Kwan N. Lau

International multicentre prospective study on microwave ablation of liver tumours: preliminary results

BACKGROUND Microwave ablation (MWA) is increasingly utilized in the treatment of hepatic tumours. Promising single-centre reports have demonstrated its safety and efficacy, but this modality has not been studied in a prospective, multicentre study. METHODS Eighteen international centres recorded operative and perioperative data for patients undergoing MWA for tumours of any origin in a voluntary Internet-based database. All patients underwent operative MWA using a 2.45-GHz generator with a 5-mm antenna. RESULTS Of the 140 patients, 114 (81.4%) were treated with MWA alone and 26 (18.6%) were treated with MWA combined with resection. Multiple tumours were treated with MWA in 40.0% of patients. A total of 299 tumours were treated in these 140 patients. The median size of ablated lesions was 2.5 cm (range: 0.5-9.5 cm). Tumours were treated with a median of one application (range: 1-6 applications) for a median of 4 min (range: 0.5-30.0 min). A power setting of 100 W was used in 78.9% of cases. Major morbidity was 8.3% and in-hospital mortality was 1.9%. CONCLUSIONS These multi-institution data demonstrate rapid ablation time and low morbidity and mortality rates in patients undergoing operative MWA with a high rate of multiple ablations and concomitant hepatic resection. Longterm follow-up will be required to determine the efficacy of MWA relative to other forms of ablative therapy.

Real-time three-dimensional guided ultrasound targeting system for microwave ablation of liver tumours: a human pilot study.

OBJECTIVES This study aimed to evaluate a novel three-dimensional ultrasound (US) guidance system for use in hepatic microwave ablation (MWA). METHODS An in vitro assessment was performed in which users with different degrees of experience were evaluated for accuracy in targeting phantom lesions embedded in agar using US alone, or US in conjunction with the InVision™ System (IVS). An eight-patient pilot trial of the IVS was then performed in the setting of open hepatic MWA, in which lesions would otherwise have been targeted with conventional US. RESULTS In vitro studies demonstrated that the IVS significantly improved targeting accuracy at all levels of operator experience (novice, beginner and expert). In the human trial, a total of 31 tumours were targeted and all lesions were hit in one pass, as assessed by independent US image observations. There were no adverse operative events; however, there was minor line-of-sight interference with the infra-red tracking mechanism when some lesions high on the dome of the liver were targeted. CONCLUSIONS The IVS significantly increased the accuracy of complex targeting procedures of phantom lesions and enhanced targeting in an eight-patient clinical pilot study. During the accrual phase of this pilot study, the development of improved non-optical tracking hardware obviated the requirement to maintain a direct line of sight. The trial was then halted prematurely in order to focus on the application of the IVS utilizing this non-optical modality.

Hepatic Tumor Ablation

Ablation of liver tumors is part of a multimodality liver-directed strategy in the treatment of various tumors. The goal of ablation is complete tumor destruction, and ultimately improvement of quality and quantity of life for the patient. Technology is evolving rapidly, with important improvements in efficacy. The current state of ablation technology and indications for ablation are described in this review.

Bile duct injury after single incision laparoscopic cholecystectomy.

This study notes that the development of single-incision laparoscopic surgery is not without risk and that obtaining the critical view in appropriately selected patients is essential for safe single-incision laparoscopic surgery.

Leptin inhibits hepatocellular carcinoma proliferation via p38-MAPK-dependent signalling

OBJECTIVES Obesity is a significant risk factor for many liver diseases, including hepatocellular carcinoma (HCC). Leptin has been identified as a central mediator of factors that regulate energy intake and expenditure, including appetite, metabolism and fat storage. The role of leptin in the initiation, development and progression of HCC remains poorly understood. The aims of this study were to determine the effect(s) of leptin on HCC cell proliferation and to identify potential signalling mechanism(s) by which leptin exerts these effects. METHODS Rat H4IIE HCC cells and H4IIE-derived HCC tumours were analysed for leptin receptor (LR) expression. H4IIE cells were treated with leptin (0-100 ng/ml) in the absence or presence of pharmacological inhibitors of p42/p44 mitogen-activated protein kinase (MAPK) (PD98059), p38-MAPK (SB202190) or Janus kinase-signal transducers and activators of transcription (JAK-STAT) (AG490; 10 µM) signalling. Cell proliferation was determined and signal pathway activity analysed. RESULTS Immunohistochemistry identified increased LR expression in HCC in human tissue. Leptin did not significantly affect H4IIE cell numbers in serum-depleted (0.1% [v/v] foetal bovine serum [FBS]) medium. However, leptin significantly inhibited serum-stimulated (1.0% [v/v] FBS) H4IIE proliferation. Immunoblot analysis demonstrated that leptin significantly activated p42/p44-MAPK, p38-MAPK and STAT3 signalling in a time-dependent manner. Pretreatment of H4IIE cells with SB202190 abrogated leptin-dependent inhibition of H4IIE proliferation, an effect not observed in cells pretreated with PD98059 or AG490. CONCLUSIONS Leptin inhibits HCC cell growth in vitro via a p38-MAPK-dependent signalling pathway. Identifying similar effects on tumour growth in vivo may provide an attractive therapeutic target for slowing HCC progression.

Evaluation of composite mesh for ventral hernia repair.

Composite mesh was associated with minimal intraabdominal adhesions, progressive in-growth of host tissue, and complete degradation of an internal polydioxanone ring that was of assistance in mesh positioning.

Pancreatic Resection in a Large Tertiary Care Community-Based Hospital: Building a Successful Pancreatic Surgery Program

Pancreatic resection can be performed safely in the community-based hospital setting only when appropriate systems are in place for patient selection and preoperative, operative, and postoperative care. Pancreatic surgery cannot be performed optimally without considerable investment in, and coordination of, multiple departments. Delivery of high-quality pancreatic cancer care demands a rigorous assessment of the hospital structure and the processes through which this care is delivered; however, when a hospital makes the considerable effort to establish the necessary systems required for delivery of quality pancreatic cancer care, the community and hospital will benefit substantially.

Hepatic Tumor Ablation: Application in a Community Hospital Setting

Primary liver tumors are a common clinical problem in the United States and worldwide. Resection has historically been used to treat liver lesions. Commonly used liver-directed therapies include transarterial chemoembolization, selective internal radiation therapy, and ablative therapy. Only ablative therapy can cause direct destruction of the targeted tissue. The commercially available modalities in the United States are all based on thermoablative technology. This article examines the various ablative technologies and their application, as well as how these procedures can be performed safely and with optimal outcomes, in a community cancer center.