a 150 W microwave system. Feasibility, safety, ablation algorithm, perioperative outcomes, and efficacy were analyzed. Comparison was made to historical patients undergoing ablation using a 100 W microwave system.
Results
There were 33 patients with 76 malignant liver lesions who underwent ablation with the 150 W system. Using a step‐wise algorithm, ablations without intraoperative complications were performed for tumors ranging in size from 0.3 to 6.7 cm. Ninety‐day morbidity was 5%, with no mortality. Compared to the 100 W system, the 150 W system shortened ablation time and created larger ablation zones with a single stick.
Conclusion
This first worldwide experience showed that surgical ablations could be safely created at 150 W using a step‐wise algorithm with complete tumor destruction achieved at short‐term follow‐up. Advantages versus 100 W systems include reduction in ablation time and creation of larger ablation zones with a single stick.
Introduction
The aims of this study were to determine the incidence of Local recurrence (LR) in patients at long‐term follow‐up after laparoscopic RFA (LRFA) and also to determine the risk factors ...for LR from a contemporary series.
Methods
Patients undergoing LRFA between 2005 and 2014 by a single surgeon were reviewed. Demographic and perioperative data were analyzed from a prospective database.
Results
LRFA was performed on 316 patients with 901 lesions. Median follow‐up was 25 months, with 76% of whom completed at least one year of follow‐up. The LR rate was 18.4%. The LR in patients followed for less than 12 months was 13.8%, 20.3% for 12 months, and 19.7% for 18 months (P = 0.02). One‐fourth of the LRs developed after the 1st year. Morbidity was 8.9% and mortality 0.3%. Tumor type, size, ablation margin, and surgeon experience affected LR, with tumor type, size, and ablation margin being independent.
Conclusions
This study shows that 14% of malignant liver tumors will develop LR within a year after LRFA. Additional 4% of the lesions will demonstrate recurrence within 1 cm of the ablation zone, mostly as part of a multifocal recurrence. Ablation margin is the only parameter that the surgeon can manipulate to decrease LR.
Background
Microwave ablation (MWA) has been recently recognized as a technology to overcome the limitations of radiofrequency ablation. The aim of the current study was to evaluate the safety and ...efficacy of a new 2.45-GHz thermosphere MWA system in the treatment of malignant liver tumors.
Methods
This was a prospective IRB-approved study of 18 patients with malignant liver tumors treated with MWA within a 3-month time period. Tumor sizes and response to MWA were obtained from triphasic liver CT scans done before and after MWA. The ablation zones were assessed for complete tumor response and spherical geometry.
Results
There were a total of 18 patients with an average of three tumors measuring 1.4 cm (range 0.2–4). Ablations were performed laparoscopically in all, but three patients who underwent combined liver resection. A single ablation was created in 72 % and overlapping ablations in 28 % of lesions. Total ablation time per patient was 15.6 ± 1.9 min. There was no morbidity or mortality. At 2-week CT scans, there was 100 % tumor destruction, with no residual lesions. Roundness indices A, B and transverse were 1.1, 0.9 and 0.9, respectively, confirming the spherical nature of ablation zones.
Conclusions
To the best of our knowledge, this is the first report of a new thermosphere MWA technology in the laparoscopic treatment of malignant liver tumors. The results demonstrate the safety of the technology, with satisfactory spherical ablation zones seen on post-procedural CT scans.
To investigate the efficacy and safety of transarterial embolization (TAE) using embolization microspheres in the treatment of non-hypervascular malignant liver tumors.
Patients with malignant ...non-hypervascular liver tumors, who were treated with TAE using embolization microspheres, were selected and analyzed retrospectively. The technical success rate, tumor response, and complications were assessed.
Six patients were included in the study: 1 patient each with hepatocellular-cholangiocarcinoma, intrahepatic cholangiocarcinoma, hepatic metastasis after resection of common bile duct carcinoma, liver metastasis from colon cancer, liver metastasis from esophageal cancer, and liver metastasis from pancreatic cancer. The technical success rate was 100%. At 1 and 3 months after TAE, tumor local reactions were seen in 6/6 and 2/6 patients, respectively, and the tumor necrosis rates were 48%-73% and 22%-68%, respectively. The main complications were those related to the embolization syndrome, including 1 case of liver abscess and 1 case of severe pain on the first day after embolization.
TAE with embolization microspheres is safe and effective in non-hypervascular liver tumors. It is a feasible option for palliative therapy of these tumors.
Minimally invasive hepatectomy for benign and malignant liver lesions has gained popularity in the past decade due to improved perioperative outcomes when compared to conventional ‘open’ technique. ...We aim to investigate our initial experience of robotic hepatectomy undertaken in our hepatobiliary program. All patients undergoing robotic hepatectomy between 2013 and 2018 were prospectively followed. Data are presented as median (mean ± SD). A total of 80 patients underwent robotic hepatectomy within the study period. 60% of the patients were women, age of 63 (62.4 ± 14.1), body mass index of 28 (29.6 ± 9.4), ASA class of 2.5 (2.5 ± 0.6), and MELD score of 7 (8.2 ± 2.8). Size of resected lesion was 3.9 (4.6 ± 3) cm. Indications for resection were metastatic lesions (30%), hepatocellular carcinoma (28%), cholangiocarcinoma (7%), gallbladder cancer (5%), neuroendocrine tumors (4%), and benign lesions (26%). Formal hepatectomy (right or left) was performed in 30% of the patients. Operative time was 233 (267.2 ± 109.6) minutes, and estimated blood loss was 150 (265.7 ± 319.9) ml. Length of hospital stay was 3 (5.0 ± 4.6) days. One patient was converted to ‘open’ approach. 10 patients experienced postoperative complications. Readmissions within 30 days of hospital discharge were seen in eight patients. Our data support that robotic hepatectomy is safe and feasible, with favorable short-term outcomes and low conversion rate. Robotic technology extends the application of minimally invasive techniques in the field of hepatobiliary surgery.
Background
Bile duct injury after ablation of malignant liver tumors (MLTs) was not unusual and should be avoided. However, few studies have focused on evaluating the risk factors for intrahepatic ...bile duct injury.
Aim
To evaluate the risk factors for intrahepatic bile duct injury after ablation of MLTs and to evaluate the minimum safe distance for ablating tumors abutting bile ducts.
Methods
Sixty-five patients with intrahepatic bile duct injury after ablation of MLTs, and 65 controls were recruited. Risk factors for intrahepatic bile duct injury were analyzed. Tumor location was recorded as ≤5 mm (group A), 5–10 mm (group B), and >10 mm (group C) from the right/left main duct or segmental bile duct.
Results
Ascites history (
P
< 0.001), TACE treatment history (
P
= 0.025), intrahepatic bile duct dilatation before ablation (
P
< 0.001), and tumor location (
P
= 0.000) were identified as significant risk factors for intrahepatic bile duct injury. Significant differences in the risk of intrahepatic bile duct injury were found between groups B and C (
P
= 0.000), but not between groups A and B (
P
= 0.751). Ascites history (
P
= 0.002) and tumor location (
P
< 0.001) were independent predictors with the OR (95 % confidence interval) of 39.31(3.95–391.69) and 16.56 (5.87–46.71), respectively.
Conclusions
Bile duct injury after ablation of MLTs was the result of local treatment-related factors combined with the patients’ general condition. The minimum safe distance for ablation of tumor abutting a bile duct was 10 mm.
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