Clinical Applications of Radiofrequency Ablation for Hepatocellular Carcinoma
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Clinical Applications of Radiofrequency Ablation for Hepatocellular Carcinoma

Clinical Applications of Radiofrequency Ablation for Hepatocellular Carcinoma


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About the Book

This dissertation, "Clinical Applications of Radiofrequency Ablation for Hepatocellular Carcinoma" by Kwok-chai, Kelvin, Ng, 吳國際, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: ABSTRACT There is a wide range of applications of radiofrequency ablation (RFA) for patients with hepatocellular carcinoma (HCC). Despite its favorable reported survival results, RFA is associated with various unresolved problems. The objectives of the present study are to investigate the different aspects of clinical applications of RFA in the management of HCC patients. Retrospective analysis of prospectively collected database was performed to evaluate the research gaps of RFA for HCC. Because of the high tumor recurrence after RFA, the impact of tumor recurrence pattern on long-term patients' survival is of great importance for the clinician to optimize the treatment strategy. It has been shown that patients with local or same segment intrahepatic recurrence had better overall survival than those with different segment intrahepatic recurrence or extrahepatic metastasis. On multivariate analysis, the pattern of recurrence was the independent prognostic factor for overall survival after RFA. Effective treatment modalities were feasible in the majority of patients with local or same segment intrahepatic recurrence. Meanwhile, aggressive management approach in terms of preemptive liver transplantation may be necessary for patients with risk factors for the development of different segment recurrence. Safety and efficacy of RFA for perivascular HCC deserves in-depth investigation because of the well known "heat-sink" effect of intrahepatic blood flow and v the potential risk of portal vein thrombosis. Retrospective comparative study has shown no statistical difference between patients with and without perivascular HCC in treatment-related mortality and morbidity, complete ablation rate, local recurrence rate and overall survival rate. Open approach of RFA is the contributing factor for the safety and high efficacy of RFA for perivascular HCC. The comparisons of therapeutic effect between RFA and other treatment modalities for unresectable HCC and intrahepatic recurrence are poorly defined. For unresectable HCC, the present study has revealed a comparable survival outcome between RFA and transarterial chemoembolization (TACE) groups. More importantly, RFA was associated with more efficient tumor control than TACE, which was illustrated by the significantly longer median time to disease progression. For recurrent HCC, the short-term efficacy of RFA was shown to be comparable to that of hepatic re-resection, in terms of hospital mortality, complication rate, and the proportion of patients with residual tumor after treatment. However, RFA was associated with a higher tumor recurrence rate than hepatic re-resection. The novel use of RFA in the acute phase of ruptured HCC has never been reported. In fact, complete hemostasis could be achieved in all patients with RFA. In contrast, transarterial embolization (TAE) failed to control tumor bleeding in 13.4% of patients. As a salvage procedure, RFA has 100% successful rate in those patients who failed TAE. In addition, complete tumor ablation by RFA was achieved in 13.3% of vi patients. This reflects the unique of RFA in terms of achieving both hemostasis and tumor clearance. With the useful information concluded in this study, the management strategy of patients with HCC by RFA can be further refined and better survival outcome would be expected. vii DOI: 10.5353/th_b3955767


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Product Details
  • ISBN-13: 9781374673076
  • Publisher: Open Dissertation Press
  • Publisher Imprint: Open Dissertation Press
  • Height: 279 mm
  • No of Pages: 234
  • Weight: 830 gr
  • ISBN-10: 1374673072
  • Publisher Date: 27 Jan 2017
  • Binding: Hardback
  • Language: English
  • Spine Width: 14 mm
  • Width: 216 mm


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