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European Radiology

, Volume 21, Issue 12, pp 2584–2596 | Cite as

Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors: a systematic review

  • Luis Calzadilla Bertot
  • Masaya Sato
  • Ryosuke TateishiEmail author
  • Haruhiko Yoshida
  • Kazuhiko Koike
Interventional

Abstract

Objectives

Reported rates of major complications and mortality of radiofrequency ablation (RFA), microwave ablation (MWA) and percutaneous ethanol injection (PEI) for the treatment of liver tumours were substantially heterogeneous among studies. The aim was to analyse the mortality and major complication rates of percutaneous RFA, PEI and MWA.

Methods

MEDLINE and EMBASE search from January 1982 to August 2010. Randomised clinical trials and observational studies, age >18, more than 50 patients for each technique analysed, studies reporting mortality and major complications were included. Random effects model was performed, with assessment for heterogeneity and publication bias.

Results

Thirty-four studies including 9531, 1185, and 1442 patients for RFA, MWA, and PEI, respectively were included. For all ablative techniques pooled proportion mortality rate was 0.16% (95% confidence interval [CI], 0.10–0.24). Pooled mortality rate associated with RFA, PEI and MWA was 0.15% (0.08–0.23), 0.59% (0.14–1.3) and 0.23% (0.0–0.58) respectively. Pooled proportion of major complications was 3.29% (2.43–4.28). Major complication rates associated with RFA, MWA, and PEI was 4.1% (3.3–5.1), 4.6% (0.7–11.8) and 2.7% (0.28–7.4) respectively.

Conclusions

Percutaneous RFA, PEI and MWA can be considered safe techniques for the treatment of liver tumours.

Keywords

Liver neoplasms Ablation techniques Mortality Complications Meta-Analysis 

Abbreviations

HCC

Hepatocellular carcinoma

RFA

Radiofrequency ablation

PEI

Percutaneous ethanol injection

MWA

Microwave ablation

CI

Confidence interval

CRC

Colorectal cancer

CT

Computed tomography

MRI

Magnetic resonance imaging

SIR

Society of interventional radiology

Notes

Acknowledgement

This work was supported in part by Health Sciences Research Grants of The Ministry of Health, Labour and Welfare of Japan (Research on Hepatitis).The supporters had no role in study design; collection, analysis, interpretation of data; writing of the report or decision to submit the manuscript for publication.

