Feasibility and safety of surgical microwave ablation for hepatocellular carcinoma in elderly patients: a single center analysis in Japan

Abstract

the feasibility and safety of microwave ablation in elderly hepatocellular carcinoma (Hcc) patients remains unknown. the aim of this study was to evaluate the feasibility and safety of surgical microwave ablation for HCC in patients older than 80 years of age. This retrospective study enrolled consecutive 114 patients older than 80 years of age who underwent surgical microwave ablation for HCC between July 1994 and December 2017. We analyzed perioperative outcomes and longterm outcomes to clarify the prognostic factors. The 1-, 3-, 5-year overall survival and recurrencefree survival rates were 97.3%, 76.0%, 49.2% and 84.2%, 44.7%, and 32.5%, respectively. The overall major morbidity rates (Clavien-Dindo grade IIIA or above) were 2.6%. There were no cases of mortality. Multivariate analysis showed that hepatitis C virus antibody (HCV-Ab) positivity and the presence of multiple tumors were independent prognostic factors for long-term outcomes. The overall survival rate of patients with HCV-Ab negative and single tumor was better than that of other patients (p = 0.026). Surgical microwave ablation was feasible and safe for elderly patients with HCC. Elderly patients with HCV-Ab negative and single tumor would be expected to have better long-term outcomes after surgical microwave ablation.

Pulsed Microwave Liver Ablation: An Additional Tool to Treat Hepatocellular Carcinoma

“…Despite this, the complication rates are comparable to other series [32][33][34][35], with a slightly longer general median hospital stay of 4.96 days (range 1-26). Curiously, a multicenter study reported just 2.9% of complications were Clavien-Dindo 1 or 2, but among 14 Centers in Italy, only 4 of them used videolaparoscopy (which we used currently), with a preferred percutaneous approach [36].…”

“…Vitale et al approximately described, for BCLC 0-A, an expected OS of 87% and 85%, respectively [44]. In the literature, OS at one year is between 80% and 98% [22,32,33,37,41,42]. In our center, we observed a one-year survival rate of 100% for patients who were BCLC 0 and 93.2% for patients who were BCLC A.…”

Safety and Feasibility of Microwave Ablation for Hepatocellular Carcinomas in the Elderly: A Systematic Review

“…Imamura et al. ( 31 ) also found that surgical MWA can be performed safely and effectively in older patients with primary HCC, with a 5-year OS rate of 49.2%. HCV-Ab positivity and multiple tumors were found to be independent predictive variables for OS in their multivariate analysis.…”

“…Three studies reported Milan criteria ( 9 , 30 , 32 ), one study used LICRADS ( 29 ), one used pathological examination of a tumor biopsy ( 31 ), and two studies used Chinese guidelines for the clinical diagnosis and staging of primary liver cancer ( 33 , 34 ) as the diagnostic criteria for defining HCC. Only two studies ( 29 , 33 ) reported MELD Score data and four studies ( 29 , 32 – 34 ) reported Child–Pugh score data.…”

Image-Guided Proton Therapy for Elderly Patients with Hepatocellular Carcinoma: High Local Control and Quality of Life Preservation

“…The number of patients was <100 and, thus, a larger number of patients needs to be investigated in the future. Representative outcomes of surgery, SBRT, and other modalities for elderly HCC report that 5-year OS ranged between 29 and 60% and grade 3 or higher morbidities between 3 and 30%, while post-operative mortalities ranged between 0 and 5% [ 5 , 6 , 7 , 24 , 25 , 26 , 27 , 28 ]. Previous findings on HR in elderly patients vary.…”