Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally adv...Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally advanced or unresectable disease.This review outlines recent technological developments in EUS-RFA,including innovations in energy delivery systems,probe design,and real-time thermal monitoring,which have improved the precision and safety of the procedure.Clinical studies combining EUS-RFA with chemotherapy have demonstrated encouraging outcomes,with improvements in overall survival,progression-free survival,tumor necrosis,and symptom control compared to chemotherapy alone.Additionally,RFA-induced tumor antigen release and modulation of the tumor microenvironment suggest a potential synergistic role with immunotherapy.Despite its promise,the widespread adoption of EUS-RFA is limited by a lack of large-scale randomized controlled trials and standardized treatment protocols.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is among the most aggressive primary liver cancers,leading to significant global mortality.While early diagnosis improves prognosis,treatment decisions,particularly between surg...BACKGROUND Hepatocellular carcinoma(HCC)is among the most aggressive primary liver cancers,leading to significant global mortality.While early diagnosis improves prognosis,treatment decisions,particularly between surgical resection and radiofrequency ablation(RFA),remain controversial.AIM To clarify this issue using sentiment analysis of medical literature alongside a meta-analysis of overall survival(OS).METHODS We included studies comparing liver resection and RFA,excluding case reports,editorials,and studies without relevant outcomes.A systematic search in PubMed and Web of Science identified 197 studies.Abstracts underwent sentiment analysis using Python’s Natural Language Toolkit library,categorizing them as favoring resection,ablation,or neutral.We also performed a meta-analysis using a random-effects model on 11 studies reporting hazard ratios(HRs)for OS.RESULTS Sentiment analysis revealed that 75.1%of abstracts were neutral,14.2%favored resection,and 10.7%favored RFA.The meta-analysis showed a significant survival advantage for liver resection,with a pooled HR of 0.5924(95%confidence interval:0.540-0.649).Heterogeneity was moderate(I²=39.98%).Despite the meta-analysis demonstrating clear survival benefits of liver resection,most abstracts maintained a neutral stance.This discrepancy highlights potential biases or hesitancy in drawing definitive conclusions.CONCLUSION The study emphasizes the need for clinicians to prioritize robust statistical evidence over narrative impressions.Liver resection remains the preferred treatment for HCC in eligible patients.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide.Transarterial chemoembolization(TACE)combined with percutaneous radiofrequency ablation(RFA)has emerged as a promising t...BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide.Transarterial chemoembolization(TACE)combined with percutaneous radiofrequency ablation(RFA)has emerged as a promising treatment strategy for patients with unresectable HCC.AIM To evaluate the effectiveness and safety of TACE combined with RFA compared to TACE alone in the management of primary HCC.METHODS A comprehensive retrospective analysis was conducted at our institution from January 2020 to January 2024,involving 106 patients diagnosed with intermediate to advanced-stage HCC.Patients were divided into two groups:Those receiving TACE alone(n=56)and those undergoing combined TACE and RFA therapy(n=50).Treatment efficacy was assessed based on tumor response rates,serum alphafetoprotein(AFP)levels,and survival outcomes.Statistical analyses,includingχ^(2)tests and Kaplan-Meier survival analysis,were performed to compare the outcomes between the two groups.RESULTS The TACE+RFA group demonstrated significantly higher rates of complete response(15 vs 4,P<0.01)and partial response(23 vs 15,P=0.046)compared to the TACE group.Conversely,the TACE group exhibited higher rates of stable disease(25 vs 7,P<0.01)and progressive disease(12 vs 5,P<0.01).Serum AFP levels decreased over time in the TACE+RFA group,while they increased in the TACE group.Survival analysis revealed superior survival outcomes in the TACE+RFA group,with higher survival rates and a prolonged median survival time compared to the TACE group.CONCLUSION The combination of RFA with TACE could offer enhanced treatment response and prolonged survival in patients with primary HCC compared to TACE alone.These findings might support the adoption of multimodal therapeutic approaches,emphasizing the importance of personalized treatment strategies in the management of HCC.展开更多
Preventing the recurrence of lung oligometastases after local therapy in patients with colorectal cancer is an area requiring investigation.A recent article demonstrated that adding capecitabine maintenance therapy af...Preventing the recurrence of lung oligometastases after local therapy in patients with colorectal cancer is an area requiring investigation.A recent article demonstrated that adding capecitabine maintenance therapy after radiofrequency ablation improved the 5-year overall survival(88.7%vs 69.1%)and reduced local tumor progression(22.7%vs 49.0%)compared with radiofrequency ablation alone.Although progression-free survival did not differ significantly between the two treatments,multivariate analysis confirmed a robust survival benefit.These findings support the use of systemic maintenance to eradicate micrometastases after locoregional control and warrant validation in prospective randomized trials.展开更多
Pancreatic neoplasms present a significant therapeutic challenge due to their complex anatomy and poor prognosis.In recent years,endoscopic ultrasound guided radiofrequency ablation(EUS-RFA)has emerged as a promising ...Pancreatic neoplasms present a significant therapeutic challenge due to their complex anatomy and poor prognosis.In recent years,endoscopic ultrasound guided radiofrequency ablation(EUS-RFA)has emerged as a promising minimally invasive therapeutic option,aiming to provide targeted treatment with improved patients’outcomes.This review aims to shed light on current evidence about the efficacy,safety,and clinical outcomes of EUS-RFA in the management of pancreatic neoplasms.We conducted a comprehensive search of literature,reviewing studies that document the application of EUS-RFA in pancreatic masses.The key metrics for efficacy included tumor size reduction,pain relief,and overall survival,while safety outcomes focused on procedural complications and post-operative recovery.EUS-RFA has demonstrated potential in effectively managing both benign and malignant pancreatic neoplasms,with several studies reporting significant reductions in tumor size and symptomatic relief.The technique is associated with a favorable safety profile,characterized by a low incidence of major complications.EUS-RFA represents a valuable addition to the therapeutic arsenal for pancreatic neoplasms,offering a viable alternative to surgical interventions,especially in patients with contraindications for surgery.Further studies are needed to establish standardized protocols and long-term outcomes,enhancing its applicability and success in clinical practice.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)in segments VII and VIII poses technical challenges for both liver resection and radiofrequency ablation(RFA).Robotic-assisted techniques may enhance safety and precision,but co...BACKGROUND Hepatocellular carcinoma(HCC)in segments VII and VIII poses technical challenges for both liver resection and radiofrequency ablation(RFA).Robotic-assisted techniques may enhance safety and precision,but comparative evidence remains limited.AIM To compare the clinical outcomes of robotic liver resection(R-LR)and robotic intraoperative RFA(RIO-RFA)for HCC located in liver segments VII and VIII.METHODS We retrospectively analyzed 93 HCC patients in segments VII/VIII with de novo(n=57)or first recurrent(n=36).HCC who underwent R-LR or RIO-RFA between 2015 and 2024.Propensity score matching was performed to reduce selection bias.Primary outcomes were overall survival(OS)and recurrence-free survival(RFS).Kaplan-Meier curves,log-rank tests,and Cox regression were used to identify prognostic factors for OS and RFS.RESULTS In the de novo group,OS and RFS did not differ significantly between R-LR and RIO-RFA before or after propensity score matching.In contrast,the recurrent group showed significantly improved OS and RFS with R-LR(P=0.005 and P=0.012,respectively).Subgroup analyses revealed that low-risk de novo patients with smaller tumors achieved superior OS after R-LR,whereas carefully selected low-risk recurrent patients undergoing RIO-RFA(smaller tumors,absence of complications)achieved outcomes comparable to R-LR.Platelet count,tumor size,and postoperative complications constituted key prognostic factors.CONCLUSION For HCC in challenging liver segments VII and VIII,R-LR and RIO-RFA achieve comparable outcomes in de novo cases,whereas R-LR confers superior survival in recurrent disease.R-LR should be prioritized for small de novo HCCs and for recurrent disease overall;RIO-RFA may serve as an effective alternative in carefully selected lowrisk recurrent patients.Tumor size,platelet count,and postoperative complications are key prognostic indicators to guide individualized treatment.展开更多
