Publications by authors named "Iwan Paolucci"
Objectives: In the current clinical practice of thermal ablation treatment for liver tumors, achieving consistent and effective clinical outcomes across tumors of varying shapes, sizes and locations remains challenging. The aim of this study was to evaluate the repeatability of a novel robotic approach for configurable ablation of distinct tumor shapes and compare it to the standard ablation technique for creating ellipsoidal ablation volumes.
Materials And Methods: The repeatability was evaluated in terms of width variability in created ablation volumes.
Objective: To evaluate the relevance of established surgical risk calculators (SRCs) for predicting complications in patients undergoing percutaneous lung cryoablation (PLC).
Methods: The institution's database was queried for PLC procedures from March 2015 to May 2024, excluding those patients with concomitant local therapies or five or more lesions treated in a single setting. Demographics, frailty metrics as defined by the surgical literature, and procedural variables were collected.
Article Synopsis
- Several new software methods have been developed to assess the minimum ablative margin during thermal ablation of colorectal liver metastases, aiming to enhance patient outcomes in a multi-institutional context.
- This retrospective study analyzed 400 cases of thermal ablation over 13 years, focusing on minimum ablative margins and their correlation with local disease progression rates.
- Results showed that a minimum ablative margin of 5 mm or more significantly reduces the risk of local tumor progression, confirming the importance of this margin across various institutions.
Article Synopsis
- * By utilizing contrast-enhanced CT images from three patients, the researchers simulated temperature distribution during MWA, aiming to predict effective ablation zones for better treatment planning.
- * Results showed a strong correlation between predicted and actual ablation zones, with Dice scores ranging from 0.73 to 0.86, demonstrating that these 3D models can enhance accuracy in MWA strategies and treatment outcomes.
Article Synopsis
- CT hepatic arteriography (CTHA) is very effective at detecting colorectal liver metastases (CLMs) but struggles with specificity for small, incidental lesions due to pseudolesions and ambiguous imaging signatures.
- A study involving 22 patients highlighted the identification of incidental ring-hyperenhancing liver micronodules (RHLMs) during CTHA, revealing that 41.7% of CTHA images contained these nodules, with many subsequently confirmed as CLMs.
- The research suggests that RHLMs detected in CTHA may serve as an early indicator for small CLMs, which could help in improving the accuracy of liver ablation procedures.
Article Synopsis
- The study aimed to evaluate how effectively two different image registration methods—deformable (DIR) and rigid (RIR)—can quantify minimal ablative margins (MAM) in patients undergoing thermal ablation for colorectal liver metastasis (CLM).
- Out of 72 patients analyzed, DIR showed better registration accuracy (0.96-0.98) compared to RIR (0.67-0.98), along with a higher predictive capability for local tumor outcomes, evidenced by a higher AUC (0.89 vs. 0.72).
- The results suggest that DIR is a superior method for quantifying MAM during intraprocedural CT imaging, thus improving the prediction of local tumor outcomes after thermal
Article Synopsis
- Malignant tumors often have complex shapes, which makes thermal ablation less effective due to standardized procedures not tailored to individual tumor geometries.
- An automated treatment model was developed that includes trajectory planning, probe insertion, dynamic energy delivery, and verification of the ablation margins, tested using a microwave ablation system on liver tumor models.
- Results showed that power and velocity adjustments during ablation could control its effectiveness and precision, supporting the potential for personalized treatment approaches in liver tumor therapy.
Article Synopsis
- The study focuses on the importance of using personalized medicine approaches, particularly survival prediction models, rather than relying solely on generalized evidence from clinical trials, highlighting the relevance of patient-specific outcomes.
- Bayesian parametric survival models were developed and assessed against traditional models like Cox Proportional Hazards and Random Survival Forest, demonstrating their effectiveness with less complexity in parameter tuning and lower risk of overfitting.
- The research indicates that Bayesian models not only perform comparably to existing models but also offer the advantage of refining predictions through Bayes rule without the need for full retraining, thus enhancing their practicality in medical settings.
Objectives: The aim of this study was to investigate the prognostic value of 3-dimensional minimal ablative margin (MAM) quantified by intraprocedural versus initial follow-up computed tomography (CT) in predicting local tumor progression (LTP) after colorectal liver metastasis (CLM) thermal ablation.
Materials And Methods: This single-institution, patient-clustered, tumor-based retrospective study included patients undergoing microwave and radiofrequency ablation between 2016 and 2021. Patients without intraprocedural and initial follow-up contrast-enhanced CT, residual tumors, or with follow-up less than 1 year without LTP were excluded.
Article Synopsis
- This study evaluates a standardized method for thermal ablation of colorectal liver metastases (CRLM), focusing on technical effectiveness and local tumor progression-free survival (LTPFS).
- The trial will include up to 50 patients, assessing various factors like minimal ablative margins, adverse events, and anesthesia time over a follow-up period of up to 2 years.
- The STEREOLAB trial aims to implement a precise workflow using advanced imaging and guidance techniques to improve ablation outcomes for CRLM patients.
Purpose: To evaluate the impact of salvage locoregional therapy (salvage-LT) on survival of hepatocellular carcinoma (HCC) patients presenting with intrahepatic tumor progression following radiotherapy.
Methods: This single-institution retrospective analysis included consecutive HCC patients having intrahepatic tumor progression following radiotherapy during 2015-2019. Overall survival (OS) was calculated from the date of intrahepatic tumor progression after initial radiotherapy by using the Kaplan-Meier method.
Article Synopsis
- Researchers studied how effective a new imaging technique is for assessing the completeness of tumor ablation in patients with colorectal liver metastasis (CLM).
- The method involves using biomechanical deformable image registration (DIR) and AI to measure the minimal ablative margin (MAM) on CT scans and track local disease progression after treatment.
