Objective To summarize recent progress of microwave ablation combined with endoscopic technique for liver cancer. Method The literatures relevant to treatment of microwave ablation combined with endoscopic technique for liver cancer in recent years were identified by searching PubMed and CNKI, then summarized and reviewed. Results The treatment of endoscopic microwave ablation or it combined with hepatectomy, interventional embolization, neoadjuvant chemotherapy, and two-step hepatectomy could expand the treatment indications for liver cancer, increase the cure rate, and reduce the intraoperative bleeding, postoperative complications and recurrence. Conclusions Microwave ablation combined with endoscopic technique has less invasion and fast recovery for patient with liver cancer. Multi-disciplinary team collaboration and rational use of varied therapeutic methods in treatment of liver cancer could help to improve treatment effect and prolong survival time of patient.
ObjectivesTo systematically review the efficacy and safety of ultrasound-guided percutaneous microwave ablation versus traditional open surgical operation in the treatment of benign thyroid nodules.MethodsPubMed, The Cochrane Library, EMbase, CBM, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on ultrasound-guided percutaneous microwave ablation versus traditional open surgery for benign thyroid nodules from inception to June 30th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was then performed by RevMan 5.3 software.ResultsA total of 38 RCTs involving 4 078 patients were included. The results of meta-analysis showed that: ultrasound-guided percutaneous microwave ablation might be more effective than traditional open surgery for the treatment of benign thyroid nodules (RR=1.09, 95% CI 1.00 to 1.19, P=0.04), and compared with traditional open surgery, ultrasound-guided percutaneous microwave ablation reduced the rate of postoperative complication (RR=0.26, 95%CI 0.21 to 0.31, P<0.000 01), shortened postoperative hospital stay (MD=–3.60, 95%CI –4.04 to –3.15, P<0.000 01) and the time consumed in operation (MD=–48.79, 95%CI –54.16 to –43.41, P<0.000 01), and reduced operative blood loss (MD=–22.02, 95%CI–23.87 to –20.17, P<0.000 01). Meanwhile, microwave ablation reduced the elevated levels of serum IL-6 content (MD=–10.34, 95%CI –10.70 to –9.97, P<0.000 01), serum CRP content (MD=–9.70, 95%CI –10.95 to –8.44, P<0.000 01) and serum TNF-α content (MD=–7.94, 95%CI –9.00 to –6.88, P<0.000 01).ConclusionsCurrent evidence shows that ultrasound-guided percutaneous microwave ablation may improve clinical efficacy and can reduce postoperative complications, bleeding volume, operation time, hospitalization days and postoperative inflammatory reaction. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
This paper explored the feasibility of using ultrasonic Nakagami statistic parameter imaging to evaluate the thermal lesion induced by microwave ablation (MWA) in porcine models. In this paper, thermal lesions were induced in livers and kidneys in 5 swines using a clinical MWA system. During this treatment progress, ultrasonic radiofrequency (RF) data were collected. The dynamic changes of Nakagami parameter in the thermal lesion were calculated, and the ultrasonic B-mode images and Nakagami images were reconstructed simultaneously. The contrast-to-noise ratio (CNR) between the thermal lesion and the surrounding normal tissue was calculated over the MWA procedure. After MWA, a bright hyperechoic region appeared in the ultrasonic Nakagami image as an indicator of the thermal lesion and this bright spot enlarged with lesion development during MWA exposure. The mean value of Nakagami parameter in the liver and kidney increased from 0.78 and 0.79 before treatment to 0.91 and 0.92 after treatment, respectively. During MWA exposure, the mean values of CNR calculated from the Nakagami parameter increased from 0.49 to 1.13 in the porcine liver and increased from 0.51 to 0.85 in the kidney, which were both higher than those calculated from the B-mode images. This in vivo study on porcine models suggested that the ultrasonic Nakagami imaging may provide an alternative modality for monitoring MWA treatment.
Increasing peripheral pulmonary nodules are detected given the growing adoption of chest CT screening for lung cancer. The invention of electromagnetic navigation bronchoscope provides a new diagnosis and treatment method for pulmonary nodules, which has been demonstrated to be feasible and safe, and the technique of microwave ablation through bronchus is gradually maturing. The one-stop diagnosis and treatment of pulmonary nodules can be completed by the combination of electromagnetic navigation bronchoscopy and microwave ablation, which will help achieve local treatment through the natural cavity without trace.
