 |
|
Cryosurgical Ablation and Radiofrequency Ablation for Unresectable Hepatic Malignant Neoplasms
A Proposed Algorithm
Anton J. Bilchik, MD, PhD;
Thomas F. Wood, MD;
David Allegra, MD;
George J. Tsioulias, MD, DMSc;
Mathew Chung, MD;
D. Michael Rose, MD;
Kenneth P. Ramming, MD;
Donald L. Morton, MD
Arch Surg. 2000;135:657-664.
Background Thermal ablation of unresectable hepatic tumors can be achieved by cryosurgical ablation (CSA) or radiofrequency ablation (RFA). The relative advantages and disadvantages of each technique have not yet been determined.
Hypothesis Radiofrequency ablation of malignant hepatic neoplasms can be performed safely, but is currently limited by size. Cryosurgical ablation, while associated with higher morbidity, is more effective for larger unresectable hepatic malignant neoplasms.
Design Retrospective analysis of prospective patient database.
Patients and Methods Between July 1992 and September 1999, 308 patients with liver tumors not amenable to curative surgical resection were treated with CSA and/or RFA (percutaneous, laparoscopic, celiotomy). No patient had preoperative evidence of extrahepatic disease. All patients underwent laparoscopy with intraoperative ultrasound if technically possible. Both RFA and CSA were performed under ultrasound guidance. Resection, as an adjunctive procedure, was combined with ablation in certain patients.
Results Laparoscopy identified extrahepatic disease in 12% of patients, and intraoperative hepatic ultrasound identified additional lesions in 33% of patients, despite extensive preoperative imaging. Radiofrequency ablation alone or combined with resection or CSA resulted in reduced blood loss (P<.05), thrombocytopenia (P<.05), and shorter hospital stay compared with CSA alone (P<.05). Median ablation times for lesions greater than 3 cm were 60 minutes with RFA and 15 minutes with CSA (P<.001). Local recurrence rates for lesions greater than 3 cm were also greater with RFA (38% vs 17%).
Conclusions Laparoscopy and intraoperative ultrasound are essential in staging patients with hepatic malignant neoplasms. Radiofrequency ablation when combined with CSA reduces the morbidity of multiple freezes. Although RFA is safer than CSA and can be performed via different approaches (percutaneously, laparoscopically, or at celiotomy), it is limited by tumor size (<3 cm). Percutaneous RFA should be considered in high-risk patients or those with small local recurrences.
From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif (Drs Bilchik, Wood, Tsioulias, Chung, Rose, and Morton), and the Century City Cancer Center, Los Angeles, Calif (Drs Bilchik, Allegra, and Ramming).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Can Surgical Research Be Ethical?
Morgenstern
SURG INNOV 2008;15:157-160.
Role of Intraoperative Thermoablation Combined With Resection in the Treatment of Hepatic Metastasis From Colorectal Cancer
Kornprat et al.
Arch Surg 2007;142:1087-1092.
ABSTRACT
| FULL TEXT
Comparison Between Local Ablative Therapy and Chemotherapy for Non-Resectable Colorectal Liver Metastases: A Prospective Study
Ruers et al.
Ann. Surg. Oncol. 2007;14:1161-1169.
ABSTRACT
| FULL TEXT
Intraoperative Triple Antenna Hepatic Microwave Ablation
Simon et al.
Am. J. Roentgenol. 2006;187:W333-W340.
ABSTRACT
| FULL TEXT
Method of Presenting Oncology Treatment Outcomes Influences Patient Treatment Decision-Making in Metastatic Colorectal Cancer
Martin et al.
Ann. Surg. Oncol. 2006;13:86-95.
ABSTRACT
| FULL TEXT
Significant Long-Term Survival After Radiofrequency Ablation of Unresectable Hepatocellular Carcinoma in Patients with Cirrhosis
Raut et al.
Ann. Surg. Oncol. 2005;12:616-628.
ABSTRACT
| FULL TEXT
The End of Cryotherapy for the Treatment of Nonresectable Hepatic Tumors?
Sheen and Siriwardena
Ann. Surg. Oncol. 2005;12:202-204.
FULL TEXT
Liver ablation therapy
Gillams
Br. J. Radiol. 2004;77:713-723.
FULL TEXT
Radiofrequency Ablation for Subcapsular Hepatocellular Carcinoma
Poon et al.
Ann. Surg. Oncol. 2004;11:281-289.
ABSTRACT
| FULL TEXT
Radiofrequency Ablation of Hepatic Malignancies: Inexpensive and Minimally Invasive but Should It Replace Resection?
Bilchik and Faries
Ann. Surg. Oncol. 2003;10:1002-1004.
FULL TEXT
Bipolar Saline-enhanced Electrode for Radiofrequency Ablation: Results of Experimental Study of in Vivo Porcine Liver
Burdio et al.
Radiology 2003;229:447-456.
ABSTRACT
| FULL TEXT
Percutaneous Ablation of Liver Tumors--Reply
Adam
Arch Surg 2003;138:809-810.
FULL TEXT
Radiofrequency Ablation of Hepatic Tumors Adjacent to the Gallbladder: Feasibility and Safety
Chopra et al.
Am. J. Roentgenol. 2003;180:697-701.
ABSTRACT
| FULL TEXT
A Comparison of Percutaneous Cryosurgery and Percutaneous Radiofrequency for Unresectable Hepatic Malignancies
Adam et al.
Arch Surg 2002;137:1332-1339.
ABSTRACT
| FULL TEXT
Ablative therapy for liver tumours
Dick et al.
Gut 2002;50:733-739.
ABSTRACT
| FULL TEXT
Hand-Assisted Laparoscopic Liver Surgery
Antonetti et al.
Arch Surg 2002;137:407-412.
ABSTRACT
| FULL TEXT
Hepatic Radiofrequency Ablation
Iannitti et al.
Arch Surg 2002;137:422-427.
ABSTRACT
| FULL TEXT
Systemic Irinotecan and Regional Floxuridine After Hepatic Cytoreduction in 185 Patients With Unresectable Colorectal Cancer Metastases
Litvak et al.
Ann. Surg. Oncol. 2002;9:148-155.
ABSTRACT
| FULL TEXT
Treatment of colorectal metastases: surgery, cryotherapy, or radiofrequency ablation
Primrose
Gut 2002;50:1-5.
ABSTRACT
| FULL TEXT
Radiofrequency Ablation of Unresectable Hepatic Malignancies: Lessons Learned
Bilchik et al.
The Oncologist 2001;6:24-33.
ABSTRACT
| FULL TEXT
Hepatic Tumors Treated with Percutaneous Radio-frequency Ablation: CT and MR Imaging Follow-up
Dromain et al.
Radiology 2002;223:255-262.
ABSTRACT
| FULL TEXT
|