References

  1. 1.
    Sutherland LM, Williams JA, Padbury RT, Gotley DC, Stokes B, Maddern GJ (2006) Radiofrequency ablation of liver tumors: a systematic review. Arch Surg 141:181–190PubMedCrossRefGoogle Scholar
  2. 2.
    Sherman M (2010) Hepatocellular carcinoma: epidemiology, surveillance, and diagnosis. Semin Liver Dis 30:3–16PubMedCrossRefGoogle Scholar
  3. 3.
    Yuen MF, Hou JL, Chutaputti A (2009) Hepatocellular carcinoma in the Asia pacific region. J Gastroenterol Hepatol 24:346–353PubMedCrossRefGoogle Scholar
  4. 4.
    Vanagas T, Gulbinas A, Pundzius J, Barauskas G (2010) Radiofrequency ablation of liver tumors (I): biological background. Medicina 46:13–17PubMedGoogle Scholar
  5. 5.
    Clinical Practice Guidelines for Hepatocellular Carcinoma—The Japan Society of Hepatology 2009 update. Hepatol Res 40(Suppl 1):2–144Google Scholar
  6. 6.
    Bruix J, Sherman M (2010) Management of hepatocellular carcinoma: an update. Hepatology (American Association for Study of Liver Disease website. Available at http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/HCCUpdate2010.pdf (Accessed December 28 2010))
  7. 7.
    Omata M, Lesmana LA, Tateishi R et al (2010) Asian Pacific Association for the Study of the liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 4:439–474PubMedCrossRefGoogle Scholar
  8. 8.
    Lencioni R (2010) Loco-regional treatment of hepatocellular carcinoma. Hepatology 52:762–773PubMedCrossRefGoogle Scholar
  9. 9.
    Lencioni R, Crocetti L, De Simone P, Filipponi F (2010) Loco-regional interventional treatment of hepatocellular carcinoma: techniques, outcomes, and future prospects. Transpl Int 23:698–703PubMedCrossRefGoogle Scholar
  10. 10.
    Curley SA, Marra P, Beaty K et al (2004) Early and late complications after radiofrequency ablation of malignant liver tumors in 608 patients. Ann Surg 239:450–458PubMedCrossRefGoogle Scholar
  11. 11.
    de Baere T, Risse O, Kuoch V et al (2003) Adverse events during radiofrequency treatment of 582 hepatic tumors. AJR Am J Roentgenol 181:695–700PubMedGoogle Scholar
  12. 12.
    Kasugai H, Osaki Y, Oka H, Kudo M, Seki T (2007) Severe complications of radiofrequency ablation therapy for hepatocellular carcinoma: an analysis of 3,891 ablations in 2,614 patients. Oncology 72(Suppl 1):72–75PubMedCrossRefGoogle Scholar
  13. 13.
    Tateishi R, Shiina S, Teratani T et al (2005) Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases. Cancer 103:1201–1209PubMedCrossRefGoogle Scholar
  14. 14.
    Crocetti L, de Baere T, Lencioni R (2010) Quality improvement guidelines for radiofrequency ablation of liver tumours. Cardiovasc Intervent Radiol 33:11–17PubMedCrossRefGoogle Scholar
  15. 15.
    Goldberg SN, Grassi CJ, Cardella JF et al (2005) Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology 235:728–739PubMedCrossRefGoogle Scholar
  16. 16.
    Omary RA, Bettmann MA, Cardella JF et al (2003) Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol 14:S293–S295PubMedGoogle Scholar
  17. 17.
    Chou R, Helfand M (2005) Challenges in systematic reviews that assess treatment harms. Ann Intern Med 142:1090–1099PubMedGoogle Scholar
  18. 18.
    Ioannidis JPA, Evans SJW, Gotzsche PC et al (2004) Better reporting of harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med 141:781–788PubMedGoogle Scholar
  19. 19.
    Loke YK, Price D, Herxheimer A, Caem G (2007) Systematic reviews of adverse effects: framework for a structured approach. BMC Med Res Methodol 7:32PubMedCrossRefGoogle Scholar
  20. 20.
    Dersimonian R, Laird N (1986) Metaanalysis in clinical-trials. Control Clin Trials 7:177–188PubMedCrossRefGoogle Scholar
  21. 21.
    Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101PubMedCrossRefGoogle Scholar
  22. 22.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634PubMedCrossRefGoogle Scholar
  23. 23.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRefGoogle Scholar
  24. 24.
    Higgins JPT GS Cochrane handbook for systematic reviews of interventions. Version 5.0.0 [updated February 2008]: The Cochrane Collaboration; . Available from: www.cochrane-handbook.org (Accessed August 28 2010)
  25. 25.
    Brunello F, Veltri A, Carucci P et al (2008) Radiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: a randomized controlled trial. Scand J Gastroenterol 43:727–735PubMedCrossRefGoogle Scholar
  26. 26.
    Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC (2005) Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut 54:1151–1156PubMedCrossRefGoogle Scholar
  27. 27.
