Transarterial chemoembolization (TACE) is the current standard of care for patients with large or multinodular hepatocellular carcinoma (HCC), preserved liver function, absence of cancer-related symptoms, and no evidence of vascular invasion or extrahepatic spread [i.e., those classified as intermediate stage according to the Barcelona Clinic Liver Cancer (BCLC) staging system]. Furthermore, in clinical practice, many patients in the early stage (i.e., single nodule or up to 3 nodules under 3 cm) carrying contraindications to curative approaches - liver resection, liver transplantation (LT) or radiofrequency ablation (RFA) - are treated with TACE.
Surgical resection is generally considered to be the only curative treatment for patients with periampullary cancer or cancer of the pancreatic head. Obstructive jaundice due to distal biliary obstruction is the most common symptom in such patients. Preoperative biliary drainage (PBD) was introduced in the 1970s to relieve the obstruction and to reverse physiological dysfunction resulting from obstructive jaundice. PBD was previously considered to improve surgical outcomes in patients with malignant distal biliary obstruction who were undergoing curative resection, with many physicians electing to perform PBD in patients who were waiting for surgery. A number of PBD methods exist, including endoscopic plastic stenting, nasobiliary drainage, metallic stenting, and percutaneous drainage. However, the overall benefit of PBD is currently controversial.
The expanded indications of partial grafts in pediatric liver transplantation have reduced waiting list mortality. However, a higher morbidity is observed, including an increased rate of biliary complications (BCs). Factors such as the type of graft, the preservation methods applied, the donor characteristics, the type of biliary reconstruction, and the number of bile ducts in the liver graft influences the occurrence of these complications. Bile leaks and strictures comprise the majority of post-transplant BCs. Biliary strictures require a high grade of suspicion, and because most children have a bileo-enteric anastomosis, its diagnosis and management rely on percutaneous hepatic cholangiography and percutaneous biliary interventions (PBI). The success rates with PBI range from 70% to 90%. Surgery is reserved for patients who have failed PBI. BCs in children after liver transplantation have a prolonged treatment and are associated with a longer length of stay and higher hospital costs. However, with early diagnosis and aggressive treatment, patient and graft survival are not significantly compromised.
Hepatocellular carcinoma (HCC) is best treated by liver transplantation, but the applicability of transplantation is greatly limited. Tumor resection in partial hepatectomy is hence resorted to. However, in most parts of the world, only 20%-30% of HCCs are resectable. The main reason for such a low resectability is a future liver remnant too small to be sufficient for the patient. To allow more HCC patients to undergo curative hepatectomy, a variety of ways have been developed to increase the resectability of HCC, mainly ways to increase the future liver remnants in patients through hypertrophy. They include portal vein embolization, sequential transarterial chemoembolization and portal vein embolization, staged hepatectomy, two-staged hepatectomy with portal vein ligation, and Associating Liver Partition and Portal Vein Ligation in Staged Hepatectomy. Herein we review, describe and evaluate these different ways, ways that can be life-saving.
AIM: To determine utility of transplant liver biopsy in evaluating efficacy of percutaneous transluminal angioplasty (PTA) for hepatic venous obstruction (HVOO).
In the last years, the development in the oncology field has been huge and rapid. In particular, the evaluation of response to anti-tumour treatments has been being object of intense research, producing significant changes. Response assessment after therapy in solid neoplasias has always used radiological imaging techniques, with tumour size reduction representing a presumed therapeutic efficacy. However, with the introduction of anti-angiogenetic drugs the evaluation of tumour size has become unsuitable because some tumours, under treatment, show only tumour perfusion changes rather than lesion shrinkage. Between different imaging techniques with contrast-enhancement, contrast-enhanced ultrasound (CEUS) and, in particular, dynamic CEUS have arisen as a promising and non-invasive device for monitoring cancer treatments. Moreover, the introduction of perfusion software has even more refined the technique since it is able to provide quantitative parameters related to blood flow and blood volume that can be associated with tumour response and clinical outcome such as the progression free survival and the overall survival. Here, we give an overview of the current status of CEUS in monitoring hepatocellular carcinoma response to different kind of treatments.
Hepatocellular cancer is the 5th most common cancer in the world and the third cause of death by malignant disease. Locoregional therapies are the most usual treatment of choice for patients with early or intermediate stage of disease. The main diagnostic tools for the detection of recurrence are the radiological techniques such as 4-phase computed tomography or dynamic contrast enhanced magnetic resonance imaging. However, in order to achieve best evaluation of treatment outcome and recurrence rates, there is a great need for the identification of specific and easily measured circulating biomarkers. The aim of this review is to analyze the existing data considering the prognostic significance of changes of serum diagnostic markers such as alpha-fetoprotein, des-gamma-carboxy prothrombin, alpha-fetoprotein-L3, angiogenetic factors (vascular endothelial growth factor, hypoxia inducible factor-1a) and immune parameters before and after radiofrequency ablation or transarterial chemoembolization.
