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Radiofrequency ablation for subcapsular hepatocellular carcinoma.

AbstractBackground: Limited data from recent studies suggested an increased risk of bleeding complications, needle-track seeding, and local recurrence after radiofrequency ablation (RFA) of subcapsular hepatocellular carcinoma (HCC). Methods: Between May 2001 and October 2002, 80 patients underwent RFA of 104 HCC nodules. Forty-eight patients had subcapsular HCC (group I), whereas the other 32 patients did not have subcapsular HCC (group II). RFA was performed via celiotomy, laparoscopy, or a percutaneous approach. Subcapsular HCCs were ablated by indirect puncture through nontumorous liver, and the needle track was thermocoagulated. Results: There were no significant differences between groups in treatment morbidity (14.6% vs. 15.6%; P = .898), mortality (2.1% vs. 0%; P = 1.000), complete ablation rate after a single session (89.4% vs. 96.9%; P = .392), local recurrence rate (4.3% vs. 12.5%; P = .216), recurrence-free survival (1 year: 60.9% vs. 49.2%; P = .258), or overall survival (1 year: 88.3% vs. 79.4%; P = .441). After a median follow-up of 13 months, no needle-track seeding or intraperitoneal metastasis was observed. Conclusions: This study shows that the results of RFA for subcapsular HCCs are comparable to those of RFA for nonsubcapsular HCCs. Subcapsular HCC should not be considered a contraindication for RFA treatment.Background: Limited data from recent studies suggested an increased risk of bleeding complications, needle-track seeding, and local recurrence after radiofrequency ablation (RFA) of subcapsular hepatocellular carcinoma (HCC). Methods: Between May 2001 and October 2002, 80 patients underwent RFA of 104 HCC nodules. Forty-eight patients had subcapsular HCC (group I), whereas the other 32 patients did not have subcapsular HCC (group II). RFA was performed via celiotomy, laparoscopy, or a percutaneous approach. Subcapsular HCCs were ablated by indirect puncture through nontumorous liver, and the needle track was thermocoagulated. Results: There were no significant differences between groups in treatment morbidity (14.6% vs. 15.6%; P = .898), mortality (2.1% vs. 0%; P = 1.000), complete ablation rate after a single session (89.4% vs. 96.9%; P = .392), local recurrence rate (4.3% vs. 12.5%; P = .216), recurrence-free survival (1 year: 60.9% vs. 49.2%; P = .258), or overall survival (1 year: 88.3% vs. 79.4%; P = .441). After a median follow-up of 13 months, no needle-track seeding or intraperitoneal metastasis was observed. Conclusions: This study shows that the results of RFA for subcapsular HCCs are comparable to those of RFA for nonsubcapsular HCCs. Subcapsular HCC should not be considered a contraindication for RFA treatment.

Outcome after partial hepatectomy for hepatocellular cancer within the Milan criteria.

There is a trend to offer liver transplantation to patients with hepatocellular carcinoma (HCC) with tumour status within the Milan criteria but with preserved liver function. This study aimed to evaluate the outcome of such patients following partial hepatectomy as primary treatment.

Delayed portal vein thrombosis after experimental radiofrequency ablation near the main portal vein

Portal venous blood flow may protect adjacent tumour cells from thermal destruction with radiofrequency ablation (RFA). This study aimed to investigate the local effect of RFA on the main portal vein branch, and the completeness of cellular ablation in its vicinity, with or without a Pringle manoeuvre using a porcine model.

Alleviating the Burden of Small-for-Size Graft in Right Liver Living Donor Liver Transplantation Through Accumulation of Experience

The issue of small‐for‐size graft (SFSG) containing the middle hepatic vein in right liver living donor liver transplantation from 1996 to 2008 (n = 320) was studied. Characteristics of donors, grafts and recipients were comparable between Era I (first 50 cases) and Era II (next 270 cases) except that the median model for end‐stage liver disease (MELD) score was higher in Era I (29 vs. 24; p = 0.024). The median graft to standard liver volume ratio (G/SLV) in Era I was 49.0% (range, 32.8–86.2%), versus 49.3% (range, 28.4–89.4%) in Era II (p = 0.498). Hospital mortality rate, the study endpoint, dropped from 16.0% (8/50) in Era I to 2.2% (6/270) in Era II (p = 0.000). Univariate analysis showed that MELD score (p = 0.002), pretransplant hepatorenal syndrome (p = 0.000) and Era I (p = 0.000) were significant in hospital mortality. Logistic regression analysis showed that only Era I (relative risk 9.758; 95% confidence interval, 2.885–33.002; p = 0.000) was significant. In Era I, G/SLV<40% had a relative risk of 7.8 (95% confidence interval, 1.225–49.677; p = 0.030). The hospital mortality rates for G/SLV<40% were 50% (3/6) and 1.9% (1/52) in Era I and II respectively. In conclusion, through accumulation of experience, SFSG became less important as a factor in hospital mortality.