The feasibility of ultrasound backscatter homodyned K model parametric imaging (termed homodyned K imaging) to monitor coagulation zone during microwave ablation was investigated. Two recent estimators for the homodyned K model parameter, RSK (the estimation method based on the signal-to-noise ratio, the skewness, and the kurtosis of the amplitude envelope of ultrasound) and XU (the estimation method based on the first moment of the intensity of ultrasound, X statistics and U statistics), were compared. Firstly, the ultrasound backscattered signals during the microwave ablation of porcine liver ex vivo were processed by the noise-assisted correlation algorithm, envelope detection, sliding window method, digital scan conversion and color mapping to obtain homodyned K imaging. Then 20 porcine livers’ microwave ablation experiments ex vivo were used to evaluate the effect of homodyned K imaging in monitoring the coagulation zone. The results showed that the area under the receiver operating characteristic curve of the RSK method was 0.77 ± 0.06 (mean ± standard deviation), and that of the XU method was 0.83 ± 0.08 (mean ± standard deviation). The accuracy to monitor the coagulation zone was (86 ± 10)% (mean ± standard deviation) by the RSK method and (90 ± 8)% (mean ± standard deviation) by the XU method. Compared with the RSK method, the Bland-Altman consistency for the coagulation zone estimated by the XU method and that of actual porcine liver tissue was higher. The time for parameter estimation and imaging by the XU method was less than that by the RSK method. We conclude that ultrasound backscatter homodyned K imaging can be used to monitor coagulation zones during microwave ablation, and the XU method is better than the RSK method.
ObjectiveTo evaluate the clinical feasibility and safety of CT-guided percutaneous microwave ablation for peripheral solitary pulmonary nodules.MethodsThe imaging and clinical data of 33 patients with pulmonary nodule less than 3 cm in diameter treated by CT-guided microwave ablation treatment (PMAT) in our hospital from July 2018 to December 2019 were retrospectively analyzed. There were 21 males and 12 females aged 38-90 (67.6±13.4) years. Among them, 26 patients were confirmed with lung cancer by biopsy and 7 patients were clinically considered as partial malignant lesions. The average diameter of 33 nodules was 0.6-3.0 (1.8±0.6) cm. The 3- and 6-month follow-up CT was performed to evaluate the therapy method by comparing the diameter and enhancement degree of lesions with 1-month CT manifestation. Short-term treatment analysis including complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) was calculated according to the WHO modified response evaluation criteria in solid tumor (mRECIST) for short-term efficacy evaluation. Eventually the result of response rate (RR) was calculated. Progression-free survival was obtained by Kaplan–Meier analysis.ResultsCT-guided percutaneous microwave ablation was successfully conducted in all patients. Three patients suffered slight pneumothorax. There were 18 (54.5%) patients who achieved CR, 9 (27.3%) patients PR, 4 (12.1%) patients SD and 2 (6.1%) patients PD. The short-term follow-up effective rate was 81.8%. Logistic analysis demonstrated that primary and metastatic pulmonary nodules had no difference in progression-free time (log-rank P=0.624).ConclusionPMAT is of high success rate for the treatment of solitary pulmonary nodules without severe complications, which can be used as an effective alternative treatment for nonsurgical candidates.
ObjectiveTo explore the clinical utility and safety of electromagnetic navigation bronchoscopy (ENB)-guided microwave ablation (MWA) in the patients with inoperable high-risk pulmonary nodules.MethodsClinical data of patients who were diagnosed with inoperable pulmonary nodules highly suspected as malignant tumors and treated with ENB-guided MWA in Zhongshan Hospital, Fudan University from December 2019 to September 2020 were retrospectively collected and analyzed to evaluate the efficacy and safety of the procedure. There were 6 males and 3 females aged 72.0 (59.5-77.0) years.ResultsTotally ENB-guided MWA was performed in 9 patients with 12 lesions. All patients suffered from at least one chronic comorbidity. The inoperable reasons included poor pulmonary function (55.6%), comorbidities of other organs which made the surgery intolerable (33.3%), multiple lesions in different lobes or segments (22.2%), personal wills (22.2%) and advanced in age (11.1%). The median diameter of nodules was 13.5 (9.5-22.0) mm and the median distance from the edge of nodules to pleura was 5.3 (1.8-16.3) mm. Bronchoscope maneuver to the targeted lesions was manipulated according to navigation pathway under visual and X-ray guidance and confirmed with radial ultrasound probe. Rapid on-site evaluation also helped with primary pathological confirmation of biopsy specimen. Among all the lesions, 4 adenocarcinoma, 1 non-small cell lung cancer-not otherwise specified and 2 inflammatory lesions were reported in postoperative pathological diagnosis, while no malignant cells were found in 5 specimens. The ablation success rate was 83.3% (10/12). For the two off-targeted lesions, percutaneous ablations were performed as salvage treatment subsequently. The median hospitalization time was 3.0 (2.0-3.0) days and no short-term complications were reported in these patients.ConclusionENB-guided MWA is a safe and effective procedure for patients with high-risk pulmonary nodules when thoracic surgery cannot be tolerated.
