Esophageal stenting after penetrating complete esophageal obstruction using a trocar stylet via a gastrostomy route: a case report.

Complete esophageal obstruction developed after radiation and endoscopic submucosal dissection therapy for a cervical esophageal cancer in a 77-year-old woman. After failure to recanalize the esophageal obstruction by endoscopic and catheterization techniques, the esophageal obstruction was penetrated using a trocar stylet needle via a gastrostomy route. A covered stent was placed across the esophageal obstruction, letting her take water and liquid food until she died 2 months later. There was no complication related to the procedures except transient chest discomfort and pain that subsided with symptomatic treatment.

Percutaneous radiologic gastrostomy in patients with malignant pharyngoesophageal obstruction.

OBJECTIVE: Percutaneous endoscopic gastrostomy is widely practiced, but we use interventional radiology techniques to perform percutaneous radiologic gastrostomy in cancer patients with conditions that prevent endoscope insertion due to pharyngoesophageal obstruction. This study retrospectively investigated the effectiveness of percutaneous radiologic gastrostomy at our hospital. METHODS: We investigated the medical records of 105 patients who underwent percutaneous radiologic gastrostomy between 2001 and 2011. The technique used for percutaneous radiologic gastrostomy comprised insufflation to dilate the stomach via a nasogastric tube, followed by fluoroscopically guided puncture and gastrostomy tube placement. In patients for whom a nasogastric tube could not be inserted, the stomach was punctured with a fine needle under ultrasonographic guidance and insufflated via this puncture needle to achieve dilation. RESULTS: Patients comprised 75 men and 30 women (mean age, 63 years). A nasogastric tube was used during percutaneous radiologic gastrostomy in 81 cases, but could not be used in 24. The percutaneous radiologic gastrostomy procedure was successful in all cases. Serious post-percutaneous radiologic gastrostomy complications comprised one case each of decreased hemoglobin requiring blood transfusion, pneumoperitonitis that was treated by a laparotomy and infected fistula requiring tube removal (3/105, 2.9%). Duration of gastrostomy tube placement was 1-731 days, and the outcome was death in 59 cases, hospital transfer in 23, tube removal in 18 and survival with gastrostomy tube in place in 5. CONCLUSIONS: Serious complications requiring treatment occurred in 2.9% of cases in which percutaneous radiologic gastrostomy was performed, with mostly good effectiveness. Percutaneous radiologic gastrostomy is feasible even for patients in whom a nasogastric tube cannot be inserted.

Computed tomography fluoroscopy-guided radiofrequency ablation following intra-arterial iodized-oil injection for hepatocellular carcinomas invisible on ultrasonographic images.

BACKGROUND: We aimed to evaluate therapeutic outcomes of radiofrequency (RF) ablation following intra-arterial iodized-oil injection for hepatocellular carcinomas (HCCs) invisible on ultrasonographic (US) images. MATERIALS AND METHODS: Informed consent was waived for this retrospective study approved by our institutional review board. Sixty-seven consecutive patients with 150 HCCs (mean diameter 1.3 ± 0.6 cm; range 0.5-4.2 cm) received 90 RF sessions following intra-arterial iodized-oil injection. Each patient had at least one HCC invisible on US images. Computed tomography (CT) fluoroscopy-guided RF ablation was performed within 1 week after the injection of iodized oil from feeding arteries of each tumor. Technical success was defined as a planned electrode placement and completion of ablation protocol. Technical success, complications, changes in liver function, local tumor progression, and survival were evaluated. RESULTS: All HCCs became visible on CT fluoroscopy after iodized-oil injection, and RF ablation was technically successful in all sessions (technical success rate, 100%, 90/90). Major complications occurred in 6 RF sessions (6.7%, 6/90), including hemorrhage (2.2%, 2/90), portal thrombosis (2.2%, 2/90), and pneumothorax (2.2%, 2/90). No significant deterioration in Child-Pugh score was found. The mean follow-up period was 23.2 ± 18.0 months. The cumulative local tumor progression rates and overall survival rates were, respectively, 3.9 and 82.7% at 1 year, 5.3 and 45.3% at 3 years, and 5.3 and 26.4% at 5 years. CONCLUSION: CT fluoroscopy-guided RF ablation following intra-arterial iodized-oil injection is a feasible, safe, and useful therapeutic option for HCCs invisible on US images.

Clinical utility of transarterial infusion chemotherapy using cisplatin-lipiodol emulsion for unresectable hepatocellular carcinoma.

