- Email: [email protected]
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where they trained as well as the referring patterns at each institution. In the process of developing an interventional oncology service, operators should choose first cases wisely. In a chemoembolization practice, initial focus should be on patients with well preserved liver function and hepatopedal portal venous flow. For RFA, treatment of small tumors will lead to the most satisfying results in a single session. If there is doubt about the ability to treat the entire lesion, one should discuss with the patient that more than one session may be needed or combine radiofrequency ablation may with chemoembolization to maximize effect. Radiofrequency ablation of tumors in challenging locations such as the dome of the liver provide specific challenges and risks such as diaphragmatic thermal injury or pneumothorax. Even with experience, it is important to discuss the potential for these complications with patients prior to the procedure. For referring physicians, informed solid post-procedural management will be an important reassurance that the IR they are sending their patients to is clinically able to treat and manage patients with complex issues. 4:20 p.m.
NET David Madofj, MD MD Andel'Son Cancer Center Houston, TX 4:35 p.m. BREAK
Taking Care of Your Patient: Symptom Management and Palliative Care Moderator: Michael C. Soulen, MD 4:50 p.m.
When Enough is Enough: The Intersection of Interventional Radiology and Palliative Care David Weissman, MD
5:50 p.m. Complications After Catheter-based Therapy Jose 1. Bilbao, MD, PhD Clinica Universitaria De Navarra Pamplona 6:10 p.m. Complications After Ablative Therapy Thierry de Baere, MD Institut Gustave Roussy Villejuif, France Radiofrequency (RF) is one of the most promising imaging-guided thermal ablation techniques used to treat liver, lung, bones, kidney and other tumors. Lessons learned from pioneers in the field of complications can lower your rate of complications by selecting appropriate patients and tumors, providing appropriate peri-ab-
P18
!ation cares, and recognizing the complications earlier enough to proVide adequate treatment. This syllabus will be limited to liver and lung. LIVER
RF ablation of liver tumors is performed either percutaneously, or during open surgelY as an adjunct to liver resection to destroy unresectable tumors, or less frequently during laparoscopy. Todate, more than 10,000 radiofrequency procedures in the liver have been reported in publications, and the technique is considered relatively safe with a mortality rate of 0 to 0.9 % , and a major complication rate of 2 to 6% [1-4]. Complication rate is lower for percutaneous RF than for surgical procedures (1, 2, 4].
Infection Abscess is the more frequent clinically symptomatic complication after radiofrequency [2, 3, 5]. This complication raises the question of prophylactic antibiotherapy but no clear cut recommendations can be given because there is no scientific proof that prophylactic antibiotherapy is of any benefit. Consequently, further comparative trials on the value and the type of prophylactiC antibiotherapy are needed. However, adequate patient selection will help in lowering the rate of such complications. Indeed, we demonstrated a highly Significant difference between the rate of abscess for patients with (3/3) and for patients without (4/223) a bilioenteric anastomosis [2]. In the same manner, Livraghi et al found 2 patients with a bilio-enteric anastomosis among the six abscesses that occurred after radiofrequency in analysis of 2,320 patients [3]. Bilioenteric anastomosis should be considered a major risk factor for septic complications after radiofrequency ablation, as we earlier demonstrated it was after transarterial chemoembolization or percutaneous ethanol injection [6]. Consequently, if radiofrequency ablation is mandatory in patients within a bilioentric anastomosis, a regimen of antibiotic prophylaxis should be tailored for them. Geschwind et al recently reported uneventful transarterial chemoembolization in patients bearing bilioenteric anastomosis using prophylaxis with intravenous tazobactam sodium/piperacillin sodium 10 g a day maintained for 3 days associated with bowel preparation with 45 ml of oral fleet phospho-soda, 1 g neomycin and 3 g a day of oral erythtromycin the day before the procedure [7]. Patients bearing biliary stents, namely crossing the ampulla, and patients who undelwent a sphincterotomy probably have a high risk of post ablation septiC complications. Furthermore, abscesses usually occurred a few weeks after RF 03 days to two months in our experience), thus indicating that there should probably be an interval between radiofrequency treatment and the administration of any subsequent immunodepressive treatment such as chemotherapy, even if it is difficult to give precise recommendations concerning the duration of this interval.
NET David Madofj, MD MD Andel'Son Cancer Center Houston, TX 4:35 p.m. BREAK
Taking Care of Your Patient: Symptom Management and Palliative Care Moderator: Michael C. Soulen, MD 4:50 p.m.
When Enough is Enough: The Intersection of Interventional Radiology and Palliative Care David Weissman, MD
5:50 p.m. Complications After Catheter-based Therapy Jose 1. Bilbao, MD, PhD Clinica Universitaria De Navarra Pamplona 6:10 p.m. Complications After Ablative Therapy Thierry de Baere, MD Institut Gustave Roussy Villejuif, France Radiofrequency (RF) is one of the most promising imaging-guided thermal ablation techniques used to treat liver, lung, bones, kidney and other tumors. Lessons learned from pioneers in the field of complications can lower your rate of complications by selecting appropriate patients and tumors, providing appropriate peri-ab-
P18
!ation cares, and recognizing the complications earlier enough to proVide adequate treatment. This syllabus will be limited to liver and lung. LIVER
RF ablation of liver tumors is performed either percutaneously, or during open surgelY as an adjunct to liver resection to destroy unresectable tumors, or less frequently during laparoscopy. Todate, more than 10,000 radiofrequency procedures in the liver have been reported in publications, and the technique is considered relatively safe with a mortality rate of 0 to 0.9 % , and a major complication rate of 2 to 6% [1-4]. Complication rate is lower for percutaneous RF than for surgical procedures (1, 2, 4].
Infection Abscess is the more frequent clinically symptomatic complication after radiofrequency [2, 3, 5]. This complication raises the question of prophylactic antibiotherapy but no clear cut recommendations can be given because there is no scientific proof that prophylactic antibiotherapy is of any benefit. Consequently, further comparative trials on the value and the type of prophylactiC antibiotherapy are needed. However, adequate patient selection will help in lowering the rate of such complications. Indeed, we demonstrated a highly Significant difference between the rate of abscess for patients with (3/3) and for patients without (4/223) a bilioenteric anastomosis [2]. In the same manner, Livraghi et al found 2 patients with a bilio-enteric anastomosis among the six abscesses that occurred after radiofrequency in analysis of 2,320 patients [3]. Bilioenteric anastomosis should be considered a major risk factor for septic complications after radiofrequency ablation, as we earlier demonstrated it was after transarterial chemoembolization or percutaneous ethanol injection [6]. Consequently, if radiofrequency ablation is mandatory in patients within a bilioentric anastomosis, a regimen of antibiotic prophylaxis should be tailored for them. Geschwind et al recently reported uneventful transarterial chemoembolization in patients bearing bilioenteric anastomosis using prophylaxis with intravenous tazobactam sodium/piperacillin sodium 10 g a day maintained for 3 days associated with bowel preparation with 45 ml of oral fleet phospho-soda, 1 g neomycin and 3 g a day of oral erythtromycin the day before the procedure [7]. Patients bearing biliary stents, namely crossing the ampulla, and patients who undelwent a sphincterotomy probably have a high risk of post ablation septiC complications. Furthermore, abscesses usually occurred a few weeks after RF 03 days to two months in our experience), thus indicating that there should probably be an interval between radiofrequency treatment and the administration of any subsequent immunodepressive treatment such as chemotherapy, even if it is difficult to give precise recommendations concerning the duration of this interval.