- Results showed that a smaller MAM (particularly 0 mm) was linked to a higher rate of local disease recurrence, while a margin of 5 mm or more was associated with no progression, highlighting the importance of adequate ablation margins.
Purpose: The aim of this study was to analyze the impact of using intra-procedural pre-ablation contrast-enhanced CT prior to percutaneous thermal ablation (pre-ablation CECT) of colorectal liver metastases (CLM) on local outcomes.
Materials And Methods: This retrospective analysis of a prospectively collected liver ablation registry included 144 consecutive patients (median age 57 years IQR [49, 65], 60% men) who underwent 173 CT-guided ablation sessions for 250 CLM between October 2015 and March 2020. In addition to oncologic outcomes, technical success was retrospectively evaluated using a biomechanical deformable image registration software for 3D-minimal ablative margin (3D-MAM) quantification.
Background: Percutaneous thermal ablation is a curative-intent locoregional therapy (LRT) for selected patients with unresectable colorectal liver metastasis (CLM). Several factors have been identified that contribute to local tumour control after ablation. However, factors contributing to disease progression outside the ablation zone after ablation are poorly understood.
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- The study evaluates a new ablation confirmation method using AI and biomechanical image registration to improve tumor treatment outcomes by ensuring better coverage with minimal ablative margins (MAM).
- It is a randomized trial involving 100 patients with liver tumors, comparing the new method to standard visual inspection techniques in assessing tumor coverage during ablation procedures.
- The trial aims to provide insights into the effectiveness of this innovative approach, potentially enhancing liver cancer treatment and patient outcomes in terms of survival and quality of life.
Background: In thermal ablation of malignant liver tumors, ablation dimensions remain poorly predictable. This study aimed to investigate factors influencing volumetric ablation dimensions in patients treated with stereotactic microwave ablation (SMWA) for colorectal liver metastases (CRLM).
Methods: Ablation volumes from CRLM ≤3 cm treated with SMWA within a prospective European multicentre trial were segmented.
Background: Three-dimensional (3D) volumetric ablation margin assessment after thermal ablation of liver tumors using software has been described, but its predictive value on treatment efficacy when accounting for other factors known to correlate ablation site recurrence (ASR) remains unknown.
Purpose: To investigate 3D quantitative ablation margins (3D-QAMs) as an algorithm to predict ASR within 1 year after stereotactic microwave ablation (SMWA) for colorectal liver metastases (CRLM).
Materials And Methods: Sixty-five tumors in 47 patients from a prospective multicenter study of patients undergoing SMWA for CRLM were included in this retrospective 3D-QAM analysis.
Background: Stereotactic navigation techniques aim to enhance treatment precision and safety in minimally invasive thermal ablation of liver tumors. We qualitatively reviewed and quantitatively summarized the available literature on procedural and clinical outcomes after stereotactic navigated ablation of malignant liver tumors.
Methods: A systematic literature search was performed on procedural and clinical outcomes when using stereotactic or robotic navigation for laparoscopic or percutaneous thermal ablation.
Article Synopsis
- * For small tumors, ablation can be a viable alternative to surgical resection, particularly as ablation technologies improve to target tumors near critical structures.
- * The effectiveness of ablation treatments is influenced by several factors including tumor size, location, and patient history, highlighting the need for a deeper understanding of tumor biology and imaging advancements to optimize treatment outcomes.
Background: In thermal ablation of liver tumors, complete coverage of the tumor volume by the ablation volume with a sufficient ablation margin is the most important factor for treatment success. Evaluation of ablation completeness is commonly performed by visual inspection in 2D and is prone to inter-reader variability. This work aimed to introduce a standardized approach for evaluation of ablation completeness after CT-guided thermal ablation of liver tumors, using volumetric quantitative ablation margins (QAM).
View Article and Find Full Text PDFUltrasound Based Planning and Navigation for Non-Anatomical Liver Resections - An Study.
IEEE Open J Eng Med Biol
February 2020
Non-anatomical resections of liver tumors can be very challenging as the surgeon cannot use anatomical landmarks on the liver surface or in the ultrasound image for guidance. This makes it difficult to achieve negative resection margins (R0) and still preserve as much healthy liver tissue as possible. Even though image-guided surgery systems have been introduced to overcome this challenge, they are still rarely used due to their inaccuracy, time-effort and complexity in usage and setup.
View Article and Find Full Text PDFBackground: To investigate efficiency, accuracy and clinical benefit of a new augmented reality system for 3D laparoscopic liver surgery.
Methods: All patients who received laparoscopic liver resection by a new image-guided surgery system with augmented 3D-imaging in a university hospital were included for analysis. Digitally processed preoperative cross-sectional imaging was merged with the laparoscopic image.
Background: Efficient laparoscopic ablation of liver tumors relies on precise tumor visualization and accurate positioning of ablation probes. This study evaluates positional accuracy and procedural efficiency of a dynamic navigation technique based on electromagnetic-tracked laparoscopic ultrasound (ELUS) for laparoscopic ablation of liver tumors.
Methods: The proposed navigation approach combines intraoperative 2D ELUS-based planning for navigated positioning of ablation probes, with immediate 3D ELUS-based validation of intrahepatic probe position.
A concept for electromagnetic navigated targeting of liver tumors using an angiographic approach.
Minim Invasive Ther Allied Technol
February 2018
Background: The benefits of using navigation technology for percutaneous local ablation of selected hepatocellular carcinoma (HCC) have been shown. Due to additional efforts in the procedural workflow, barriers to introducing navigation systems on a broad clinical level remain high. In this work, initial steps toward a novel concept for simple and precise targeting of HCC are evaluated.
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