BACKGROUND: We evaluated the clinical efficacy of transarterial infusion chemotherapy using a cisplatin-lipiodol emulsion for unresectable hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Fifty-seven patients with advanced HCC, with no indications for surgical resection or local ablative therapy, such as percutaneous ethanol injection and radiofrequency ablation, were enrolled in this retrospective study. RESULTS: Twelve patients were treated with cisplatin-alone at a dose of 65 mg/m(2) by infusion into the artery. Forty-two patients were treated with the same dose of cisplatin suspended in 1-10 ml of lipiodol (C/LPD). Cumulative survival rates in the cisplatin-treated group were 46.2% at one year, and 18.5% at two years, whereas these in the C/LPD group were 81.6% and 44.4%, respectively, with a significant difference between the two groups (p<0.01). In the cisplatin-treated group (n=13), no (0%) patients had a complete response (CR), two (15%) a partial response (PR), three (23%) no change (NC), and eight (62%) progressive disease (PD). In the C/LPD group (n=44), four (9%) patients had CR, 16 (35%) PR, 12 (26%) NC, and 12 (26%) PD. CR and PR were seen in 15% of the cisplatin-treated group and in 44% of the C/LPD group. C/LPD was significantly more effective than cisplatin-alone (p=0.039). Some patients showed tumor response to C/LPD after intra-arterial infusion of low-dose 5-fluorouracil. CONCLUSION: C/LPD produced superior effects compared to cisplatin-alone for unresectable HCC, causing no major side-effects, and increasing the survival rate.

Radiofrequency ablation for colorectal liver metastases: prognostic factors in non-surgical candidates.

PURPOSE: To determine prognostic factors in patients with colorectal liver metastases who were not surgical candidates and received liver radiofrequency (RF) ablation. MATERIALS AND METHODS: RF ablation was done for 141 colorectal liver metastases in 84 patients. There were 63 (75.0 %, 63/84) males and 21 (25.0 %, 21/84) females, with a mean age of 64.6 ± 10.3. The mean maximum tumor diameter was 2.3 ± 1.4 cm (range 0.5-9.0 cm). Extrahepatic metastases were associated at the time of liver RF ablation in 23 patients (27.4 %, 23/84), and 12 (14.3 %, 12/84) had lung metastases considered controllable by planned lung RF ablation. Prognostic factors were evaluated by univariate and multivariate analyses. RESULTS: There was no procedure-related mortality. The 1-, 3-, and 5-year overall survival rates were 90.6 % (95 %CI, 83.9-97.2 %), 44.9 % (95 %CI, 31.8-57.9 %), and 20.8 % (95 %CI, 7.3-34.3 %), respectively, with a median survival of 34.9 months. The univariate analysis showed that tumor diameter larger than 3 cm, tumor multiplicity, uncontrollable extrahepatic disease, and previous chemotherapy history were significantly worse prognostic factors. The former three factors remained significant for worse prognosis in the multivariate Cox model. Extrahepatic disease was not a prognostic factor when it could be controlled. CONCLUSION: Tumor size and number, and uncontrollable extrahepatic metastases were significant prognostic factors.

Incidence and cause of hypertension during adrenal radiofrequency ablation.

PURPOSE: To evaluate the incidence and cause of hypertension prospectively during adrenal radiofrequency ablation (RFA). METHODS: For this study, approved by our institutional review board, written informed consent was obtained from all patients. Patients who received RFA for adrenal tumors (adrenal ablation) and other abdominal tumors (nonadrenal ablation) were included in this prospective study. Blood pressure was monitored during RFA. Serum adrenal hormone levels including epinephrine, norepinephrine, dopamine, and cortisol levels were measured before and during RFA. The respective incidences of procedural hypertension (systolic blood pressure >200 mmHg) of the two patient groups were compared. Factors correlating with procedural systolic blood pressure were evaluated by regression analysis. RESULTS: Nine patients underwent adrenal RFA and another 9 patients liver (n = 5) and renal (n = 4) RFA. Asymptomatic procedural hypertension that returned to the baseline by injecting calcium blocker was found in 7 (38.9%) of 18 patients. The incidence of procedural hypertension was significantly higher in the adrenal ablation group (66.7%, 6/9) than in the nonadrenal ablation group (11.1%, 1/9, P < 0.0498). Procedural systolic blood pressure was significantly correlated with serum epinephrine (R (2) = 0.68, P < 0.0001) and norepinephrine (R (2) = 0.72, P < 0.0001) levels during RFA. The other adrenal hormones did not show correlation with procedural systolic blood pressure. CONCLUSION: Hypertension occurs frequently during adrenal RFA because of the release of catecholamine.

Lung radiofrequency ablation for the treatment of unresectable recurrent non-small-cell lung cancer after surgical intervention.

