The understanding of Radio frequency Ablation on the primary HCC &the metastatic HCC.
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Transcript of The understanding of Radio frequency Ablation on the primary HCC &the metastatic HCC.
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Moon-kyu Kwon, il-kwon Han,Ji-sang Jung, Soo-jung Yoon,Je-hoon Yoo, *Ha-jung Joo.
The understanding of Radio frequency Ablation on the primary HCC &th
e metastatic HCC.
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RFA(Radiofrequency Ablation) Of Understanding
RFA is ?The co-relationships of the size and the number of tumor on the therapy.The comparison of percutaneous RFA & The comparison of percutaneous RFA & RFA after an open surgery.RFA after an open surgery.
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RF(Radiofrequency )is?
Radiofrequency라디오 송신 주파수 300-1200Khz
RFA400 -500kHZ 교류전류
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Principles Of RFA
Alternating Electrical Current
Ionic agitation
Coagulation Necrosis
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RF Mechanism Electric circuit
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RF Electrode Mechanism
Roll-Roll-offoff
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Co-relation of Power & Impedance
RadioFrequency AblationIn Vitro Liver (Typical)
Voltage Constant Throughout
0
20
40
60
0 1 2 3 4 5 6 7 8 9 10
Time (Min.)
Pow
er (W
.) &
Impe
danc
e(W
)
Power Rises asImpedance Falls
Power Falls asImpedance Rises
POWER
IMPEDANCE
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Depolyment ofRF Electroid
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US monitoring of Ablation
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Percutaneous RFA of liver metastases
Radiofrequency ablation of the liver: current status
American Journal of Roentgenology. 176:3-16, 2001 Jan
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Major Complication of RF AblationThe Korean Study Group of Radiofrequency Ablation
51 of 1154 patients (3.3%)hepatic abscess (n=13, 0.8%)peritoneal hemorrhage (n=7, 0.5%)ground pad burn (n=6, 0.4%)pneumothorax or hemothorax (n=6, 0.4%)biloma (n=3, 0.2%)sepsis, hepatic infarction, hepatic failure, bile duct injury, vasovagal reflex, massive AV shunt,diaphragmatic injury, renal infarct, gastric ulcer, pseudoaneursym of abdominal wall, transient ischemic attack, colonic perforation
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After Intra-op RF Ablation
Pre-Procesure MRI
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Contraindication of RFA
Prothrombin time: < 50%. Platelet count: <50.000/ℓ.Ascites Patient.Severe lung dysfunctionAcute Infection Symptom.Metastasis to another organ except liver.Portal vein tumor thrombosisHepatic encephalopathyImmunocompromised patientPregnant patient
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Indication of RFA
Primary or Metastatic hepatic tumors5cm or smallerFour fewer number
cf) Severance:5cm(single),3cm(3 ea)
1cm or more deep to liver capsule2cm or away from large vessels(Heat sink Effect)
Dodd et al radiographic2000
15 Primary HCC M/59
Percutaneous RFA
F/U 48 HrsF/U 48 Hrs
Pre CTPre CT Tx SonoTx Sono
F/U 3MF/U 3M
M/50M/50
HCCHCC
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M/62Rectal
ca
Pre Intra-op RFA CT
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M/62Rectal
ca
Intra-op RFA ( (2 weeks f/u)
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M/62Rectal cancer
Intra-op RFA ( (1 Year f/u)
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M/60Rectal cancer with multiple liver metastasis
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Intraoperative RF Ablation After Mile’s op.
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RFA(Radiofrequency Ablation) Of Understanding
RFA is ?The co-relationships of the size and the number of tumor on the therapy.The comparison of percutaneous RFA & The comparison of percutaneous RFA & RFA after an open surgery.RFA after an open surgery.
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Object
Duration: 2002, 3. ~ 2003, 5.Pt: Total : 73 (m/52 , f/21)Average year: 575cm < , 4ea <= : A group5cm >= , 3ea >= : B groupRFA after an open surgery : C groupPercutaneous RFA : D group
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Material
Leveen needle : 2.0cm, 3.0cm, 3.5cm, 4.0cmGenerator: RF3000 (Power 200W)Ground pad : 4ea
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Evaluation of Therapy
High echogenecity on US after RFA.Difficult to Differential diagnosis remaining tumor.
48Hrs & 3M F/U ㅡ sequential Liver CTInitial CT Comparison.DDx by Contrast Media enhancement.
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Procedure of RFA 1
After Open surgery :Grounding pad contact to each on two thigh.Under general anesthesia.Sono guiding puncture.
Percutaneous RFA :Demerol 50mg Im injection(pre 30min).Grounding pad contact to each on two thigh.Fentanyl citrat 100ug Iv inj(start time).Sono guiding puncture.
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Procedure of RFA 2
RF generation :Needle 100c10 min ~ 15 min
Due to size and number of tumorMove & Repeat ablation.
Fully high Echo checkF/u: 48Hrs ,3Months (Sequential Liver CT exam).
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Result 1
0102030405060708090
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PrimaryHcc
MetastasisHcc
Recur rate
A (5cm<,4ea <=)그룹B (5cm>=, 3ea>=)그룹
5
19
7
42
8.3%
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Conclusion 1
The sizes and the numbers of the lesion were contributing a signicant effect
on the therapy. Size & number ↓ : Therapy effect ↑
Primary HCC> Metastasis HCC
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Result 214
101011
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2 21 1
011
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OFTEN SURGERY WITH RFA(C group) PERCUTANEOUS WITH RFA(D group)
HCCRECTAL CACOLON CASTOMACHBREST CAGB CAPANCREST CA
N=37 N=36
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Result 2-1Often Surgery With RFAOften Surgery With RFA Percutaneous With RFAPercutaneous With RFA
PainPain LOWLOW HIGHHIGH
ApproachableApproachable EASYEASY DIFFICULTDIFFICULT
Bleeding controlBleeding control EASYEASY DIFFICULTDIFFICULT
ComplicationComplication LOWLOW HIGHHIGH
One-step surgical One-step surgical approach to primary approach to primary
lesionlesion
POSSIBLEPOSSIBLE IMPOSSIBLEIMPOSSIBLE
concentration of operatorconcentration of operator GOODGOOD BADBAD
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Conclusion 2
RFA after an open surgery,father than the percutaneous RFA ,had better result in perfection.
Easy Approaching to lesion.Hemostatic during hemorrhagic situationPatient’ control.The same time,metastastic hematoma in surgical method.
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Perspective of RFA
Reducing blood flow during ablation therapy.Total portal inflow occlusion.Angiographic balloon occlusion.Embolization prior to ablation.
Combining thermal ablation with chemotherapy.Co-access needle use.
(Biopsy,One puncture site channel use RFA)
Lung ca, bone ca, breast, renal…(Primary ca).