BACKGROUND No clear guidelines for long-term postoperative maintenance therapy have been established for patients with lung oligometastases from colorectal cancer(CRC)who achieve radiological no evidence of disease af...BACKGROUND No clear guidelines for long-term postoperative maintenance therapy have been established for patients with lung oligometastases from colorectal cancer(CRC)who achieve radiological no evidence of disease after radiofrequency ablation(RFA)treatment.We compared the outcomes of patients with lung oligometa-stases from CRC after RFA plus maintenance capecitabine with RFA alone.AIM To determine whether adding capecitabine to RFA improves prognosis compared with RFA alone.METHODS This multicenter retrospective study included consecutive patients from two tertiary cancer centers treated for pulmonary oligometastases from CRC between 2016 and 2023.Subjects were assigned to RFA plus capecitabine(combined)or RFA alone(only RFA)groups.Primary outcomes included overall survival(OS)and progression-free survival(PFS)survival and the secondary outcome was local tumor progression(LTP).The OS,PFS,and LTP rates were compared between the two groups.In addition,prognostic factors were identified using univariate and multivariate analyses.RESULTS Combination therapy(RFA+capecitabine,n=148)and RFA monotherapy(n=99)were compared in patients with CRC and lung metastases.The median OS was 37.8 months(22.4,50.3),the PFS was 18.7 months(13.0,36.5),and the LTP was 31.5 months(20.0,52.4)in the Only RFA group.The OS increased significantly(P=0.011)and the LTP decreased at all time points(P<0.001)in the combined group.The multivariate cox analysis revealed that combined chemotherapy significantly improved OS,with hazard ratios ranging from 0.29 to 0.35(all P<0.015)after adjusting for demographic,tumor,and treatment-related factors.The risk of death was consistently lower in the combination therapy group compared to RFA monotherapy.CONCLUSION RFA prolongs survival and local control in patients with CRC pulmonary oligometastases.Adjuvant capecitabine increases OS and reduces LTP compared to RFA alone,but PFS did not significantly change.展开更多
Background:Radiofrequency ablation(RFA)is an efficient treatment with unlimited potential for liver cancer that can effectively reduce patient mortality.Understanding the biological process related with RFA treatment ...Background:Radiofrequency ablation(RFA)is an efficient treatment with unlimited potential for liver cancer that can effectively reduce patient mortality.Understanding the biological process related with RFA treatment is important for improving treatment strategy.This study aimed to identify the critical targets for regulating the efficacy of RFA.Methods:The RFA treatment in hepatocellular carcinoma(HCC)tumor models in vivo,was analyzed by RNA sequencing technology.The heat treatment in vitro for HCC tumor cells was also constructed to explore the mechanism after RFA treatment in tumor cells.Nanoparticles with high affinity to tumor cells were applied as a new therapy to interfere with the expression of maternal embryonic leucine zipper kinase(MELK).Results:It was found that RFA treatment upregulated MELK expression,and MELK inhibition promoted RFA efficacy by immunogenic cell death and the antitumor response,including anti-tumoral macrophage polarization and increased CD8+T cell cytotoxicity in HCC.Mechanically,MELK binds to fatty acid-binding protein 5(FABP5),and affects its ubiquitination through the K48R pathway to increase its stability,thereby activating protein kinase B(Akt)/mammalian target of rapamycin(mTOR)signaling axis to weaken the RFA-mediated antitumor effect.In addition,the synthesis of arginylglycylaspartic acid(RGD)-lipid nanoparticles(LNPs)targeting tumor cell-intrinsic MELK enhanced RFA efficacy in HCC.Conclusions:MELK is a therapeutic target by regulating RFA efficacy in HCC,and targeting MELK via RGD-LNPs provides new insight into improving RFA efficacy in HCC clinical treatment and combating the malignant progression of liver cancer.展开更多
BACKGROUND The impact of entecavir(ETV),tenofovir disoproxil fumarate(TDF),and tenofovir alafenamide fumarate(TAF)on long-term recurrence and overall survival in patients with hepatitis B cirrhosis-related hepatocellu...BACKGROUND The impact of entecavir(ETV),tenofovir disoproxil fumarate(TDF),and tenofovir alafenamide fumarate(TAF)on long-term recurrence and overall survival in patients with hepatitis B cirrhosis-related hepatocellular carcinoma(HCC)who AIM To compare the 3-year recurrence and survival rates among HCC patients receiving these three first-line oral anti-hepatitis B virus(anti-HBV)agents after RFA.METHODS This retrospective cohort study included patients with hepatitis B cirrhosis who were initially diagnosed with HCC at Tianjin Third Central Hospital,China,from August 2018 to December 2020,and had complete clinical data.All patients were followed up for at least 144 weeks.Cox regression analysis was performed to identify independent risk factors for HCC recurrence.Recurrence-free survival was analyzed using Kaplan-Meier curves,and Cox regression models were constructed after adjusting for gamma-glutamyl transferase,alpha-fetoprotein,and Barcelona Clinic Liver Cancer staging.RESULTS A total of 319 patients receiving oral anti-HBV therapy were divided into three groups:ETV group(n=191),TDF group(n=76),and TAF group(n=52).At 6 and 12 months,there were no significant differences in recurrence rates between the groups.However,at 24 and 36 months,the TDF and TAF groups exhibited significantly lower recurrence rates compared with the ETV group[24 months:TDF,hazard ratio(HR)=0.51,95%confidence interval(CI):0.29-0.91,P=0.022;TAF,HR=0.54,95%CI:0.28-1.03,P=0.046;36 months:TDF,HR=0.57,95%CI:0.35-0.93,P=0.025;TAF,HR=0.54,95%CI:0.31-0.96,P=0.037].The 3-year mortality rates were similar across the three groups(ETV:21.47%,TDF:18.42%,TAF:23.08%;P=0.790).CONCLUSION Among patients with hepatitis B cirrhosis-related HCC,TDF and TAF are associated with lower 2-year and 3-year HCC recurrence rates after curative RFA treatment compared with ETV.However,there were no significant differences in 3-year mortality rates between the ETV,TDF,and TAF groups.展开更多
Objective: To assess the predictors of successful inactivation of benign thyroid nodules using radiofrequency ablation (RFA) and the hormonal responses thereafter. Methods: A retrospective study conducted at Zhongnan ...Objective: To assess the predictors of successful inactivation of benign thyroid nodules using radiofrequency ablation (RFA) and the hormonal responses thereafter. Methods: A retrospective study conducted at Zhongnan Hospital of Wuhan University (January 2022 to January 2024) analysed thyroid tumor characteristics using B-mode ultrasound, colour Doppler imaging, and CEUS post-RFA. Thyroid hormone levels were also assessed before RFA and at 1, 3, and 6 months after the procedure. Results: The study involved 72 patients with benign thyroid nodules, comprising 13 males and 59 females, with a mean age of 45.8 ± 12.1 years. Complete inactivation was achieved in 70.8% of nodules, while 29.2% showed partial inactivation. Nodules with complete inactivation exhibited more calcification (p = 0.040), whereas those with partial inactivation demonstrated higher vascularity (p Conclusion: In conclusion, this study found that therapeutic RFA effectively achieves high rates of complete inactivation in benign thyroid nodules, with the degree of inactivation mainly influenced by nodule vascularity and calcifications.展开更多
BACKGROUND According to the GLOBCAN2022 database,pancreatic cancer has become the 6th leading cause of cancer-related death worldwide.The latest statistics suggest that the incidence of pancreatic cancer is increasing...BACKGROUND According to the GLOBCAN2022 database,pancreatic cancer has become the 6th leading cause of cancer-related death worldwide.The latest statistics suggest that the incidence of pancreatic cancer is increasing at a rate of 0.5%to 1.0%per year,and it is expected to become the 2nd leading cause of tumor-related deaths in the United States by 2030.More than 50%of pancreatic cancer patients have already developed distant metastases at the time of diagnosis,with the liver being the most common site.Patients with pancreatic cancer with liver metastasis(PCLM)have a worse prognosis than those with locally progressed pancreatic cancer,with a median survival of less than six months.Therefore,the outcome of liver metastases is often a vital determinant of the prognosis of patients with PCLM.There are few successful cases of localized treatment for PCLM patients.Our department recently performed local radiofrequency ablation(RFA)treatment for a PCLM patient through an evidence-based medicine approach,with remarkable therapeutic effects.CASE SUMMARY The patient was admitted to the hospital on May 03,2018,3 weeks after pancreatic cancer surgery.In October 2017,the patient presented with lower back pain.No abnormalities were detected via computed tomography(CT),colonoscopy,or gastroscopy.However,on March 18,2018,the patient was investigated in a foreign hospital via CT,which suggested occupational lesions in the descending