PURPOSE: A retrospective evaluation was done of clinical utility of lung radiofrequency (RF) ablation in recurrent non-small-cell lung cancer (NSCLC) after surgical intervention. METHODS: During May 2003 to October 2010, 44 consecutive patients (26 male and 18 female) received curative lung RF ablation for 51 recurrent NSCLC (mean diameter 1.7±0.9 cm, range 0.6 to 4.0) after surgical intervention. Safety, tumor progression rate, overall survival, and recurrence-free survival were evaluated. Prognostic factors were evaluated in multivariate analysis. RESULTS: A total of 55 lung RF sessions were performed. Pneumothorax requiring pluerosclerosis (n=2) and surgical suture (n=1) were the only grade 3 or 4 adverse events (5.5%, 3 of 55). During mean follow-up of 28.6±20.3 months (range 1 to 98), local tumor progression was found in 5 patients (11.4%, 5 of 44). The 1-, 3-, and 5-year overall survival rates were 97.7, 72.9, and 55.7%, respectively. The 1- and 3-year recurrence-free survival rates were 76.7 and 41.1%, respectively. Tumor size and sex were independent significant prognostic factors in multivariate analysis. The 5-year survival rates were 73.3% in 18 women and 60.5% in 38 patients who had small tumors measuring≤3 cm. CONCLUSION: Our results suggest that lung RF ablation is a safe and useful therapeutic option for obtaining long-term survival in treated patients.

Complications after 1000 lung radiofrequency ablation sessions in 420 patients: a single center's experiences.

OBJECTIVE: This study retrospectively evaluates complications after lung radiofrequency ablation (RFA). MATERIALS AND METHODS: Complications were assessed for each RFA session in 420 consecutive patients with 1403 lung tumors who underwent 1000 RFA sessions with a cool-tip RFA system. A major complication was defined as a grade 3 or 4 adverse event. Risk factors affecting frequent major complications that occurred with an incidence of 1% or more were detected using multivariate analysis. RESULTS: Four deaths (0.4% [4/1000]) related to RFA procedures occurred. Three patients died of interstitial pneumonia. The other patient died of hemothorax. The major complication rate was 9.8% (98/1000). Frequent major complications were aseptic pleuritis (2.3% [23/1000]), pneumonia (1.8% [18/1000]), lung abscess (1.6% [16/1000]), bleeding requiring blood transfusion (1.6% [16/1000]), pneumothorax requiring pleural sclerosis (1.6% [16/1000]), followed by bronchopleural fistula (0.4% [4/1000]), brachial nerve injury (0.3% [3/1000]), tumor seeding (0.1% [1/1000]), and diaphragm injury (0.1% [1/1000]). Puncture number (p < 0.02) and previous systemic chemotherapy (p < 0.05) were significant risk factors for aseptic pleuritis. Previous external beam radiotherapy (p < 0.001) and age (p < 0.02) were significant risk factors for pneumonia, as were emphysema (p < 0.02) for lung abscess, and serum platelet count (p < 0.002) and tumor size (p < 0.02) for bleeding. Emphysema (p < 0.02) was a significant risk factor for pneumothorax requiring pleural sclerosis. CONCLUSION: Lung RFA is a relatively safe procedure, but it can be fatal. Risk factors found in this study will help to stratify high-risk patients.

Midterm results of radiofrequency ablation versus nephrectomy for T1a renal cell carcinoma.

PURPOSE: The aim of this study was to retrospectively evaluate midterm results of renal radiofrequency (RF) ablation compared to the results after nephrectomy in patients with T1a renal cell carcinoma (RCC). MATERIALS AND METHODS: A total of 115 patients with a single RCC measuring

Radiofrequency ablation for the treatment of bone metastases from hepatocellular carcinoma.

OBJECTIVE: The objective of our study was to retrospectively evaluate the clinical utility of bone radiofrequency ablation in patients with bone metastases from hepatocellular carcinoma (HCC). MATERIALS AND METHODS: At three institutions, 40 consecutive HCC patients with 54 bone metastases received radiofrequency ablation. The mean maximum diameter of the bone metastases was 4.8 +/- 2.3 (SD) cm (range, 1.0-12.0 cm). The feasibility and safety of the procedure and the pain relief achieved from the procedure were reviewed. Technical success was defined as correct placement of the radiofrequency electrode into the tumor target and completion of the planned ablation protocol. Survival and prognostic factors were evaluated. RESULTS: Technical success was 100%. No major complication occurred aside from transient nerve injury in one patient (2.5%, 1/40). Pain relief was achieved in all patients with painful bone metastases except one (96.6%, 28/29). The respective 1-, 2-, and 3-year survival rates were 34.2% (95% CI, 19.2-49.1), 19.9% (95% CI, 7.0-32.8), and 10.0% (95% CI, 0-20.2), with a median survival time of 7.1 months. Complete ablation of bone metastases, a single bone lesion, negative alpha-fetoprotein levels, and the absence of viable intrahepatic lesions were significant factors for a better prognosis. The median survival time was, respectively, 12.5 months in 16 patients with negative alpha-fetoprotein levels, 16.8 months in 12 patients with complete tumor ablation, 16.8 months in 16 patients with a single bone metastasis, and 21.9 months in 17 patients with no viable intrahepatic HCCs. CONCLUSION: Bone radiofrequency ablation is a safe, useful, and feasible therapeutic option for relieving pain in patients with HCC bone metastases. Prognostic factors reported herein can facilitate stratification of patients with HCC bone metastases.

