Peter Schullian1, Edward Johnston2, Gregor Laimer1, Daniel Putzer1, Gernot Eberle1, Arno Amann3, Maria Effenberger4, Manuel Maglione5, Martin C Freund6, Alexander Loizides6, Reto Bale7. 1. Section of Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria. 2. The Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK. 3. Department of Internal Medicine V, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria. 4. Department of Internal Medicine I, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria. 5. Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria. 6. Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria. 7. Section of Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria. reto.bale@i-med.ac.at.
Abstract
OBJECTIVES: To assess the frequency of major complications after multi-probe stereotactic radiofrequency ablation (SRFA) in a large cohort of patients over 15 years and to elucidate risk factors for adverse events. MATERIALS AND METHODS: A retrospective study was carried out between July 2003 and December 2018. Seven hundred ninety-three consecutive patients (median 65.0 years (0.3-88), 241 women and 552 men, were treated in 1235 SRFA sessions for 2475 primary and metastatic liver tumors with a median tumor size of 3.0 cm (0.5-18 cm). The frequency of major complications was evaluated according to SIR guidelines and putative predictors of adverse events analyzed using simple and multivariable logistic regression. RESULTS: Thirty-day mortality after SRFA was 0.5% (6/1235) with an overall major complication rate of 7.4% (91/1235). The major complication rate decreased from 11.5% (36/314) (before January 2011) to 6.0% (55/921) (p = 0.001). 50.5% (46/91) of major complications were successfully treated in the same anesthetic session by angiographic coiling for hemorrhage and chest tube insertion for pneumothorax. History of bile duct surgery/intervention, number of coaxial needles, and location of tumors in segment IVa or VIII were independent prognostic factors for major complications following multivariable logistic regression analysis. Simple logistic regression revealed the number of tumors, tumor size, location close to the diaphragm, tumor conglomerate, and segment VII as other significant predictors. CONCLUSION: SRFA of liver tumors is safe and can extend the treatment spectrum of conventional RFA. Adaptations over time combined with increasing experience resulted in a significant decrease in complications. KEY POINTS: • In 1235 ablation sessions in 793 patients over 15 years, we found a mortality rate of 0.5% (6/1235) and an overall major complication rate of 7.4%, which fell from 11.5 (36/314) to 6.0% (55/921, p = 0.001) after January 2011, likely due to procedural adaptations. • History of bile duct surgery/intervention (p = 0.013, OR = 3.290), number of coaxial needles (p = 0.026, OR = 1.052), and location of tumors in segment IVa (p = 0.016, OR = 1.989) or VIII (p = 0.038, OR = 1.635) were found to be independent prognostic factors. • Simple logistic regression revealed that number of tumors, tumor size, location close to the diaphragm, tumor conglomerates, and segment VII were other significant predictors of major complications.
OBJECTIVES: To assess the frequency of major complications after multi-probe stereotactic radiofrequency ablation (SRFA) in a large cohort of patients over 15 years and to elucidate risk factors for adverse events. MATERIALS AND METHODS: A retrospective study was carried out between July 2003 and December 2018. Seven hundred ninety-three consecutive patients (median 65.0 years (0.3-88), 241 women and 552 men, were treated in 1235 SRFA sessions for 2475 primary and metastatic liver tumors with a median tumor size of 3.0 cm (0.5-18 cm). The frequency of major complications was evaluated according to SIR guidelines and putative predictors of adverse events analyzed using simple and multivariable logistic regression. RESULTS: Thirty-day mortality after SRFA was 0.5% (6/1235) with an overall major complication rate of 7.4% (91/1235). The major complication rate decreased from 11.5% (36/314) (before January 2011) to 6.0% (55/921) (p = 0.001). 50.5% (46/91) of major complications were successfully treated in the same anesthetic session by angiographic coiling for hemorrhage and chest tube insertion for pneumothorax. History of bile duct surgery/intervention, number of coaxial needles, and location of tumors in segment IVa or VIII were independent prognostic factors for major complications following multivariable logistic regression analysis. Simple logistic regression revealed the number of tumors, tumor size, location close to the diaphragm, tumor conglomerate, and segment VII as other significant predictors. CONCLUSION:SRFA of liver tumors is safe and can extend the treatment spectrum of conventional RFA. Adaptations over time combined with increasing experience resulted in a significant decrease in complications. KEY POINTS: • In 1235 ablation sessions in 793 patients over 15 years, we found a mortality rate of 0.5% (6/1235) and an overall major complication rate of 7.4%, which fell from 11.5 (36/314) to 6.0% (55/921, p = 0.001) after January 2011, likely due to procedural adaptations. • History of bile duct surgery/intervention (p = 0.013, OR = 3.290), number of coaxial needles (p = 0.026, OR = 1.052), and location of tumors in segment IVa (p = 0.016, OR = 1.989) or VIII (p = 0.038, OR = 1.635) were found to be independent prognostic factors. • Simple logistic regression revealed that number of tumors, tumor size, location close to the diaphragm, tumor conglomerates, and segment VII were other significant predictors of major complications.
Authors: Emily A Knott; Timothy J Ziemlewicz; Sam J Lubner; John F Swietlik; Sharon M Weber; Annie M Zlevor; Colin Longhurst; J Louis Hinshaw; Meghan G Lubner; Daniel L Mulkerin; Daniel E Abbott; Dustin Deming; Noelle K LoConte; Nataliya Uboha; Allison B Couillard; Shane A Wells; Paul F Laeseke; Marci L Alexander; Fred T Lee Journal: J Gastrointest Oncol Date: 2021-08
Authors: M J van Amerongen; P Mariappan; P Voglreiter; R Flanagan; S F M Jenniskens; M Pollari; M Kolesnik; M Moche; J J Fütterer Journal: Int J Comput Assist Radiol Surg Date: 2021-05-11 Impact factor: 2.924
Authors: Nikiforos Vasiniotis Kamarinos; Efsevia Vakiani; Mithat Gonen; Nancy E Kemeny; Carlie Sigel; Leonard B Saltz; Karen T Brown; Anne M Covey; Joseph P Erinjeri; Lynn A Brody; Etay Ziv; Hooman Yarmohammadi; Henry Kunin; Afsar Barlas; Elena N Petre; Peter T Kingham; Michael I D'Angelica; Katia Manova-Todorova; Stephen B Solomon; Constantinos T Sofocleous Journal: Cancers (Basel) Date: 2022-01-29 Impact factor: 6.639