part of the duodenum,and magnetic resonance imaging suggested pancreatic occupancy.He was considered to be suffering from pancreatic cancer.He underwent laparoscopic-assisted pancreatic+duodenum+superior mesenteric vein partial resection and reconstruction under general anesthesia on March 26,2018 at The Affiliated Hospital of Xuzhou Medical University.The pancreas and duodenum were partially resected.Postoperative pathology showed adenocarcinoma of the pancreas(moderately differentiated),partly mucinous carcinoma,invading the mucosal layer of the duodenum;the tumor size was 4.5 cm×4 cm×4 cm.There was no apparent nerve or vascular invasion.There was no cancer or involvement of the pancreas section or expected hepatic duct margins.There was no cancer involvement in the gastric and duodenal sections.There was no cancer metastasis to the peripheral lymph nodes of the pancreas(0/9).No metastasis to the gastric lesser curvature or more significant curvature lymph nodes(0/1,0/5)was detected,and the peri-intestinal lymph nodes showed no cancer metastasis(0/4).Although the gallbladder showed signs of chronic cholecystitis,there was no cancer involvement,and the lymph nodes in Groups 12 and 13 also showed no cancer metastasis(0/6,0/1).His postoperative recovery was acceptable.CT was performed on May 2018 at our hospital and found the following:(1)Double lung bronchial vascular bundles slightly heavier than normal;(2)Postoperative changes in the pancreas and a retention tube shadow in front of the head of the pancreas;(3)Small cysts in the right lobe of the liver;(4)Abdominopelvic effusion;and(5)Para splenic enlargement.pTNM stage:PT3N0M0.The patient was in the second stage of postoperative pancreatic cancer,with a potential risk of recurrence considering the patient's postoperative body quality deviation.The patient was unable to tolerate the standard multidrug combination and underwent six cycles of single-agent gemcitabine chemotherapy from May 10,2018 to August 31,2018(the specific drug dosage was 1.4 g/d1/d8 gemcitabine injection,which was repeated every 21 days).Efficacy was determined to be stable disease after 2,4,and 6 cycles.The side effects during treatment were tolerable.CONCLUSION This case suggests that RFA can serve as a viable local treatment modality for selected patients with PCLM,offering a chance for long-term survival.Such localized interventions,when carefully tailored,may complement systemic therapies in controlling metastatic pancreatic cancer.展开更多
BACKGROUND Recent studies have revealed that endoscopic minimally invasive treatment of early esophageal cancer and precancerous lesions is as effective as traditional surgery and offer considerable advantages,such as...BACKGROUND Recent studies have revealed that endoscopic minimally invasive treatment of early esophageal cancer and precancerous lesions is as effective as traditional surgery and offer considerable advantages,such as minimal invasiveness,enhanced safety,lower costs,and improved quality of life after surgery.AIM To analyze factors affecting postoperative fever in patients with early esophageal squamous cell carcinoma and precancerous lesions who underwent endoscopic radiofrequency ablation(ERFA).METHODS Clinical data of 29 patients with esophageal lesions admitted to The Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University between March 2022 and June 2024 were retrospectively analyzed.All patients underwent ERFA and were divided into a fever group and a non-fever group based on whether they experienced fever after surgery.The general characteristics of both groups were analyzed,and univariate analysis of variance and multivariate logistic regression were conducted to examine the factors that influence the incidence of fever in patients with early esophageal squamous cell carcinoma and precancerous lesions treated with ERFA.RESULTS Among the 29 patients with esophageal lesions treated with ERFA,11 did not experience fever,whereas 18(62.07%)experienced it.Univariate analysis of variance showed that the ablation length and duration of postoperative fasting were significantly different between the fever and non-fever groups(P<0.05),whereas the operation time,postoperative use of hormones,postoperative use of antibiotics,and pathological type were not significantly different between these groups(P>0.05).Multivariate logistic regression indicated that the ablation length and duration of postoperative fasting were independent factors influencing the occurrence of post-ERFA fever.CONCLUSION The incidence of fever is high in patients with early esophageal lesions treated with ERFA,which is related to the ablation length and duration of postoperative fasting.The results can guide modifications in the treatment and nursing plans for patients with esophageal lesions to reduce the risk of postoperative fever.展开更多
BACKGROUND KRAS mutation status and primary tumor location serve as critical prognostic factors for colorectal liver metastases(CLMs).Emerging evidence suggests a potential interaction between these two variables that...BACKGROUND KRAS mutation status and primary tumor location serve as critical prognostic factors for colorectal liver metastases(CLMs).Emerging evidence suggests a potential interaction between these two variables that may influence clinical outcomes.AIM To investigate the association of KRAS mutations with recurrence in patients with CLM who underwent radiofrequency ablation(RFA)according to the primary tumor location.METHODS This retrospective study analyzed 164 patients with KRAS-determined CLM treated with percutaneous RFA between January 2012 and December 2018.The clinicopathological characteristics,recurrence patterns,and survival outcomes were systematically evaluated.RESULTS A total of 164 patients(mean age:58.0±9.8 years,range:34-83 years)who underwent percutaneous RFA of 325 CLMs(mean size:2.2±1.0 cm,range:0.7-5.0 cm)were included in the study.Eighty-nine(54.3%)patients had wild-type KRAS,and 75(45.7%)patients had mutated KRAS.Compared with wild-type patients,patients with KRAS mutations presented significantly higher local tumor progression rates(30.7%vs 14.6%,P=0.013).Among 126 patients(76.8%)who experienced post-RFA recurrence,61.6%developed intrahepatic metastases,and 53.7%developed extrahepatic metastases.Primary tumor location significantly modified KRASrelated outcomes:Compared with wild-type patients,left-sided colorectal cancer(CRC)patients with KRAS mutations presented higher intrahepatic recurrence rates(77.2%vs 52.5%,P=0.003)and shorter median intrahepatic recurrence-free survival(15 vs 25 months,P=0.007).No significant differences in KRAS expression were detected in right-sided tumors.CONCLUSION KRAS mutation status predicts differential recurrence patterns after CLM ablation,with significant prognostic implications,specifically in left-sided CRCs.These findings underscore the importance of integrating molecular profiling and primary tumor characteristics in therapeutic decision-making for patients with metastatic CRC.展开更多
Objective: To study the importance of percutaneous radiofrequency ablation (PRFA) guided by ultrasound for inoperable recurrent hepatocellular carcinoma.Methods: Forty-seven patients with inoperable recurrent hepatoce...Objective: To study the importance of percutaneous radiofrequency ablation (PRFA) guided by ultrasound for inoperable recurrent hepatocellular carcinoma.Methods: Forty-seven patients with inoperable recurrent hepatocellular carcinoma underwent percutaneous radiofrequency ablation (PRFA) under ultrasond between October 1999 and July 2001. Twenty-four patients had single recurrent tumor and 23 patients had multiple lesions. Twelve patients had single lesion with less than 3.5 cm in diameter. All patients were followed up to examine the value of AFP, MRI or CT after PRFA. Kaplan-Meier estimation was used to analyze the survival rate.Results: The 1-, 2- and 3-year survival rate in single lesion group was 65.2%, 37.5% and 37.5% respectively. The survival rate of 1 and 2 years was 41.7% and 19.5% in the multiple lesions group. The 1-, 2-and 3-year survival rate in single lesion groups with less than 3.5 cm in diameter was 83.3%, 51.4% and 51.4% respectively.Conclusion: PRFA is one of the important comprehensive methods for recurrent hepatocellular carcinoma. According to the size, number and recurrent time, PRFA can be performed separately or combined with transcatheter arterial chemoembolization for inoperable recurrent hepatocellular carcinoma. This method can control the recurrence and increase the survival rate effectively. Key words recurrence - hepatocellular cacinoma - radiofrequency ablation展开更多