    Shibata T, Maetani Y, Isoda H, Hiraoka M (2006) Radiofrequency ablation for small hepatocellular carcinoma: prospective comparison of internally cooled electrode and expandable electrode. Radiology 238:346–353PubMedCrossRefGoogle Scholar
  28. 28.
    Shiina S, Tagawa K, Niwa Y et al (1993) Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients. AJR Am J Roentgenol 160:1023–1028PubMedGoogle Scholar
  29. 29.
    Livraghi T, Giorgio A, Marin G et al (1995) Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology 197:101–108PubMedGoogle Scholar
  30. 30.
    Giorgio A, Tarantino L, de Stefano G et al (2000) Ultrasound-guided percutaneous ethanol injection under general anesthesia for the treatment of hepatocellular carcinoma on cirrhosis: long-term results in 268 patients. Eur J Ultrasound 12:145–154PubMedCrossRefGoogle Scholar
  31. 31.
    Livraghi T, Goldberg SN, Lazzaroni S et al (2000) Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology 214:761–768PubMedGoogle Scholar
  32. 32.
    Ikeda M, Okada S, Ueno H, Okusaka T, Kuriyama H (2001) Radiofrequency ablation and percutaneous ethanol injection in patients with small hepatocellular carcinoma: a comparative study. Jpn J Clin Oncol 31:322–326PubMedCrossRefGoogle Scholar
  33. 33.
    Buscarini L, Buscarini E, Di Stasi M, Vallisa D, Quaretti P, Rocca A (2001) Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term results. Eur Radiol 11:914–921PubMedCrossRefGoogle Scholar
  34. 34.
    Livraghi T, Solbiati L, Meloni MF et al (2003) Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 226:441–451PubMedCrossRefGoogle Scholar
  35. 35.
    Guglielmi A, Ruzzenente A, Battocchia A, Tonon A, Fracastoro G, Cordiano C (2003) Radiofrequency ablation of hepatocellular carcinoma in cirrhotic patients. Hepatogastroenterology 50:480–484PubMedGoogle Scholar
  36. 36.
    Buscarini E, Buscarini L (2004) Radiofrequency thermal ablation with expandable needle of focal liver malignancies: complication report. Eur Radiol 14:31–37PubMedCrossRefGoogle Scholar
  37. 37.
    Rhim H, Yoon KH, Lee JM et al (2003) Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. Radiographics 23:123–134PubMedCrossRefGoogle Scholar
  38. 38.
    Ruzzenente A, Manzoni GD, Molfetta M et al (2004) Rapid progression of hepatocellular carcinoma after radiofrequency ablation. World J Gastroenterol 10:1137–1140PubMedGoogle Scholar
  39. 39.
    Gillams AR, Lees WR (2004) Radio-frequency ablation of colorectal liver metastases in 167 patients. Eur Radiol 14:2261–2267PubMedCrossRefGoogle Scholar
  40. 40.
    Chen MH, Yang W, Yan K et al (2004) Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients–mathematic model, overlapping mode, and electrode placement process. Radiology 232:260–271PubMedCrossRefGoogle Scholar
  41. 41.
    Lu DS, Yu NC, Raman SS et al (2005) Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation. Hepatology 41:1130–1137PubMedCrossRefGoogle Scholar
  42. 42.
    Lu MD, Xu HX, Xie XY et al (2005) Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma: a retrospective comparative study. J Gastroenterol 40:1054–1060PubMedCrossRefGoogle Scholar
  43. 43.
    Raut CP, Izzo F, Marra P et al (2005) Significant long-term survival after radiofrequency ablation of unresectable hepatocellular carcinoma in patients with cirrhosis. Ann Surg Oncol 12:616–628PubMedCrossRefGoogle Scholar
  44. 44.
    Chen MH, Yang W, Yan K et al (2005) Treatment efficacy of radiofrequency ablation of 338 patients with hepatic malignant tumor and the relevant complications. World J Gastroenterol 11:6395–6401PubMedGoogle Scholar
  45. 45.
    Cabassa P, Donato F, Simeone F, Grazioli L, Romanini L (2006) Radiofrequency ablation of hepatocellular carcinoma: long-term experience with expandable needle electrodes. AJR Am J Roentgenol 186:S316–S321PubMedCrossRefGoogle Scholar
  46. 46.
    Solmi L, Nigro G, Roda E (2006) Therapeutic effectiveness of echo-guided percutaneous radiofrequency ablation therapy with a LeVeen needle electrode in hepatocellular carcinoma. World J Gastroenterol 12:1098–1104PubMedGoogle Scholar
  47. 47.
    Choi D, Lim HK, Rhim H et al (2007) Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: long-term results and prognostic factors in a large single-institution series. Eur Radiol 17:684–692PubMedCrossRefGoogle Scholar
  48. 48.
    Choi D, Lim HK, Rhim H et al (2007) Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy: long-term results and prognostic factors. Ann Surg Oncol 14:2319–2329PubMedCrossRefGoogle Scholar
  49. 49.
