Resection percutaneous

There are no clear recommendations concerning indications for percutaneous interventional procedures. It is uncertain whether the metastases have been completely removed when guiding is based on imaging techniques. Moreover, the extent of the placed necrosis can only be assessed in a limited way however, evaluation is more exact if the resected tissue is analyzed histologically. 

A 39-year-old army officer had bouts of palpitation and dizziness. There were no risk factors for chronic liver disease apart from a family history of hemochromatosis. His cardiovascular and nervous systems were normal but there was 5 cm hepatomegaly. Percutaneous liver biopsy showed grade 4 siderosis in parenchymal and non-parenchymal liver cells and a mild inflammatory infiltrate with minimal portal fibrosis. He had 45 liters of blood venesected over the next 18 months and a repeat biopsy 3 years later showed a non-cirrhotic liver with no stainable iron. He developed a non-resectable primary hepatocellular clear cell carcinoma 17 years after the initial diagnosis. 

Unresectable and chemorefractory malignant tumors in the liver are a major cause of death in solid tumors. Potentially curative surgery is uncommon for these patients. A number of liver-directed therapies are now available and are making important contributions to quality of life, prolonged time to liver progression, and overall survival. Limited surgery involving laparoscopy and percutaneous access approaches enables local tumor resection, cryotherapy, laser-induced interstitial thermotherapy, and radiofrequency ablation. 

Percutaneous Resection of Transitional Cell Carcinoma of the PC System 163... 

FrancicaG,MaroneG (1999) Ultrasound-guided percutaneous treatment of hepatocellular carcinoma by radiofrequency hyperthermia with a cooled-tip needle . A preliminary clinical experience. Eur J Ultrasound 9 145-153 Franco D, Capussotti L, Smadja C, Bouzari H, Meakins J, Kemeny F et al (1990) Resection of hepatocellular carcinomas. Results in 72 European patients with cirrhosis. Gastroenterology 98 733-738... 

ScHEELE et al. 1995). Therefore, surgical resection is still considered to be the gold standard in Hver metasta-ses, while chemotherapy and radiation therapy are seen as palliative treatment options. However, due to risk factors only 10 to 25% of aU patients suffering from Uver metastases are suitable candidates for Uver surgery. This has a major impact on the demand for minimally invasive treatments achieving an effective and reproducible percutaneous tumor ablation while simultaneously lowering both morbidity and costs. 

Percutaneous thermal ablation therapies have been receiving increasing attention as a potential primary treatment for focal HCC and fiver metastases. Possible advantages of ablative therapies as compared to surgical resection include a lower morbidity and mortality... 

Nevertheless, the indication of percutaneous microwave coagulation therapy as an alternative to hepatic resection should be limited to cases of a well-differentiated HCC tumor smaller than 2 cm up... 

Huang GT, Lee PH, Tsang YM, Lai MY, Yang PM, Hu RH, Chen PJ, Kao JH, Sheu JC (2005) Percutaneous ethanol injection versus surgical resection for the treatment of small hepatocellular carcinoma a prospective study. Ann Surg 242 36-42... 

Sakamoto M, Hirohashi S (1998) Natural history and prognosis of adenomatous hyperplasia and early hepatocellular carcinoma multi-institutional analysis of 53 nodules followed up for more than 6 months and 141 patients with single early hepatocellular carcinoma treated by surgical resection or percutaneous ethanol injection. Jpn J Clin Oncol 28 604-608... 

Fig. 3.3.1. This flowchart illustrates the algorithm used for selecting the appropriate treatment option for patients with hepatocellular carcinoma (HCC) including surgical resection, transplantation, radiofrequency ablation RFA)y transarte-rial chemoembolization (TAC ), new agents such as selective internal radiation therapy (SIRT)y systemic therapy and best supportive care. RFA is offered to patients with early-stage HCC with a single tumor smaller than 5 cm or as many as three lesions, each smaller than 3 cm, good performance status and evidence for neither vascular invasion nor extrahepatic tumor spread based on clinical and imaging flndings. (M Metastases, N nodules, PEI percutaneous ethanol injection, PST performance status test.) "Cadaveric liver transplantation or living donor liver transplantation With permission from Llovet et al. (2003) Lancet 362 1907-1917...

Lai EC, Ean ST, Lo CM, Chu KM, Liu CL, Wong J (1995) Hepatic resection for hepatocellular carcinoma. An audit of 343 patients. Ann Surg 221 291-298 Lencioni R, Bartolozzi C, Caramella D et al (1995) Treatment of small hepatocellular carcinoma with percutaneous ethanol injection. Analysis of prognostic factors in 105 Western patients. Cancer 76 1737-1746 Lencioni R, Cioni D, Crocetti L, Bartolozzi C (2004) Percutaneous ablation of hepatocellular carcinoma state-of-the-art. Liver Transpl 10 S91-S97... 

Sarasin FP, Giostra E, Mentha G, Hadengue A (1998) Partial hepatectomy or orthotopic liver transplantation for the treatment of resectable hepatocellular carcinoma A cost-effectiveness perspective. Hepatology 28 436-442 Tateishi R, Shiina S, Teratani T et al (2005) Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases. Cancer 103 1201-1209 Ulmer SC (2000) Hepatocellular carcinoma. A concise guide to its status and management. Postgrad Med 107 117-124... 

Between June 1993 and April 2007, 84 patients with 115 intrahepatic lesions were treated with MR-guided LITT. The male female ratio was 63 21 and 56 patients had percutaneous transarterial che-moembolization as their initial treatment. We also included patients with recurrent liver metastases after partial liver resection, patients with metastases in both liver lobes, patients with locally non-resect-able lesions, and patients who had general contraindications for surgery or refused surgical resection. 

Percutaneous ethanol injection (PBI) is a technique for the treatment of HCC which is now considered to represent a reliable alternative to surgical resection. Bthanol shows selective diffusion in HCC, due to the softer consistency and hypervascularity of these lesions it carries little or no risk to the remaining parenchyma. Livraghi et al. (1999), in a multicentric trial involving nine centers, observed in patients with solitary lesions of less than 5 cm diameter a 3-year survival rate of 79%, and a 5-year survival rate of 47%. The results obtained with PBI certainly compete with the results of surgery and are influenced by the size of the lesions and the severity of cirrhosis (Livraghi et al. 1995). 

Rossi S, Fornari F, Pathies C et al (1990) Thermal lesions induced by 480 kHz localized current field in guinea pig and pig liver. Tumori 76 54-57 Scheele J, Stang R, Altendorf-Hofmann A et al (1995) Resection of colorectal liver metastases. World J Surg 19 59-71 Siperstein AE, Berber E (2001) Cryoablation, percutaneous alcohol injection, and radiofrequency ablation for treatment of neuroendocrine liver metastases. World J Surg 25 693-696... 

Adson MA, Heerden van J, Adson MH, Wagner IS, Ilstrup DM (1984) Resection of hepatic metastases from colorectal cancer. Arch Surg 119 647-651 Amin Z, Lees WR, Bown SG (1993) Hepatocellular carcinoma CT appearance after percutaneous ethanol ablation therapy. Radiology 188 882-883 Ardalan B, Sridhar KS, Benedetto P et al (1991) A phase I, II study of high-dose 5-fluorouracil and high-dose leu-... 

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