The management of early stage hepatocellular carcinoma(HCC)presents significant challenges.While radiofrequency ablation(RFA)has shown safety and effectiveness in treating HCC,with lower mortality rates and shorter ho...The management of early stage hepatocellular carcinoma(HCC)presents significant challenges.While radiofrequency ablation(RFA)has shown safety and effectiveness in treating HCC,with lower mortality rates and shorter hospital stays,its high recurrence rate remains a significant impediment.Consequently,achieving improved survival solely through RFA is challenging,particularly in retrospective studies with inherent biases.Ultrasound is commonly used for guiding percutaneous RFA,but its low contrast can lead to missed tumors and the risk of HCC recurrence.To enhance the efficiency of ultrasound-guided percutaneous RFA,various techniques such as artificial ascites and contrast-enhanced ultrasound have been developed to facilitate complete tumor ablation.Minimally invasive surgery(MIS)offers advantages over open surgery and has gained traction in various surgical fields.Recent studies suggest that laparoscopic intraoperative RFA(IORFA)may be more effective than percutaneous RFA in terms of survival for HCC patients unsuitable for surgery,highlighting its significance.Therefore,combining MIS-IORFA with these enhanced percutaneous RFA techniques may hold greater significance for HCC treatment using the MIS-IORFA approach.This article reviews liver resection and RFA in HCC treatment,comparing their merits and proposing a trajectory involving their combination in future therapy.展开更多
BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients w...BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice,yet the safety and effect of endobiliary radiofrequency ablation(EB-RFA)combined PTCD is rarely reported,in this article,we report our experience of EB-RFA combined PTCD in such patients.AIM To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice.METHODS Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected,the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases.The general conditions of all patients,preoperative tumour markers,total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB),alkaline phosphatase(ALP),and glutamyl transferase(GGT)before and on the 7th day after the procedure,as well as perioperative complications,stent patency time and patient survival were recorded.RESULTS All patients successfully completed the operation,TBIL and DBIL decreased significantly in all patients at the 7th postoperative day(P=0.009 and 0.006,respectively);the values of ALB,ALP and GGT also decreased compared with the preoperative period,but the difference was not statistically significant.Perioperative biliary bleeding occurred in 2 patients,which was improved after transfusion of blood and other conservative treatments,pancreatitis appeared in 1 patient after the operation,no serious complication and death happened after operation.Except for 3 patients with loss of visits,the stent patency rate of the remaining 14 patients was 100%71%and 29%at the 1^(st),3^(rd),and 6^(th)postoperative months respectively,with a median survival of 4 months.CONCLUSION EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety,which is worthy of further clinical practice.展开更多
Objective To explore the feasibility of electroacupuncture compound anesthesia in radiofrequency ablation for hypertrophic inferior turbinate.Methods The patients confirmed to the enrolled criteria were randomly divid...Objective To explore the feasibility of electroacupuncture compound anesthesia in radiofrequency ablation for hypertrophic inferior turbinate.Methods The patients confirmed to the enrolled criteria were randomly divided into an observation group（n=31） and a control group（n=30）.In the observation group,electroacupuncture was applied to Sìbái（四白 ST 2）,Xiàguān（下关 ST 7）,Hégǔ（合谷 LI 4） and Zhīgōu（支沟 TE 6） on the left side for the anesthesia and the routine local anesthesia was done on the right side.In the control group,the routine local anesthesia was adopted on both sides.The feelings of pain,circulatory index and operation effect were observed and compared between the two groups.Results During radiofrequency ablation,the pain grades of two measurements on the left side and the 2nd measurement on the right in the observation group were all lower than those in the control group（all P〈0.05）.In the observation group,the pain grade on the left side was lower than that on the right side（P〈0.05）,and the systolic blood pressure and the heart rate were lower than those in the control group when undergoing the 2nd radiofrequency ablation on the right side and on the left side,respectively（all P〈0.05）.There was no significant difference in operation effect between the two groups.Conclusion Electroacupuncture compound anesthesia can meet the analgesia requirement of radiofrequency ablation for hypertrophic inferior turbinate,and would be helpful to prevent cyclic fluctuation during the operation at the same time.展开更多
Objective A 7-year experience for the treatment strategy using mono- and bi-polar radiofrequency （RF） ablation procedures in a heterogeneous group of patients was reported. Methods Between July 2003 and May 2009, th...Objective A 7-year experience for the treatment strategy using mono- and bi-polar radiofrequency （RF） ablation procedures in a heterogeneous group of patients was reported. Methods Between July 2003 and May 2009, the data of 314 consecutive patients aged 13 -75 （48.70 ± 11.09 ）undergone the radiofrequency ablation procedure for atrial fibrillation （AF） associated with concomitant cardiac surgery were analyzed. Monopolar was used for 91 patients; Medtronic bi-polar RF ablation procedure for 92 patients and Atricure RF ablation procedure for 131 patients. All patients were combined with valve surgery. Regular follow-ups were performed at 3, 6 month after surgery. Results Hospital mortality after combined open heart and surgical RF ablation was 0 %. The success rates for sinus rhythm conversion with monopolar RF were 73.6 % immediately, 74. 7 % at 3 months, 79. 1% at 6 months ; with Medtronic bi- polar RF, the rates were 78.3 % immediately, 82. 8 % at 3 months, 84 % at 6 months ; with Atricure bi-polar RF, the rates were 82. 4 % immediately, 84. 1% at 3 months, 83.9 % at 6 months. Conclusions The use of RF ablation procedures is a safe and efficient option to cure AF during open heart surgery in a selective group of patients.展开更多
The liver is a common location of both primary and secondary malignancies. For unresectable liver cancer, many local ablative therapies have been developed. These include e.g., percutaneous ethanol injection (PEI), pe...The liver is a common location of both primary and secondary malignancies. For unresectable liver cancer, many local ablative therapies have been developed. These include e.g., percutaneous ethanol injection (PEI), percutaneous acetic acid injection, radiofrequency ablation (RFA), cryoablation, microwave ablation, laserinduced thermotherapy, and high-intensity focused ultrasound. RFA has recently gained interest and is the most widely applied thermoablative technique. RFA allows more effective tumor control in fewer treatment sessions compared with PEI, but with a higher rate of complications. However, there are certain circumstances where PEI therapy represents a better strategy to control liver tumors than RFA, especially in situations where RFA is difficult, for example when large vessels surround the tumor. In the context of hepatocellular carcinoma (HCC), both RFA and PEI are feasible and of benefit in non-operable patients. RFA seems superior to PEI in HCC > 2 cm, and the combination of interventions may be of benefit in selected patients. Liver resection is superior to RFA for patients with HCC meeting the Milan criteria, but RFA can be employed in tumors ≤ 3 cm and where there is an increased expected operative mortality. In addition, some lines of evidence indicate that RFA and PEI can be employed as a bridge to liver transplantation. The use of RFA in colorectal liver metastases is currently limited to unresectable disease and for patients unfit for surgery. The aim of this article is to summarize the current status of RFA in the management of liver tumors and compare it to the cheap and readily available technique of PEI.展开更多
AIM:To investigate the major complications after radiofrequency ablation(RFA) for the treatment of liver tumors and analyze possible risk factors that precipitate these complications.METHODS:From March 2001 to April 2...AIM:To investigate the major complications after radiofrequency ablation(RFA) for the treatment of liver tumors and analyze possible risk factors that precipitate these complications.METHODS:From March 2001 to April 2008,255 patients with liver tumors(205 male,50 female;age range,18-89 years;mean age,56.0 years) who received RFA were enrolled in this study.Of these patients,212 had hepatocellular carcinoma,39 had metastatic liver tumors and four had cholangiocellular carcinoma.One hundred and forty eight patients had a single tumor,and 107 had multiple tumors.Maximum diameter of the tumors ranged 1.3-20 cm(mean,5.1 cm).All patients were treated with a cooled-tip perfusion electrode attached to a radiofrequency generator(Radionics,Burlington,MA,USA).RFA was performed via the percutaneous approach(n = 257),laparoscopy(n = 7),or open surgical treatment(n = 86).The major complications related to RFA were recorded.The resultant data were analyzed to determine risk factors associated these complications.RESULTS:Among the 255 patients,425 liver tumors were treated and 350 RFA sessions were performed.Thirty-seven(10%) major complications were observed which included 13 cases of liver failure,10 cases of hydrothorax requiring drainage,three casesof tumor seeding,one case of upper gastrointestinal bleeding,one case ofintrahepatic abscess,one case of bile duct injury,one case of cardiac arrest,and five cases of hyperglycemia.Seven patients had more than two complications.Liver failure was the most severe complication and was associated with the highest mortality.Eleven patients died due to worsening liver decompensation.Child-Pugh classification(P = 0.001) and choice of approach(P = 0.045) were related to post-treatment liver failure,whereas patient age,tumor size and number were not significant factors precipitating this complication.CONCLUSION:RFA can be accepted as a relatively safe procedure for the treatment of liver tumors.However,attention should be paid to possible complications even though the incidences of these complications are rare.Careful patient selection and the best approach choice(percutaneous,laparoscopy,or laparotomy) will help to minimize the incidence and morbidity rate of complications which occur after RFA.展开更多