    Poggi G, Riccardi A, Quaretti P et al (2007) Complications of percutaneous radiofrequency thermal ablation of primary and secondary lesions of the liver. Anticancer Res 27:2911–2916PubMedGoogle Scholar
  50. 50.
    Livraghi T, Meloni F, Di Stasi M et al (2008) Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology 47:82–89PubMedCrossRefGoogle Scholar
  51. 51.
    Kondo Y, Yoshida H, Tateishi R, Shiina S, Kawabe T, Omata M (2008) Percutaneous radiofrequency ablation of liver cancer in the hepatic dome using the intrapleural fluid infusion technique. Br J Surg 95:996–1004PubMedCrossRefGoogle Scholar
  52. 52.
    Tsai WL, Cheng JS, Lai KH et al (2008) Clinical trial: percutaneous acetic acid injection vs. percutaneous ethanol injection for small hepatocellular carcinoma—a long-term follow-up study. Aliment Pharm Therapy 28:304–311CrossRefGoogle Scholar
  53. 53.
    Zavaglia C, Corso R, Rampoldi A et al (2008) Is percutaneous radiofrequency thermal ablation of hepatocellular carcinoma a safe procedure? Eur J Gastroenterol Hepatol 20:196–201PubMedCrossRefGoogle Scholar
  54. 54.
    Chen TM, Huang PT, Lin LF, Tung JN (2008) Major complications of ultrasound-guided percutaneous radiofrequency ablations for liver malignancies: single center experience. J Gastroenterol Hepatol 23:e445–e450PubMedCrossRefGoogle Scholar
  55. 55.
    Casaril A, Abu Hilal M, Harb A, Campagnaro T, Mansueto G, Nicoli N (2008) The safety of radiofrequency thermal ablation in the treatment of liver malignancies. Eur J Surg Oncol 34:668–672PubMedCrossRefGoogle Scholar
  56. 56.
    Sartori S, Tombesi P, Macario F et al (2008) Subcapsular liver tumors treated with percutaneous radiofrequency ablation: a prospective comparison with nonsubcapsular liver tumors for safety and effectiveness. Radiology 248:670–679PubMedCrossRefGoogle Scholar
  57. 57.
    Gillams AR, Lees WR (2009) Five-year survival in 309 patients with colorectal liver metastases treated with radiofrequency ablation. Eur Radiol 19:1206–1213PubMedCrossRefGoogle Scholar
  58. 58.
    Liang P, Wang Y, Yu X, Dong B (2009) Malignant liver tumors: treatment with percutaneous microwave ablation–complications among cohort of 1136 patients. Radiology 251:933–940PubMedCrossRefGoogle Scholar
  59. 59.
    Bouza C, Lopez-Cuadrado T, Alcazar R, Saz-Parkinson Z, Amate JM (2009) Meta-analysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma. BMC Gastroenterol 9:31PubMedCrossRefGoogle Scholar
  60. 60.
    Ong SL, Gravante G, Metcalfe MS, Strickland AD, Dennison AR, Lloyd DM (2009) Efficacy and safety of microwave ablation for primary and secondary liver malignancies: a systematic review. Eur J Gastroenterol Hepatol 21:599–605PubMedCrossRefGoogle Scholar
  61. 61.
    Shibata T, Iimuro Y, Yamamoto Y et al (2002) Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy. Radiology 223:331–337PubMedCrossRefGoogle Scholar
  62. 62.
    Llovet JM, Vilana R, Bru C et al (2001) Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology 33:1124–1129PubMedCrossRefGoogle Scholar
  63. 63.
    Livraghi T, Lazzaroni S, Meloni F, Solbiati L (2005) Risk of tumour seeding after percutaneous radiofrequency ablation for hepatocellular carcinoma. Br J Surg 92:856–858PubMedCrossRefGoogle Scholar
  64. 64.
    Stigliano R, Marelli L, Yu D, Davies N, Patch D, Burroughs A (2007) Seeding risk following percutaneous approach to hepatocellular carcinoma—seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma. What is the risk and the outcome? Seeding risk for percutaneous approach of HCC. Liver Transplant 13:1603–1603CrossRefGoogle Scholar
  65. 65.
    Imamura J, Tateishi R, Shiina S et al (2008) Neoplastic seeding after radiofrequency ablation for hepatocellular carcinoma. Am J Gastroenterol 103:3057–3062PubMedCrossRefGoogle Scholar
  66. 66.
    Latteri F, Sandonato L, Di Marco V et al (2008) Seeding after radiofrequency ablation of hepatocellular carcinoma in patients with cirrhosis: a prospective study. Dig Liver Dis 40:684–689PubMedCrossRefGoogle Scholar
  67. 67.
    Poon RT, Ng KK, Lam CM, Ai V, Yuen J, Fan ST (2004) Radiofrequency ablation for subcapsular hepatocellular carcinoma. Ann Surg Oncol 11:281–289PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2011

Authors and Affiliations

  • Luis Calzadilla Bertot
    • 1
  • Masaya Sato
    • 1
  • Ryosuke Tateishi
    • 1
    Email author
  • Haruhiko Yoshida
    • 1
  • Kazuhiko Koike
    • 1
  1. 1.Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan

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