Impact of radiofrequency ablation on the management of patients with hepatocellular carcinoma in a specialized centre

Radiofrequency ablation (RFA) has been used increasingly in the treatment of hepatocellular carcinoma (HCC). The aim of this study was to investigate changes in the treatment pattern of primary HCC following the implementation of RFA in a specialized surgical centre.

Efficacy and safety of radiofrequency ablation for perivascular hepatocellular carcinoma without hepatic inflow occlusion

The role of radiofrequency ablation (RFA) for perivascular (up to 5 mm from the major intrahepatic portal vein or hepatic vein branches) hepatocellular carcinoma (HCC) is unclear because of possible incomplete tumour ablation and potential vascular damage. This study aimed to evaluate the safety and efficacy of RFA for perivascular HCC without hepatic inflow occlusion.

Randomized clinical trial of hepatic resection versus radiofrequency ablation for early-stage hepatocellular carcinoma.

Hepatic resection and radiofrequency ablation (RFA) are treatment options for early‐stage hepatocellular carcinoma (HCC). Whether tumour recurrence and long‐term survival favour either treatment has not been established. This randomized trial aimed to test the hypothesis that RFA is superior to hepatic resection in terms of lower tumour recurrence rate and better long‐term survival.

FTY720 suppresses liver tumor metastasis by reducing the population of circulating endothelial progenitor cells, myeloid-derived suppressor cells and regulatory T cells

P-203 DISSEMINATED NOCARDIOSIS: A RARE INFECTIOUS COMPLICATION FOLLOWING NON-HEART-BEATING DONOR LIVER TRANSPLANTATION. Santos JiménezGalanes, Juan Carlos Meneu Diaz, Baltasar Perez-Saborido, Almudena Moreno Elola-Olaso, Yiliam Fundora Suarez, Manuel Abradelo Usera, Alberto Gimeno Calvo, Enrique Moreno González. Surgery and Abdominal Organs Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain INTRODUCTION Nocardiosis is an infrequent disease that use to affect patients who present a cellular immunodeficiency, such as transplant recipients on immunosuppression treatment, and although uncommon associate high rates of morbidity and mortality. Disseminated Nocardiasis affecting central nervous system (CNS), abdomen, skin and lungs has been described in bone marrow, lung and kidney transplanted patients. However, to our knowledge, no cases involving these three structures have been reported in liver transplant recipients. CASE REPORT Herein, we report a case of CNS, pulmonary and cutaneous nocardiosis in a liver transplant recipient from a non-heart-beating donor due to hepatitis C virus related cirrhosis and hepatocellular carcinoma. At 7 postransplant month, patient was admitted at emergency department presenting bad general health status, fever, edema and subcutaneous nodules in legs. A computed tomography scan was performed revealing multiple nodules disseminated thorough both lungs, abdomen, brain a subcutaneous tissue. By these clinical and radiogical fi ndings needle biopsy was performed over one of the subcutaneous nodules. Cultures of the material tested positive for Nocardia farcinica. Thus, we started treatment with intravenous sulfamethoxazoletrimethoprim (SMZ-TMP) shifted after one month to oral. Radiological examination performed after two weeks of treatment showed a 70% reduction on subcutaneous, pulmonary and cerebral lesions. After six months of SMZTMP treatment, patient remained free of the symptoms, with involution of the subcutaneous nodules and signifi cant radiological improvement. CONCLUSION Among opportunistic infections appearing in liver transplant recipients, Nocardia spp. should have special consideration according to the success in early treated patients and bad prognosis in cases of delayed diagnose.This journal supplement labeled: The International Liver Transplantation Society: 16th Annual International Congress

Epithelial to mesenchymal transition in development of liver fibrosis in small-for-size fatty liver graft