文摘Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally advanced or unresectable disease.This review outlines recent technological developments in EUS-RFA,including innovations in energy delivery systems,probe design,and real-time thermal monitoring,which have improved the precision and safety of the procedure.Clinical studies combining EUS-RFA with chemotherapy have demonstrated encouraging outcomes,with improvements in overall survival,progression-free survival,tumor necrosis,and symptom control compared to chemotherapy alone.Additionally,RFA-induced tumor antigen release and modulation of the tumor microenvironment suggest a potential synergistic role with immunotherapy.Despite its promise,the widespread adoption of EUS-RFA is limited by a lack of large-scale randomized controlled trials and standardized treatment protocols.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is among the most aggressive primary liver cancers,leading to significant global mortality.While early diagnosis improves prognosis,treatment decisions,particularly between surgical resection and radiofrequency ablation(RFA),remain controversial.AIM To clarify this issue using sentiment analysis of medical literature alongside a meta-analysis of overall survival(OS).METHODS We included studies comparing liver resection and RFA,excluding case reports,editorials,and studies without relevant outcomes.A systematic search in PubMed and Web of Science identified 197 studies.Abstracts underwent sentiment analysis using Python’s Natural Language Toolkit library,categorizing them as favoring resection,ablation,or neutral.We also performed a meta-analysis using a random-effects model on 11 studies reporting hazard ratios(HRs)for OS.RESULTS Sentiment analysis revealed that 75.1%of abstracts were neutral,14.2%favored resection,and 10.7%favored RFA.The meta-analysis showed a significant survival advantage for liver resection,with a pooled HR of 0.5924(95%confidence interval:0.540-0.649).Heterogeneity was moderate(I²=39.98%).Despite the meta-analysis demonstrating clear survival benefits of liver resection,most abstracts maintained a neutral stance.This discrepancy highlights potential biases or hesitancy in drawing definitive conclusions.CONCLUSION The study emphasizes the need for clinicians to prioritize robust statistical evidence over narrative impressions.Liver resection remains the preferred treatment for HCC in eligible patients.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide.Transarterial chemoembolization(TACE)combined with percutaneous radiofrequency ablation(RFA)has emerged as a promising treatment strategy for patients with unresectable HCC.AIM To evaluate the effectiveness and safety of TACE combined with RFA compared to TACE alone in the management of primary HCC.METHODS A comprehensive retrospective analysis was conducted at our institution from January 2020 to January 2024,involving 106 patients diagnosed with intermediate to advanced-stage HCC.Patients were divided into two groups:Those receiving TACE alone(n=56)and those undergoing combined TACE and RFA therapy(n=50).Treatment efficacy was assessed based on tumor response rates,serum alphafetoprotein(AFP)levels,and survival outcomes.Statistical analyses,includingχ^(2)tests and Kaplan-Meier survival analysis,were performed to compare the outcomes between the two groups.RESULTS The TACE+RFA group demonstrated significantly higher rates of complete response(15 vs 4,P<0.01)and partial response(23 vs 15,P=0.046)compared to the TACE group.Conversely,the TACE group exhibited higher rates of stable disease(25 vs 7,P<0.01)and progressive disease(12 vs 5,P<0.01).Serum AFP levels decreased over time in the TACE+RFA group,while they increased in the TACE group.Survival analysis revealed superior survival outcomes in the TACE+RFA group,with higher survival rates and a prolonged median survival time compared to the TACE group.CONCLUSION The combination of RFA with TACE could offer enhanced treatment response and prolonged survival in patients with primary HCC compared to TACE alone.These findings might support the adoption of multimodal therapeutic approaches,emphasizing the importance of personalized treatment strategies in the management of HCC.
文摘Preventing the recurrence of lung oligometastases after local therapy in patients with colorectal cancer is an area requiring investigation.A recent article demonstrated that adding capecitabine maintenance therapy after radiofrequency ablation improved the 5-year overall survival(88.7%vs 69.1%)and reduced local tumor progression(22.7%vs 49.0%)compared with radiofrequency ablation alone.Although progression-free survival did not differ significantly between the two treatments,multivariate analysis confirmed a robust survival benefit.These findings support the use of systemic maintenance to eradicate micrometastases after locoregional control and warrant validation in prospective randomized trials.
文摘Pancreatic neoplasms present a significant therapeutic challenge due to their complex anatomy and poor prognosis.In recent years,endoscopic ultrasound guided radiofrequency ablation(EUS-RFA)has emerged as a promising minimally invasive therapeutic option,aiming to provide targeted treatment with improved patients’outcomes.This review aims to shed light on current evidence about the efficacy,safety,and clinical outcomes of EUS-RFA in the management of pancreatic neoplasms.We conducted a comprehensive search of literature,reviewing studies that document the application of EUS-RFA in pancreatic masses.The key metrics for efficacy included tumor size reduction,pain relief,and overall survival,while safety outcomes focused on procedural complications and post-operative recovery.EUS-RFA has demonstrated potential in effectively managing both benign and malignant pancreatic neoplasms,with several studies reporting significant reductions in tumor size and symptomatic relief.The technique is associated with a favorable safety profile,characterized by a low incidence of major complications.EUS-RFA represents a valuable addition to the therapeutic arsenal for pancreatic neoplasms,offering a viable alternative to surgical interventions,especially in patients with contraindications for surgery.Further studies are needed to establish standardized protocols and long-term outcomes,enhancing its applicability and success in clinical practice.
基金Supported by Feng Chia University/Chung Shan Medical University,No.FCU/CSMU 112-001Taiwan National Science and Technology Council,No.NSTC 114-2221-E-035-036.
文摘BACKGROUND Hepatocellular carcinoma(HCC)in segments VII and VIII poses technical challenges for both liver resection and radiofrequency ablation(RFA).Robotic-assisted techniques may enhance safety and precision,but comparative evidence remains limited.AIM To compare the clinical outcomes of robotic liver resection(R-LR)and robotic intraoperative RFA(RIO-RFA)for HCC located in liver segments VII and VIII.METHODS We retrospectively analyzed 93 HCC patients in segments VII/VIII with de novo(n=57)or first recurrent(n=36).HCC who underwent R-LR or RIO-RFA between 2015 and 2024.Propensity score matching was performed to reduce selection bias.Primary outcomes were overall survival(OS)and recurrence-free survival(RFS).Kaplan-Meier curves,log-rank tests,and Cox regression were used to identify prognostic factors for OS and RFS.RESULTS In the de novo group,OS and RFS did not differ significantly between R-LR and RIO-RFA before or after propensity score matching.In contrast,the recurrent group showed significantly improved OS and RFS with R-LR(P=0.005 and P=0.012,respectively).Subgroup analyses revealed that low-risk de novo patients with smaller tumors achieved superior OS after R-LR,whereas carefully selected low-risk recurrent patients undergoing RIO-RFA(smaller tumors,absence of complications)achieved outcomes comparable to R-LR.Platelet count,tumor size,and postoperative complications constituted key prognostic factors.CONCLUSION For HCC in challenging liver segments VII and VIII,R-LR and RIO-RFA achieve comparable outcomes in de novo cases,whereas R-LR confers superior survival in recurrent disease.R-LR should be prioritized for small de novo HCCs and for recurrent disease overall;RIO-RFA may serve as an effective alternative in carefully selected lowrisk recurrent patients.Tumor size,platelet count,and postoperative complications are key prognostic indicators to guide individualized treatment.