AIM: To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt (TIPSS) in refractory hepatic hydrothorax (RHH) in a systematic review and cumulative meta-analysis.
The prevalence of thyroid nodules found by means of palpation is approximately 5%, but an estimated 50% of unselected populations have nodules that can be discovered at ultrasonography (US). Ninety-five percent of all thyroid nodules are benign, and one-third of them show continuous growth. However, some of these nodules should be treated because patients report compression symptoms or cosmetic concerns. Although surgery is still the main therapeutic strategy, it carries a 2%–10% risk of complications such as hypocalcemia, transient or permanent recurrent laryngeal nerve palsy, bleeding, or postoperative infection. For this reason, various nonsurgical, minimally invasive techniques have been developed at specialized treatment centers. Percutaneous ethanol injection has been shown to be effective for cystic thyroid nodules; yet its application in benign solid nodules is limited due to the possibility of serious complications including recurrent nerve palsy, Horner syndrome, neck hematoma, thrombosis of the ipsilateral jugular vein, necrosis of the larynx and skin, or facial dysesthesia with increased tear flow. Innovative percutaneous thermal procedures such as US-guided laser or radiofrequency ablation can reduce the thyroid nodule size considerably. Although both procedures are considered safe, transient adverse effects including impaired vocal cord mobility have been observed.
Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy and the third leading cause of cancer-related death worldwide. Although thermal ablation, surgical resection, and orthotopic liver transplantation represent curative treatments for HCC, only 15% of patients with HCC are candidates for definitive therapy because of advanced multifocal intrahepatic disease, poor hepatic reserve, extrahepatic tumor spread, and/or scarcity of donor organs. Local-regional therapies, including transarterial chemoembolization and yttrium 90 (90Y) radioembolization, have promising roles in the management of HCC. In two randomized controlled trials, chemoembolization demonstrated improvement in survival in selected patients with intermediate-stage HCC.
Thermal ablation techniques, such as percutaneous microwave coagulation and radiofrequency ablation (RFA), were developed as percutaneous local treatments for small hepatocellular carcinoma (HCC), and RFA is now performed frequently. Although a sufficient margin of RFA is necessary to reduce local tumor progression, the shape of the ablated area is sometimes irregular because of the cooling effect of large vessels, and the ablation size is limited due to increased resistance and impedance after RFA alone for HCC. A reduction in blood flow can reportedly increase the area of tumor ablation in animals, and a reduction in the tumor arterial supply due to occlusion of either the hepatic artery with a balloon catheter or the feeding arteries with gelatin sponge particles has been shown to increase the ablated area in humans.
In the field of oncology, accurate liver imaging is critically important for appropriate management of cancer patients. The liver is the second most common site of metastatic disease after lymph node metastases and the most common metastatic site in patients with colorectal cancer. Primary liver tumors are common, with hepatocellular carcinoma (HCC) representing the most common primary hepatic malignancy and the third most common cause of cancer-related death worldwide. Accurate imaging techniques for early detection, staging, and monitoring of liver disease are of utmost importance.
Principles of evidence-based medicine were embraced by radiology later than by other specialties in clinical medicine. Although treatment efficacy is usually demonstrated by means of randomized controlled trials, the use of imaging is often based on lower levels of evidence. Currently, less than one-third of diagnostic imaging procedures performed routinely in clinical practice have sufficient evidence to support the procedure’s use. The adoption of evidence-based medicine in imaging has been delayed for several reasons, with continual technologic innovation being one of the most important. This is because imaging technology improves so rapidly that the evaluation of an existing imaging test may become outdated before the evaluation has been completed, especially when long-term patient outcome data are required.
Purpose: There have been few case reports describing cystic duct stent insertion in the management of acute cholecystitis secondary to benign disease with no case series published to date. We present our series demonstrating the role of cystic duct stents in managing benign gallbladder disease in those patients unfit for surgery.
Purpose: To evaluate the safety of radioembolization (RE) with 90Yttrium (90Y) resin microspheres depending on coiling or no-coiling of aberrant/high-risk vessels.
Cookies Sociales
Son esos botones que permiten compartir el contenido del sitio web en sus redes sociales (Facebook, Twitter y Linkedin, previo tu consentimiento y login) a través de sistemas totalmente gestionados por dichas redes sociales, así como los recursos (pej. videos) y material que se encuentra en nuestra web, y que de igual manera se presta y gestiona completamente por un tercero.
Si no acepta estas cookies, no podrá compartir nuestro contenido a través de los botones, y en su caso, no podrás visualizar el contenido de terceros que hayamos incrustado en el sitio.
No las utilizamos