P-203 DISSEMINATED NOCARDIOSIS: A RARE INFECTIOUS COMPLICATION FOLLOWING NON-HEART-BEATING DONOR LIVER TRANSPLANTATION. Santos JiménezGalanes, Juan Carlos Meneu Diaz, Baltasar Perez-Saborido, Almudena Moreno Elola-Olaso, Yiliam Fundora Suarez, Manuel Abradelo Usera, Alberto Gimeno Calvo, Enrique Moreno González. Surgery and Abdominal Organs Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain INTRODUCTION Nocardiosis is an infrequent disease that use to affect patients who present a cellular immunodeficiency, such as transplant recipients on immunosuppression treatment, and although uncommon associate high rates of morbidity and mortality. Disseminated Nocardiasis affecting central nervous system (CNS), abdomen, skin and lungs has been described in bone marrow, lung and kidney transplanted patients. However, to our knowledge, no cases involving these three structures have been reported in liver transplant recipients. CASE REPORT Herein, we report a case of CNS, pulmonary and cutaneous nocardiosis in a liver transplant recipient from a non-heart-beating donor due to hepatitis C virus related cirrhosis and hepatocellular carcinoma. At 7 postransplant month, patient was admitted at emergency department presenting bad general health status, fever, edema and subcutaneous nodules in legs. A computed tomography scan was performed revealing multiple nodules disseminated thorough both lungs, abdomen, brain a subcutaneous tissue. By these clinical and radiogical fi ndings needle biopsy was performed over one of the subcutaneous nodules. Cultures of the material tested positive for Nocardia farcinica. Thus, we started treatment with intravenous sulfamethoxazoletrimethoprim (SMZ-TMP) shifted after one month to oral. Radiological examination performed after two weeks of treatment showed a 70% reduction on subcutaneous, pulmonary and cerebral lesions. After six months of SMZTMP treatment, patient remained free of the symptoms, with involution of the subcutaneous nodules and signifi cant radiological improvement. CONCLUSION Among opportunistic infections appearing in liver transplant recipients, Nocardia spp. should have special consideration according to the success in early treated patients and bad prognosis in cases of delayed diagnose.This journal supplement labeled: The International Liver Transplantation Society: 16th Annual International Congress

MicroRNA signatures associated with acute phase small-for-size liver graft injury and tumor invasiveness

P-203 DISSEMINATED NOCARDIOSIS: A RARE INFECTIOUS COMPLICATION FOLLOWING NON-HEART-BEATING DONOR LIVER TRANSPLANTATION. Santos JiménezGalanes, Juan Carlos Meneu Diaz, Baltasar Perez-Saborido, Almudena Moreno Elola-Olaso, Yiliam Fundora Suarez, Manuel Abradelo Usera, Alberto Gimeno Calvo, Enrique Moreno González. Surgery and Abdominal Organs Transplantation Department, 12 de Octubre University Hospital, Madrid, Spain INTRODUCTION Nocardiosis is an infrequent disease that use to affect patients who present a cellular immunodeficiency, such as transplant recipients on immunosuppression treatment, and although uncommon associate high rates of morbidity and mortality. Disseminated Nocardiasis affecting central nervous system (CNS), abdomen, skin and lungs has been described in bone marrow, lung and kidney transplanted patients. However, to our knowledge, no cases involving these three structures have been reported in liver transplant recipients. CASE REPORT Herein, we report a case of CNS, pulmonary and cutaneous nocardiosis in a liver transplant recipient from a non-heart-beating donor due to hepatitis C virus related cirrhosis and hepatocellular carcinoma. At 7 postransplant month, patient was admitted at emergency department presenting bad general health status, fever, edema and subcutaneous nodules in legs. A computed tomography scan was performed revealing multiple nodules disseminated thorough both lungs, abdomen, brain a subcutaneous tissue. By these clinical and radiogical fi ndings needle biopsy was performed over one of the subcutaneous nodules. Cultures of the material tested positive for Nocardia farcinica. Thus, we started treatment with intravenous sulfamethoxazoletrimethoprim (SMZ-TMP) shifted after one month to oral. Radiological examination performed after two weeks of treatment showed a 70% reduction on subcutaneous, pulmonary and cerebral lesions. After six months of SMZTMP treatment, patient remained free of the symptoms, with involution of the subcutaneous nodules and signifi cant radiological improvement. CONCLUSION Among opportunistic infections appearing in liver transplant recipients, Nocardia spp. should have special consideration according to the success in early treated patients and bad prognosis in cases of delayed diagnose.This journal supplement labeled: The International Liver Transplantation Society: 16th Annual International Congress