基金Supported by the National Natural Science Foundation of China,No.82072034。
文摘BACKGROUND No clear guidelines for long-term postoperative maintenance therapy have been established for patients with lung oligometastases from colorectal cancer(CRC)who achieve radiological no evidence of disease after radiofrequency ablation(RFA)treatment.We compared the outcomes of patients with lung oligometa-stases from CRC after RFA plus maintenance capecitabine with RFA alone.AIM To determine whether adding capecitabine to RFA improves prognosis compared with RFA alone.METHODS This multicenter retrospective study included consecutive patients from two tertiary cancer centers treated for pulmonary oligometastases from CRC between 2016 and 2023.Subjects were assigned to RFA plus capecitabine(combined)or RFA alone(only RFA)groups.Primary outcomes included overall survival(OS)and progression-free survival(PFS)survival and the secondary outcome was local tumor progression(LTP).The OS,PFS,and LTP rates were compared between the two groups.In addition,prognostic factors were identified using univariate and multivariate analyses.RESULTS Combination therapy(RFA+capecitabine,n=148)and RFA monotherapy(n=99)were compared in patients with CRC and lung metastases.The median OS was 37.8 months(22.4,50.3),the PFS was 18.7 months(13.0,36.5),and the LTP was 31.5 months(20.0,52.4)in the Only RFA group.The OS increased significantly(P=0.011)and the LTP decreased at all time points(P<0.001)in the combined group.The multivariate cox analysis revealed that combined chemotherapy significantly improved OS,with hazard ratios ranging from 0.29 to 0.35(all P<0.015)after adjusting for demographic,tumor,and treatment-related factors.The risk of death was consistently lower in the combination therapy group compared to RFA monotherapy.CONCLUSION RFA prolongs survival and local control in patients with CRC pulmonary oligometastases.Adjuvant capecitabine increases OS and reduces LTP compared to RFA alone,but PFS did not significantly change.
基金supported by the National Natural Science Foundation of China(82072025,82072026,82102162,and 82303886)the“Leading Goose”Research and Development Program of Zhejiang Province(2023C03062)+1 种基金the National Natural Science Foundation of Zhejiang Province(LY22H160040 and LQ22H180010)the Key Research and Development Project of Lishui City(2022ZDYF12,2022ZDYF20,and 2022ZDYF20).
文摘Background:Radiofrequency ablation(RFA)is an efficient treatment with unlimited potential for liver cancer that can effectively reduce patient mortality.Understanding the biological process related with RFA treatment is important for improving treatment strategy.This study aimed to identify the critical targets for regulating the efficacy of RFA.Methods:The RFA treatment in hepatocellular carcinoma(HCC)tumor models in vivo,was analyzed by RNA sequencing technology.The heat treatment in vitro for HCC tumor cells was also constructed to explore the mechanism after RFA treatment in tumor cells.Nanoparticles with high affinity to tumor cells were applied as a new therapy to interfere with the expression of maternal embryonic leucine zipper kinase(MELK).Results:It was found that RFA treatment upregulated MELK expression,and MELK inhibition promoted RFA efficacy by immunogenic cell death and the antitumor response,including anti-tumoral macrophage polarization and increased CD8+T cell cytotoxicity in HCC.Mechanically,MELK binds to fatty acid-binding protein 5(FABP5),and affects its ubiquitination through the K48R pathway to increase its stability,thereby activating protein kinase B(Akt)/mammalian target of rapamycin(mTOR)signaling axis to weaken the RFA-mediated antitumor effect.In addition,the synthesis of arginylglycylaspartic acid(RGD)-lipid nanoparticles(LNPs)targeting tumor cell-intrinsic MELK enhanced RFA efficacy in HCC.Conclusions:MELK is a therapeutic target by regulating RFA efficacy in HCC,and targeting MELK via RGD-LNPs provides new insight into improving RFA efficacy in HCC clinical treatment and combating the malignant progression of liver cancer.
基金Supported by Tianjin Health Project of China,No.TJWJ2022XK029.
文摘BACKGROUND The impact of entecavir(ETV),tenofovir disoproxil fumarate(TDF),and tenofovir alafenamide fumarate(TAF)on long-term recurrence and overall survival in patients with hepatitis B cirrhosis-related hepatocellular carcinoma(HCC)who AIM To compare the 3-year recurrence and survival rates among HCC patients receiving these three first-line oral anti-hepatitis B virus(anti-HBV)agents after RFA.METHODS This retrospective cohort study included patients with hepatitis B cirrhosis who were initially diagnosed with HCC at Tianjin Third Central Hospital,China,from August 2018 to December 2020,and had complete clinical data.All patients were followed up for at least 144 weeks.Cox regression analysis was performed to identify independent risk factors for HCC recurrence.Recurrence-free survival was analyzed using Kaplan-Meier curves,and Cox regression models were constructed after adjusting for gamma-glutamyl transferase,alpha-fetoprotein,and Barcelona Clinic Liver Cancer staging.RESULTS A total of 319 patients receiving oral anti-HBV therapy were divided into three groups:ETV group(n=191),TDF group(n=76),and TAF group(n=52).At 6 and 12 months,there were no significant differences in recurrence rates between the groups.However,at 24 and 36 months,the TDF and TAF groups exhibited significantly lower recurrence rates compared with the ETV group[24 months:TDF,hazard ratio(HR)=0.51,95%confidence interval(CI):0.29-0.91,P=0.022;TAF,HR=0.54,95%CI:0.28-1.03,P=0.046;36 months:TDF,HR=0.57,95%CI:0.35-0.93,P=0.025;TAF,HR=0.54,95%CI:0.31-0.96,P=0.037].The 3-year mortality rates were similar across the three groups(ETV:21.47%,TDF:18.42%,TAF:23.08%;P=0.790).CONCLUSION Among patients with hepatitis B cirrhosis-related HCC,TDF and TAF are associated with lower 2-year and 3-year HCC recurrence rates after curative RFA treatment compared with ETV.However,there were no significant differences in 3-year mortality rates between the ETV,TDF,and TAF groups.
文摘Objective: To assess the predictors of successful inactivation of benign thyroid nodules using radiofrequency ablation (RFA) and the hormonal responses thereafter. Methods: A retrospective study conducted at Zhongnan Hospital of Wuhan University (January 2022 to January 2024) analysed thyroid tumor characteristics using B-mode ultrasound, colour Doppler imaging, and CEUS post-RFA. Thyroid hormone levels were also assessed before RFA and at 1, 3, and 6 months after the procedure. Results: The study involved 72 patients with benign thyroid nodules, comprising 13 males and 59 females, with a mean age of 45.8 ± 12.1 years. Complete inactivation was achieved in 70.8% of nodules, while 29.2% showed partial inactivation. Nodules with complete inactivation exhibited more calcification (p = 0.040), whereas those with partial inactivation demonstrated higher vascularity (p Conclusion: In conclusion, this study found that therapeutic RFA effectively achieves high rates of complete inactivation in benign thyroid nodules, with the degree of inactivation mainly influenced by nodule vascularity and calcifications.
