Minimally invasive microwave ablation provides excellent long‐term outcomes for otherwise inaccessible hepatocellular cancer

Abstract

Background and Objectives: Thermal ablation can be used as a bridge to transplant or with curative intent for hepatocellular carcinoma (HCC). We report our experience with laparoscopic ablation of HCC in patients deemed inaccessible by the percutaneous approach.Methods: We performed a retrospective review of surgical ablations from 2009 to 2017. Patient demographics, disease and treatment characteristics, and outcomes were abstracted from the medical record. Kaplan-Meier modeling was performed for survival and recurrence.Results: Thirty-three patients were included with a median age of 62 (interquartile range [IQR], 57-67). Most patients were male (76%) and Caucasian (70%). Ninety-seven percent had underlying cirrhosis. Median model for end stage liver disease-sodium was 9.5 (IQR,(8)(9)(10)(11)(12). The median maximal diameter of ablated lesions was 2.6 cm (IQR, 1.8-3.0). Thirty-nine lesions were ablated; 97% were completed laparoscopically. The median maximal diameter of the ablation zone was 4.8 cm (IQR, 3.8-5.7) with a median difference of ablation zone to the tumor of 2.0 cm (IQR, 1.5-2.75). Twelve patients received additional treatment. Median disease-free survival was 66.7 months and median follow-up 42.9 months. Disease recurrence occurred in 13 patients (39%)systemic recurrence in 6%, intrahepatic recurrence in 27% and local recurrence in 6%.Conclusion: Laparoscopic thermal ablation of HCC is safe and provides good oncologic outcomes for otherwise inaccessible tumors. K E Y W O R D S disease recurrence, hepatocellular carcinoma, laparoscopic surgery, minimally invasive surgery, thermal ablation

A Review of Resection and Surgical Ablation for Primary and Secondary Liver Cancers

“…Our group has reported excellent minimally invasive success rates and long-term outcomes for surgical ablations performed where the lesion was deemed inaccessible percutaneously. 32 Central tumors within 1 cm of the biliary hilum are not amenable to ablation regardless of the approach, due to hilar stricture or central vascular injury. Notably, some groups have reported improved outcomes with surgical ablations for tumors in locations near major vascular structures.…”

How important is the role of iterative liver direct surgery in patients with hepatocellular carcinoma for a transplant center located in an area with a low rate of deceased donation?

“…Similarly, risk factors for RHCC with open LR followed by LT were determined to be elevated AFP levels, microvascular invasion, tumor grade, and multinodular tumors. However, instead of primary LT or open LR, laparoscopic liver resection (LLR) and ablation before LT are the new preferred treatment approaches due to the significant improvements in survival and patient outcomes (24)(25)(26)(27). This study aims to describe our experience in applying the iterative treatment approach to a cohort of HCC patients within the Milan criteria and to explore the role of surgical management and clinical risk factors that could impact RHCC and OS after LT.…”