ObjectiveTo investigate the feasibility and safety of DynaCT microwave ablation (MWA) guided by 3D iGuide puncture technology for lung cancer.MethodsThe clinical data of 19 patients with primary or metastatic lung cancer who underwent DynaCT MWA from June 2019 to December 2020 in our hospital were retrospectively analyzed, including 15 males and 4 females with an average age of 64.9±11.7 years. The technical success rates, adverse reactions and complications, postoperative hospital stay, and local therapeutic efficacy were recorded.ResultsTechnical success rate was 100.0%. The mean time required to target and place the needle was 15.7±3.7 min and the mean ablation time was 5.7±1.6 min. Thirteen patients underwent biopsy synchronously before the ablation, and 10 (76.9%) patients had positive pathological results. The main adverse reactions were pain (7/19, 36.8%), post-ablation syndrome (4/19, 21.1%) and cough (2/19, 10.5%). The minor complications were pneumothorax (6/19, 31.6%), hemorrhage (5/19, 26.3%), pleural effusion (2/19, 10.5%) and cavity (1/19, 5.3%). Three patients had moderate pneumothorax and received closed thoracic drainage. The median hospitalization time after ablation was 2.0 (2.0, 3.0) d, and no patient died during the perioperative period. The initial complete ablation rate was 89.5% (17 patients) and the incomplete ablation rate was 10.5% (2 patients) at 1-month follow-up, and no local progression was observed.ConclusionDynaCT MWA of lung cancer under the guidance of 3D iGuide system is safe and feasible with a high short-term local control rate, but the long-term efficacy remains to be further observed.
The precise anatomical division of liver segments is the foundation of liver surgery, while the anatomical division of the S9 segment of liver is a further precise division of the caudate lobe of the liver. This article retrospectively analyzed and summarized the precise minimally invasive ablation and follow-up results of four representative lesions of the S9 segment of liver, including primary liver cancer, recurrent liver cancer, metastatic liver cancer, and focal liver hyperplasia, treated at Affiliated Dongguan Hospital of Southern Medical University. The aim of this study is to explore the minimally invasive ablation effect of lesions located at the S9 segment of liver under CT guidance.
ObjectiveTo evaluate the effectiveness and safety of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) combined with laparoscopic-assisted microwave ablation (Lap-MWA) for the liver resection in the treatment of unresectable primary hepatic carcinoma. Methods This study analyzed the clinical data of 12 hepatic carcinoma patients who underwent ALPPS combined with Lap-MWA for the liver resection from January 2019 to June 2021 in the Department of Hepato-Pancreato-Biliary Surgery of Qinzhou First People’s Hospital. The patients had insufficient future liver remnant (FLR) and different degrees of liver cirrhosis. The 1-stage ALPPS was to perform after the laparoscopic-assisted ligation of the portal vein of the loaded tumor. At the same time, the microwave ablation was used for the liver parenchyma segmentation under the guidance of laparoscopic ultrasound (LUS) without separating liver parenchyma. Other steps were the same as classic ALPPS. Results All the 12 patients successfully completed the operation. The 1-stage ALPPS lasted 90–130 min, (110.25±35.34) min; the blood loss was 80–140 mL, (100.37±42.24) mL. The interval between 2 stages was 12–16 d, (14.0±2.5) d. The FLR/standard liver volume (SLV) increased to (58.00±3.30) %. The 2-stage ALPPS lasted 120–180 min, (150±30) min; the blood loss was 300–1 200 mL, (453.50±107.70) mL; the hospital stay after 2 stages of ALPPS operations was 11–16 d, (14±2) d. Among all patients, 4 U of leukocyte suspension was transfused in 1 patient, and pleural ascites occurred in 3 patients. There were no serious complications such as liver failure and severe infection, and no death cases. The total hospital stay was 14–22 d, (17±3) d. After the 1-stage ALPPS, the total bilirubin, white blood cells, glutamic-pyruvic transaminase level increased (P＜0.05), and total bilirubin and white blood cells gradually returned to the normal level on the 5th day after 1-stage ALPPS. On the 1st day after finishing the 2-stage ALPPS, albumin and hemoglobin decreased, while white blood cells, total bilirubin, prothrombin time and glutamic-pyruvic transaminase increased in varying degrees (P<0.05). And on the 5th day after the 2-stage ALPPS, all indicators gradually returned to normal. All the patients were followed up for 6–30 months, (20±6) months. Two patients died of tumor recurrence and metastasis at 6.2 months and 13 months after the surgery, respectively. No recurrence was found in other patients, and their life quality was good. Conclusion Preliminary results of this study indicate that ALPPS combined with Lap-MWA is safe and effective for the treatment of unresectable primary hepatic carcinoma.