文摘BACKGROUND According to the GLOBCAN2022 database,pancreatic cancer has become the 6th leading cause of cancer-related death worldwide.The latest statistics suggest that the incidence of pancreatic cancer is increasing at a rate of 0.5%to 1.0%per year,and it is expected to become the 2nd leading cause of tumor-related deaths in the United States by 2030.More than 50%of pancreatic cancer patients have already developed distant metastases at the time of diagnosis,with the liver being the most common site.Patients with pancreatic cancer with liver metastasis(PCLM)have a worse prognosis than those with locally progressed pancreatic cancer,with a median survival of less than six months.Therefore,the outcome of liver metastases is often a vital determinant of the prognosis of patients with PCLM.There are few successful cases of localized treatment for PCLM patients.Our department recently performed local radiofrequency ablation(RFA)treatment for a PCLM patient through an evidence-based medicine approach,with remarkable therapeutic effects.CASE SUMMARY The patient was admitted to the hospital on May 03,2018,3 weeks after pancreatic cancer surgery.In October 2017,the patient presented with lower back pain.No abnormalities were detected via computed tomography(CT),colonoscopy,or gastroscopy.However,on March 18,2018,the patient was investigated in a foreign hospital via CT,which suggested occupational lesions in the descending part of the duodenum,and magnetic resonance imaging suggested pancreatic occupancy.He was considered to be suffering from pancreatic cancer.He underwent laparoscopic-assisted pancreatic+duodenum+superior mesenteric vein partial resection and reconstruction under general anesthesia on March 26,2018 at The Affiliated Hospital of Xuzhou Medical University.The pancreas and duodenum were partially resected.Postoperative pathology showed adenocarcinoma of the pancreas(moderately differentiated),partly mucinous carcinoma,invading the mucosal layer of the duodenum;the tumor size was 4.5 cm×4 cm×4 cm.There was no apparent nerve or vascular invasion.There was no cancer or involvement of the pancreas section or expected hepatic duct margins.There was no cancer involvement in the gastric and duodenal sections.There was no cancer metastasis to the peripheral lymph nodes of the pancreas(0/9).No metastasis to the gastric lesser curvature or more significant curvature lymph nodes(0/1,0/5)was detected,and the peri-intestinal lymph nodes showed no cancer metastasis(0/4).Although the gallbladder showed signs of chronic cholecystitis,there was no cancer involvement,and the lymph nodes in Groups 12 and 13 also showed no cancer metastasis(0/6,0/1).His postoperative recovery was acceptable.CT was performed on May 2018 at our hospital and found the following:(1)Double lung bronchial vascular bundles slightly heavier than normal;(2)Postoperative changes in the pancreas and a retention tube shadow in front of the head of the pancreas;(3)Small cysts in the right lobe of the liver;(4)Abdominopelvic effusion;and(5)Para splenic enlargement.pTNM stage:PT3N0M0.The patient was in the second stage of postoperative pancreatic cancer,with a potential risk of recurrence considering the patient's postoperative body quality deviation.The patient was unable to tolerate the standard multidrug combination and underwent six cycles of single-agent gemcitabine chemotherapy from May 10,2018 to August 31,2018(the specific drug dosage was 1.4 g/d1/d8 gemcitabine injection,which was repeated every 21 days).Efficacy was determined to be stable disease after 2,4,and 6 cycles.The side effects during treatment were tolerable.CONCLUSION This case suggests that RFA can serve as a viable local treatment modality for selected patients with PCLM,offering a chance for long-term survival.Such localized interventions,when carefully tailored,may complement systemic therapies in controlling metastatic pancreatic cancer.
文摘BACKGROUND Recent studies have revealed that endoscopic minimally invasive treatment of early esophageal cancer and precancerous lesions is as effective as traditional surgery and offer considerable advantages,such as minimal invasiveness,enhanced safety,lower costs,and improved quality of life after surgery.AIM To analyze factors affecting postoperative fever in patients with early esophageal squamous cell carcinoma and precancerous lesions who underwent endoscopic radiofrequency ablation(ERFA).METHODS Clinical data of 29 patients with esophageal lesions admitted to The Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University between March 2022 and June 2024 were retrospectively analyzed.All patients underwent ERFA and were divided into a fever group and a non-fever group based on whether they experienced fever after surgery.The general characteristics of both groups were analyzed,and univariate analysis of variance and multivariate logistic regression were conducted to examine the factors that influence the incidence of fever in patients with early esophageal squamous cell carcinoma and precancerous lesions treated with ERFA.RESULTS Among the 29 patients with esophageal lesions treated with ERFA,11 did not experience fever,whereas 18(62.07%)experienced it.Univariate analysis of variance showed that the ablation length and duration of postoperative fasting were significantly different between the fever and non-fever groups(P<0.05),whereas the operation time,postoperative use of hormones,postoperative use of antibiotics,and pathological type were not significantly different between these groups(P>0.05).Multivariate logistic regression indicated that the ablation length and duration of postoperative fasting were independent factors influencing the occurrence of post-ERFA fever.CONCLUSION The incidence of fever is high in patients with early esophageal lesions treated with ERFA,which is related to the ablation length and duration of postoperative fasting.The results can guide modifications in the treatment and nursing plans for patients with esophageal lesions to reduce the risk of postoperative fever.
基金Supported by Capital Health Development Research Project,No.2020-2-2152National Natural Science Foundation of China,No.82472002.
文摘BACKGROUND KRAS mutation status and primary tumor location serve as critical prognostic factors for colorectal liver metastases(CLMs).Emerging evidence suggests a potential interaction between these two variables that may influence clinical outcomes.AIM To investigate the association of KRAS mutations with recurrence in patients with CLM who underwent radiofrequency ablation(RFA)according to the primary tumor location.METHODS This retrospective study analyzed 164 patients with KRAS-determined CLM treated with percutaneous RFA between January 2012 and December 2018.The clinicopathological characteristics,recurrence patterns,and survival outcomes were systematically evaluated.RESULTS A total of 164 patients(mean age:58.0±9.8 years,range:34-83 years)who underwent percutaneous RFA of 325 CLMs(mean size:2.2±1.0 cm,range:0.7-5.0 cm)were included in the study.Eighty-nine(54.3%)patients had wild-type KRAS,and 75(45.7%)patients had mutated KRAS.Compared with wild-type patients,patients with KRAS mutations presented significantly higher local tumor progression rates(30.7%vs 14.6%,P=0.013).Among 126 patients(76.8%)who experienced post-RFA recurrence,61.6%developed intrahepatic metastases,and 53.7%developed extrahepatic metastases.Primary tumor location significantly modified KRASrelated outcomes:Compared with wild-type patients,left-sided colorectal cancer(CRC)patients with KRAS mutations presented higher intrahepatic recurrence rates(77.2%vs 52.5%,P=0.003)and shorter median intrahepatic recurrence-free survival(15 vs 25 months,P=0.007).No significant differences in KRAS expression were detected in right-sided tumors.CONCLUSION KRAS mutation status predicts differential recurrence patterns after CLM ablation,with significant prognostic implications,specifically in left-sided CRCs.These findings underscore the importance of integrating molecular profiling and primary tumor characteristics in therapeutic decision-making for patients with metastatic CRC.
文摘Objective: To study the importance of percutaneous radiofrequency ablation (PRFA) guided by ultrasound for inoperable recurrent hepatocellular carcinoma.Methods: Forty-seven patients with inoperable recurrent hepatocellular carcinoma underwent percutaneous radiofrequency ablation (PRFA) under ultrasond between October 1999 and July 2001. Twenty-four patients had single recurrent tumor and 23 patients had multiple lesions. Twelve patients had single lesion with less than 3.5 cm in diameter. All patients were followed up to examine the value of AFP, MRI or CT after PRFA. Kaplan-Meier estimation was used to analyze the survival rate.Results: The 1-, 2- and 3-year survival rate in single lesion group was 65.2%, 37.5% and 37.5% respectively. The survival rate of 1 and 2 years was 41.7% and 19.5% in the multiple lesions group. The 1-, 2-and 3-year survival rate in single lesion groups with less than 3.5 cm in diameter was 83.3%, 51.4% and 51.4% respectively.Conclusion: PRFA is one of the important comprehensive methods for recurrent hepatocellular carcinoma. According to the size, number and recurrent time, PRFA can be performed separately or combined with transcatheter arterial chemoembolization for inoperable recurrent hepatocellular carcinoma. This method can control the recurrence and increase the survival rate effectively. Key words recurrence - hepatocellular cacinoma - radiofrequency ablation
基金Supported by Feng Chia University/Chung Shan Medical University,No.FCU/CSMU 112-001(to Peng CM and Liu YJ)Taiwan National Science and Technology Council,No.111-2314-B-035-001-MY3Taichung Armed Forces General Hospital,No.107A42.
