Local control of hepatocellular carcinoma and colorectal liver metastases after surgical microwave ablation without concomitant hepatectomy

Abstract

Purpose Microwave ablation (MWA) is an accepted technique in the multimodal treatment of hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM). Study endpoints were to evaluate the local efficacy of surgical MWA in selected patients with oligonodular disease without the combination of liver resection to allow a clear interpretation of the follow-up imaging and compare it to the results on percutaneous MWA available in the literature. Methods Consecutive MWA-only procedures performed between May 2013 and May 2018 for HCC and CRLM with free-hand ultrasound guidance were identified. MWA systems with 2450 MHz were used. Incomplete ablation (IA) was defined as residual disease within 1 cm of the ablation site at the first post-ablation imaging and local recurrence (LR) as the presence of disease after at least one tumor-free imaging. Results A total of 70 tumors in 47 patients were treated with 46 laparoscopic and 1 open procedures. Each patient had no more than 3 tumors, and median size of the lesions was 15 mm (IQR: 10-22). After a median follow-up of 26 months (IQR: 12-40), IA rate was 8.6% and LR rate was 29.4%. Multivariable analysis showed that vascular proximity (OR = 3.4; 95% CI = 1.26-9.22; p=0.016) was the only significant predictor of the combined outcome IA or LR. Discussion In the present study, after mostly laparoscopic MWA, LR was higher than the rates available in the literature for percutaneous MWA of HCC but lower than in the limited studies analyzing isolated percutaneous MWA of liver metastases. Future developments may help establish the role of each therapeutic modality per tumor, in order to improve the outcomes.

Role of Sonazoid enhanced ultrasound assistant laparoscopic radiofrequency ablation in treating liver malignancy—A single‐center retrospective cohort study

“…First, the exposure of tumors in difficult positions, such as segments VII, VIII, and I, could be challenging and need hepatic mobilization, and tumors in these difficult locations may often be excluded by some high‐quality studies 18 ; second, it is hard to puncture the tumor following the trajectory in coordination with laparoscopic intraoperative ultrasound. 19 , 20 Therefore, the localization of laparoscopic intraoperative ultrasound required experienced doctors and possessed a learning curve. In this study, all recruited operations were completed by the same surgeon and his team to ensure consistent quality.…”

Predictive Factors for Local Recurrence after Intraoperative Microwave Ablation for Colorectal Liver Metastases

“…The couinaud's segments 1, 7, and 8 were defined as the posterosuperior segments [15]. Contact with the hepatic vein (HV)/ inferior vena cava (IVC) was defined as present when a lesion was in direct contact with the first or second trunk of the HV or IVC.…”

“…However, local tumor recurrence is a major setback associated with ablation therapy, which occurs in MWA and RFA. Local treatment failure ranging from 20 to 60% has been reported with RFA [12,13] and 6 to 20% with MWA [11,14,15]. The local recurrence (LR) rate may be lower for patients with CRLM treated with MWA than those treated with RFA [14].…”

“…The tumor size [9,11,12,15,[17][18][19][20], tumor location (subcapsular [9] and perivascular [11,13,17]), and ablation margin size [18,20,21] are LR prognostic factors for ablation. Recently, ablation margin size has been considered the most important factor for LR after ablation [20][21][22].…”

Hepatocellular Carcinoma Intrinsic Cell Death Regulates Immune Response and Prognosis

“…Additionally, the protumorigenic environment resulting from a sublethal ablation may be reflected also at a systemic level due to the diffusion of cytokines in the serum. Indeed, experimental studies demonstrated that the growth of distant cancers was found related to the different parameters of ablation performed in the liver (85)(86)(87)(88)(89). The key immune modulators produced by damaged liver tissue after ablation are the HSPs, which are expressed as a defense against hyperthermia and may serve as a prognostic marker of ablation, although warranting further tests in clinical settings (90).…”