Percutaneous transhepatic drainage of inaccessible abdominal abscesses following abdominal surgery under real-time CT-fluoroscopic guidance.

This study evaluated the safety, feasibility, and clinical utility of transhepatic drainage of inaccessible abdominal abscesses retrospectively under real-time computed tomographic (CT) guidance. For abdominal abscesses, 12 consecutive patients received percutaneous transhepatic drainage. Abscesses were considered inaccessible using the usual access route because they were surrounded by the liver and other organs. The maximum diameters of abscesses were 4.6-9.5 cm (mean, 6.7 +/- 1.4 cm). An 8-Fr catheter was advanced into the abscess cavity through the liver parenchyma using real-time CT fluoroscopic guidance. Safety, feasibility, procedure time, and clinical utility were evaluated. Drainage catheters were placed with no complications in abscess cavities through the liver parenchyma in all patients. The mean procedure time was 18.8 +/- 9.2 min (range, 12-41 min). All abscesses were drained. They shrank immediately after catheter placement. In conclusions, this transhepatic approach under real-time CT fluoroscopic guidance is a safe, feasible, and useful technique for use of drainage of inaccessible abdominal abscesses.

A case report of 20 lung radiofrequency ablation sessions for 50 lung metastases from parathyroid carcinoma causing hyperparathyroidism.

A 47-year-old man presented with multiple lung metastases from parathyroid carcinoma that caused hyperparathyroidism and refractory hypercalcemia. Lung radiofrequency (RF) ablation was repeated to decrease the serum calcium and parathyroid hormone levels and improve general fatigue. Pulmonary resection was combined for lung hilum metastases. The patient is still alive 4 years after the initial RF session. He has received 20 RF sessions for 50 lung metastases during this period.

Massive hemoptysis from pulmonary artery pseudoaneurysm caused by lung radiofrequency ablation: successful treatment by coil embolization.

A 75-year-old man received lung radiofrequency (RF) ablation to treat lung metastases from hepatocellular carcinoma. Massive hemoptysis occurred 1 week after lung RF ablation. Emergent contrast-enhanced CT and pulmonary arteriography revealed a pulmonary artery pseudoaneurysm, which was embolized with coils. The postembolization course was uneventful. Hemoptysis did not recur for 5 months.

Long-term results of radiofrequency ablation in colorectal lung metastases: single center experience.

This study was undertaken to evaluate long-term results of radiofrequency (RF) ablation in patients with colorectal lung metastases and to stratify patients benefitting from lung RF ablation. Lung RF ablation was performed in 78 patients with 198 colorectal lung metastases. Safety, local tumor progression, and survival were evaluated retrospectively. The mean follow-up period after the 140 lung RF ablation sessions was 24.6+/-7.6 months. Pneumothorax and pleural effusion requiring chest tube placement occurred respectively in 18 (12.9%, 18/140) and 2 (1.4%, 2/140) sessions. The respective 1-, 3- and 5-year local tumor progression rates were 10.1% (95% CI, 2.9-17.3%), 20.6% (95% CI, 8.9-22.2%) and 20.6% (95% CI, 8.9-22.2%). The 1-, 3- and 5-year survival rates were 83.9% (95% CI, 75.2-92.7%), 56.1% (95% CI, 41.7-70.5%) and 34.9% (95% CI, 18.0-51.9%), with median survival time of 38.0 months. Univariate analysis revealed maximum tumor diameter of 3 cm or less, single-lung metastasis, lack of extrapulmonary metastasis and normal carcinoembryonic antigen (CEA) level as better prognostic factors. The latter two were significant independent prognostic factors. The 1-, 3- and 5-year survival rates were 97.7% (95% CI, 93.3-100%), 82.5% (95% CI, 68.2-96.8%) and 57.0% (95% CI, 34.7-79.2%) in 54 patients with no extrapulmonary metastases and 96.9% (95% CI, 90.8-100%), 86.1% (95% CI, 71.1-100%) and 62.5% (95% CI, 36.3-88.6%) in 33 patients with negative CEA levels. Lung RF ablation is a safe and useful therapeutic option. These identified prognostic factors will help to stratify patients who benefit from lung RF ablation.