文摘The management of early stage hepatocellular carcinoma(HCC)presents significant challenges.While radiofrequency ablation(RFA)has shown safety and effectiveness in treating HCC,with lower mortality rates and shorter hospital stays,its high recurrence rate remains a significant impediment.Consequently,achieving improved survival solely through RFA is challenging,particularly in retrospective studies with inherent biases.Ultrasound is commonly used for guiding percutaneous RFA,but its low contrast can lead to missed tumors and the risk of HCC recurrence.To enhance the efficiency of ultrasound-guided percutaneous RFA,various techniques such as artificial ascites and contrast-enhanced ultrasound have been developed to facilitate complete tumor ablation.Minimally invasive surgery(MIS)offers advantages over open surgery and has gained traction in various surgical fields.Recent studies suggest that laparoscopic intraoperative RFA(IORFA)may be more effective than percutaneous RFA in terms of survival for HCC patients unsuitable for surgery,highlighting its significance.Therefore,combining MIS-IORFA with these enhanced percutaneous RFA techniques may hold greater significance for HCC treatment using the MIS-IORFA approach.This article reviews liver resection and RFA in HCC treatment,comparing their merits and proposing a trajectory involving their combination in future therapy.
文摘BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice,yet the safety and effect of endobiliary radiofrequency ablation(EB-RFA)combined PTCD is rarely reported,in this article,we report our experience of EB-RFA combined PTCD in such patients.AIM To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice.METHODS Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected,the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases.The general conditions of all patients,preoperative tumour markers,total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB),alkaline phosphatase(ALP),and glutamyl transferase(GGT)before and on the 7th day after the procedure,as well as perioperative complications,stent patency time and patient survival were recorded.RESULTS All patients successfully completed the operation,TBIL and DBIL decreased significantly in all patients at the 7th postoperative day(P=0.009 and 0.006,respectively);the values of ALB,ALP and GGT also decreased compared with the preoperative period,but the difference was not statistically significant.Perioperative biliary bleeding occurred in 2 patients,which was improved after transfusion of blood and other conservative treatments,pancreatitis appeared in 1 patient after the operation,no serious complication and death happened after operation.Except for 3 patients with loss of visits,the stent patency rate of the remaining 14 patients was 100%71%and 29%at the 1^(st),3^(rd),and 6^(th)postoperative months respectively,with a median survival of 4 months.CONCLUSION EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety,which is worthy of further clinical practice.
基金Supported by Foundation Project in Guang'anmen Hospital,China Academy of Chinese Medical Sciences:2006 S 195
文摘Objective To explore the feasibility of electroacupuncture compound anesthesia in radiofrequency ablation for hypertrophic inferior turbinate.Methods The patients confirmed to the enrolled criteria were randomly divided into an observation group（n=31） and a control group（n=30）.In the observation group,electroacupuncture was applied to Sìbái（四白 ST 2）,Xiàguān（下关 ST 7）,Hégǔ（合谷 LI 4） and Zhīgōu（支沟 TE 6） on the left side for the anesthesia and the routine local anesthesia was done on the right side.In the control group,the routine local anesthesia was adopted on both sides.The feelings of pain,circulatory index and operation effect were observed and compared between the two groups.Results During radiofrequency ablation,the pain grades of two measurements on the left side and the 2nd measurement on the right in the observation group were all lower than those in the control group（all P〈0.05）.In the observation group,the pain grade on the left side was lower than that on the right side（P〈0.05）,and the systolic blood pressure and the heart rate were lower than those in the control group when undergoing the 2nd radiofrequency ablation on the right side and on the left side,respectively（all P〈0.05）.There was no significant difference in operation effect between the two groups.Conclusion Electroacupuncture compound anesthesia can meet the analgesia requirement of radiofrequency ablation for hypertrophic inferior turbinate,and would be helpful to prevent cyclic fluctuation during the operation at the same time.
文摘Objective A 7-year experience for the treatment strategy using mono- and bi-polar radiofrequency （RF） ablation procedures in a heterogeneous group of patients was reported. Methods Between July 2003 and May 2009, the data of 314 consecutive patients aged 13 -75 （48.70 ± 11.09 ）undergone the radiofrequency ablation procedure for atrial fibrillation （AF） associated with concomitant cardiac surgery were analyzed. Monopolar was used for 91 patients; Medtronic bi-polar RF ablation procedure for 92 patients and Atricure RF ablation procedure for 131 patients. All patients were combined with valve surgery. Regular follow-ups were performed at 3, 6 month after surgery. Results Hospital mortality after combined open heart and surgical RF ablation was 0 %. The success rates for sinus rhythm conversion with monopolar RF were 73.6 % immediately, 74. 7 % at 3 months, 79. 1% at 6 months ; with Medtronic bi- polar RF, the rates were 78.3 % immediately, 82. 8 % at 3 months, 84 % at 6 months ; with Atricure bi-polar RF, the rates were 82. 4 % immediately, 84. 1% at 3 months, 83.9 % at 6 months. Conclusions The use of RF ablation procedures is a safe and efficient option to cure AF during open heart surgery in a selective group of patients.
文摘The liver is a common location of both primary and secondary malignancies. For unresectable liver cancer, many local ablative therapies have been developed. These include e.g., percutaneous ethanol injection (PEI), percutaneous acetic acid injection, radiofrequency ablation (RFA), cryoablation, microwave ablation, laserinduced thermotherapy, and high-intensity focused ultrasound. RFA has recently gained interest and is the most widely applied thermoablative technique. RFA allows more effective tumor control in fewer treatment sessions compared with PEI, but with a higher rate of complications. However, there are certain circumstances where PEI therapy represents a better strategy to control liver tumors than RFA, especially in situations where RFA is difficult, for example when large vessels surround the tumor. In the context of hepatocellular carcinoma (HCC), both RFA and PEI are feasible and of benefit in non-operable patients. RFA seems superior to PEI in HCC > 2 cm, and the combination of interventions may be of benefit in selected patients. Liver resection is superior to RFA for patients with HCC meeting the Milan criteria, but RFA can be employed in tumors ≤ 3 cm and where there is an increased expected operative mortality. In addition, some lines of evidence indicate that RFA and PEI can be employed as a bridge to liver transplantation. The use of RFA in colorectal liver metastases is currently limited to unresectable disease and for patients unfit for surgery. The aim of this article is to summarize the current status of RFA in the management of liver tumors and compare it to the cheap and readily available technique of PEI.
文摘AIM:To investigate the major complications after radiofrequency ablation(RFA) for the treatment of liver tumors and analyze possible risk factors that precipitate these complications.METHODS:From March 2001 to April 2008,255 patients with liver tumors(205 male,50 female;age range,18-89 years;mean age,56.0 years) who received RFA were enrolled in this study.Of these patients,212 had hepatocellular carcinoma,39 had metastatic liver tumors and four had cholangiocellular carcinoma.One hundred and forty eight patients had a single tumor,and 107 had multiple tumors.Maximum diameter of the tumors ranged 1.3-20 cm(mean,5.1 cm).All patients were treated with a cooled-tip perfusion electrode attached to a radiofrequency generator(Radionics,Burlington,MA,USA).RFA was performed via the percutaneous approach(n = 257),laparoscopy(n = 7),or open surgical treatment(n = 86).The major complications related to RFA were recorded.The resultant data were analyzed to determine risk factors associated these complications.RESULTS:Among the 255 patients,425 liver tumors were treated and 350 RFA sessions were performed.Thirty-seven(10%) major complications were observed which included 13 cases of liver failure,10 cases of hydrothorax requiring drainage,three casesof tumor seeding,one case of upper gastrointestinal bleeding,one case ofintrahepatic abscess,one case of bile duct injury,one case of cardiac arrest,and five cases of hyperglycemia.Seven patients had more than two complications.Liver failure was the most severe complication and was associated with the highest mortality.Eleven patients died due to worsening liver decompensation.Child-Pugh classification(P = 0.001) and choice of approach(P = 0.045) were related to post-treatment liver failure,whereas patient age,tumor size and number were not significant factors precipitating this complication.CONCLUSION:RFA can be accepted as a relatively safe procedure for the treatment of liver tumors.However,attention should be paid to possible complications even though the incidences of these complications are rare.Careful patient selection and the best approach choice(percutaneous,laparoscopy,or laparotomy) will help to minimize the incidence and morbidity rate of complications which occur after RFA.
